Meeting the challenge of population health: what we can learn from Kaiser Permanente
7 May 2015
I first heard of Kaiser Permanente in 1997. Alan Milburn, the then health minister, had asked officials to look into the approaches Kaiser Permanente used to deliver health care. Finding out who (or what) Kaiser Permanente was, in a pre-internet age, was a challenge. No one even seemed to be entirely sure how to spell it! But gradually, the Kaiser Permanente (KP) model rose in everyone’s consciousness, as did its clinical leadership, its use of data and, of course, the ‘Kaiser pyramid.’
Many people from the NHS went out to see the KP model in action in its hometown of Oakland, California. People were generally positive and many of the ideas started to permeate. In the recent period of austerity, however, fewer people have made the visit, so when I had the chance to do so last month, I wondered whether it would still come across as advanced and impressive as it had appeared in the 1990s or whether the NHS had now ‘caught up’.
Kaiser Permanente dominates the skyline around Oakland, just as the Kaiser ship-building and construction industries would have done in the 1940s. Although I could now spell Kaiser Permanente, I realised that I was quite ignorant about its foundations.
Henry Kaiser anticipated that sick and injured workers could affect productivity, and that a healthy workforce was a productive workforce. So he employed Sidney Garfield, a physician who had established an innovative field hospital funded through a prepayment system for workers building the Colorado River Aqueduct in the '30s, to set up a health care service for his expanding workforce. This developed into the Kaiser hospital system and the Permanente Medical groups, akin to our CCGs. KP now covers nearly 10 million people across eight states and the District of Columbia.
Everyone I met at KP told a variant of this story, placing emphasis on whichever part had most resonance with them. The stories people tell speak volumes about an organisation and the pride and sense of identity this history bestowed on people was a case in point.
While there is no denying the transformation that the NHS has been through in the past 20 years, KP is still surging ahead in its ideas and commitment to improve health and health care. The pioneering spirit on which it was founded is as alive now as it faces new challenges of containing costs, addressing the diseases associated with modern living, and as a provider for people covered by the government’s Medicare programme. In the past, the one challenge I would hear people make when they talked about KP was that it was easier for them as they didn’t have to cover everyone. With the Affordable Care Act, this has changed and they have stepped into the space of universal access.
Kaiser Permanente acts not just as an insurer and provider of health care, but as a health leader. It sees its role as covering influencing national and federal policy, collaborating with community assets to promote health, to supporting prevention and providing care. KP is constantly looking for the opportunity to intervene and make a difference to people’s health and wellbeing at the earliest stage. With the demise of PCTs, I wondered whether the NHS is able to do as much as it could in this space.
The extent to which KP has moved into the area of proactive care is impressive. For example, there is a structured description of what members (people who have a health plan with KP) can expect pre-consultation, during the consultation and post-consultation, by condition. There’s an online personal action plan which sets out exactly the components of care a member should receive and alerts them when gaps occur. And there’s a systematic trawling of data through their Proactive Office Encounter programme to find and remedy gaps in care.
In preventing disease and deterioration, KP has harnessed the potential of social media. Its 'Prevent' program allows people to sign up to virtual groups with shared goals around exercise and weight loss. An individual’s commitment to improve is amplified by being part of a group and getting regular feedback on how they are all doing. The platform provides tips and advice (self-paced learning modules based on the diabetes prevention programme, in addition to access to a health coach), and enables members to share their own ideas and successes. On ‘graduation’ from the initial programme, members join the alumni (called ‘Sustain’) and continue to be supported by the online network and community leader.
Finally, KP’s strategies to address the factors outside of health care delivery that impact on individuals’ health is being tested and evaluated through their Complex Care program. So much of this resonates with the challenges the NHS faces with an ageing population – the need to integrate the role of the community into care plans, the importance of a holistic assessment of needs and support – I was left feeling that there was so much more to learn.
Jo is Director of Strategy and Innovation at the Health Foundation, www.twitter.com/JoBibbyTH