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VOLUME 1 | ISSUE 2 | APRIL 2011

Board Chairs Blog . . . By Colin Cave, MD | Chair of the Board With the exception of Molly Herrmann, our Legal Counsel, it’s rare to find anyone who gets excited about our Northwest Permanente bylaws.bylaws. Yet, they are crucial to the functioning of our corporation.

By Chong Lee, MD | Interim Executive Medical Director Each spring, leaders from Health Plan and Northwest Permanente work together to set our insurance rates for the following year. During this year's “2012 rate setting budget" we 'refreshed' the 2009 regional strategic plan out into 2014. The 2012 rate setting and strategic refresh will be presented to the Health Plan National Leadership and our NWP Board of Directors. Our 2009 strategy in care delivery was developing medical homes in primary care and for complex patients, like CHF. The intent in the refresh was not to “redo” the plan; rather to set a clear pathway to 2014 by updating our strategy, targets, and high level tactics to address major changes including the economy, health care reform, lower Medicare reimbursement, and the Kaiser Westside Medical Center. The current strategic refresh work has re-affirmed our long term view to position KPNW as the high quality affordable option in our market. How do we do that? Our leaders believe that our integrated care delivery model

is our primary product (not the insurance plans we sell) and differentiates us in the market. The Medical Home Model is our vehicle for driving clinical, cultural, and financial transformation. It is critical that we sustain membership growth beyond our current plan because the Kaiser Westside Medical Center opens in 2013. Leading with quality is our business strategy and focusing on the people strategy will drive a culture of high performance. These strategies did not change from 2009, but assessment is that we are at risk because of the unprecedented uncertainty in health care, our member growth trajectory is lower than our aspirations, and we have significant economic risk (cost trends continue to climb, major capital investments, and high employee benefits costs to name but a few). NWP and HP executives are confident that by following our refreshed roadmap we can achieve our 2014 goals and adapt to the uncertainties of health care reform. Much remains to be determined. Look for future communications outlining our specific actions, accountabilities and owners to deliver on our priorities.

Keeping physicians and employees in touch Pages 2-3:

Page 5:

Operation’s Running: Specialty Care, Resource Stewardship, Primary Care

Communications Village

Page 3: Quality Corner

Page 4: Health Connect Bytes Tips for Leaders

Page 6: Department Spotlight: Rockwood

Page 7: Up Close with Stu Levy | Comings and Goings

Page 8: This week in email | Historical Facts & More

While the search for the new EMD progresses, the Bylaws Committee has been tasked with evaluating the current bylaws pertaining to the EMD position and bringing recommended amendments to the Board for consideration. Your Bylaws Committee has already begun to research other organizations and Permanente Groups, and has had preliminary discussions on this issue. In addition, you will be receiving a survey from the committee in a few weeks asking for your inputon the following:

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Should the NWP EMD be an elected member of the Board? Should the EMD have voting rights? Who has the right to remove the EMD? What is the ideal term an EMD should serve?

When you receive the survey, please take a few moments to complete it. There may not be any perfectly “right” answers to these questions, but we need to address the issue and move forward. We will do so in as meaningful and as thoughtful a way as possible, and your feedback is very important. Thank-you in advance for taking the time to help. Colin - colin.cave@kp.org

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Executive Medical Director Straight “Talking”

Last year, the Board election brought to light a possible “glitch” in our current bylaws. Our bylaws state that our Executive Medical Director (EMD) has to hold a Board seat, but no seat is reserved for the EMD. We now have nine Board members, but no permanent EMD.

How to Attend a NWP Board Meeting The Board of Directors meets on the 3rd Thursday each month and shareholders are welcome to attend. Please contact mary.m.connell@kp.org if you would like to

attend so that we can take care of logistics including ordering lunch. - Colin Cave MD


Operation’s Running’s: Medical Home By Rick Strauss, MD, Tom Hickey, MD and Mark Kleinman, MD, (AMDs Operations)

Reducing variation is not “cookbook medicine” Nowadays, KPHC protocols are the “way we do business”. Back in the paper days I was vehemently opposed to preprinted orders, an obvious and relatively simple example of reducing variation. I thought that it was at best a time saving device that robbed me of my chance to individualize orders and encroached on my sovereignty. I didn’t realize that a checklist approach improved safety by reducing errors and saved time that I could spend on thinking how to take care of the patient. For quite some time we have been discussing the need to “reduce variation.” If I were to ask 10 physicians what that means I’d likely get at least that many answers (as well as some scornful or “get a life” looks). Unwarranted variation in any process is wasteful and often leads to confusion and sometimes unintended sub-optimal outcomes. For example, a hypothetical patient with a family history of colon cancer calls the GI department to find out when they need their next one since it’s been 5 years. The call gets routed to the back office to an MA who then may attempt to answer from a protocol; route it to the RN or to a pool or to the physician who did the colonoscopy for an opinion. If the MD is not available will one of his partners give the same answer? Is it time now, or in 5 years, or should he get a fecal blood test and if negative then wait another 5 years? Did the variability in the way the patient accessed the GI office, or the MA handled the call or the various opinions that the patient could have received add any “value” to either the patient experience, the ultimate outcome or our cost structure? If your answer is yes, please give me a call. One of our 2011 NWP goals is to reduce variation. In general surgery they are going to standardize the trays used for the 2 or 3 most common operations. In OB/Gyn they are standardizing the hospital discharge process and track reduction of readmissions (similar to the hospitalists who have taken the lead in this endeavor). In urology, they are piloting a novel approach to contact referring docs Page 2

and patients in near real time to address outpatient referrals with a standardized triage approach. In oncology, they are using standardized methodology to determine which patients are appropriate for outside referrals when their disease has failed to respond to one of our protocols. In an ongoing collaborative effort between Primary and Specialty care through the Master Service Agreement work, we have created Quick Guides to care. These guides address commonly referred conditions, Primary Care recommendations for care and when to refer to Specialty Care. These guides are designed to reduce variation by assisting Primary Care physicians with the care of the patient and improve the quality of referrals for specialists. We have completed 16 of these Quick Guides to date, and will have the remainder completed early next year. If you have an idea you’d like to share, pilot or implement I’d like to hear about it.

Resource Stewardship & Quality Value Management I have been in my role as VP and AMD for Hospital Services and Resource Stewardship for just about one year. In this article, I want to review the Resource Stewardship/Quality Value Management work in 2010 and what we are planning for 2011/12. 2010 Activities: 12 months ago the region was under some stress, related to unanticipated membership loss and higher than anticipated outside medical costs. We developed several “big plays” which focused on improving the value for members through focus on contracting, claims, Regional Telephonic Medical Center (RTMC) enhancements, referral management, drug utilization management, improved patient flow at KSMC, and a focus on regaining membership losses. As a result of lots of good work throughout the region and particularly the commitment of NWP clinicians we ended the year on a positive note financially and also in quality and service. Quality Value Management (QVM) is the term we will use to describe the focus of our efforts. The term Utilization Management has traditionally been used, but our real goal is to add value for mem

Visit the KSMC website bers through improving quality and efficiency. Reducing waste and reducing unwarranted variation in practice are key elements of QVM. 2011 Activities: We have a new Health Plan Director of Resource Stewardship and Quality Value Management, Steven Goldberg. Steve comes to us with a wealth of knowledge and experience and I am delighted to have him in this critical leadership role. I have asked Rahul Rastogi, MD to be the NWP Director of Quality Value Management, which will expand on his current role as Clinical Director of RTMC. We will continue the efforts to improve value at KSMC. One key aspect is the work called “patient flow/efficiency”, which is modeled off work at Baldwin Park Medical Center in Southern California. They recently won the Voh’s Quality award. View a video about their work and information about Baldwin Park and the other Voh’s awards and nominees here. We plan to develop a regional bed board and start a daily virtual hospitalist rounding program. This will be modeled off a program in Colorado and will help us better manage our members at non-plan hospitals. We are instituting a more rigorous claims review-post care, prepayment review to ensure we pay appropriately for care received from outside institutions. We will continue work to improve the processes in the Regional Referral Center, and continue the work to enhance value of imaging services and pharmacy prescribing, as well as implementing new nurse advice protocols (see box below). Thanks to all of you for your commitment to quality and to improving the value we provide our members. I encourage you to contact me with ideas to improve value and am always looking for individuals interested in participating in this work.

View an example of a nurse protocol chart note here

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Quality Corner: Medicare 5 Star Refresher continued from page 2

Primary Care: Chronic Opiates I would like to share some of the things we are working on in the area of Chronic Opiate Management. You have done amazing work in reducing the utilization of Oxycontin. We have energized Primary Care physicians and leaders working on multiple areas of this complex situation. We have instituted an Opiate Oversight Committee that will work to assist our clinicians in managing the patient group on the very high end of dosage use. At the same time, our Primary Care physicians and leaders are working on a regional injectable narcotic policy to compliment the already agreed upon discontinuation of injectable meperidine (Demerol) in ambulatory clinics.

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Another stream of work is addressing the issue of patients changing physicians specifically for the acquisition of their 'preferred' opiate prescription and dosing. We have 2 offices, Mt. Scott and Tualatin that are working towards this goal to end “doctor hopping” for the purpose of acquiring pain meds only and they may be both our pilot sites and our learning laboratories for this work. There are some legal and regulatory issues we need to address and that work is actively moving forward. The last thing I want to touch on is the idea of a regional standard upper dose limit for chronic non-malignant pain. This practice has been adopted by several groups, most notably the Multnomah County Health System. Several of us did a sight visit, talked to physician leaders and pharmacy leaders and learned a lot about upper dose limits and what setting a clear standard offers a large medical practice. More on this in the coming months. Lastly, I want to again thank the STORM team, our Pain department, our Addiction Medicine department and our Pharmacy. All continue to be invaluable in this work.

Visit the KPNW Primary Care website

By Maureen Wright, MD | AMD Quality Systems

For NWP, it’s all in the stars! In 2007, the federal government Center for Medicare and Medicaid Services (CMS) created a dashboard of measures with star ratings called the Medicare Health Plan Quality and Performance Ratings, to evaluate specific health plan quality and service measures. Each year, a report is released that compares plans and serves to assist members and prospective members to make enrollment decisions.

more attractive to current and potential members. In addition, the financial reward will help offset the impending reductions in Medicare reimbursements and help us keep our plans more affordable. A 5 star rating equates to approximately $45 million dollars of additional revenue annually! What’s more, a significant number baby boomer will reach retirement over the next few years, providing us with a tremendous opportunity to outshine other plans.

What’s New? As part of health care reform, CMS is attaching quality bonus payments to the Medicare “star” ratings to reward high-quality care and drive quality improvement. The ratings are assigned on a 5-point scale with halfpoint increments.

Where are we now? Our service scores, while gradually rising, still rank below many other health plans. Currently, our overall Medicare star rating is 4.5. We’re not far from reaching our goal, but it will take concerted effort to strengthen our performance on weaker measures.

What Does This Mean for NWP? First, it is important to note that Medicare is approximately 13% of our KPNW membership but contributes 30% of our revenue. That said, Medicare Advantage plans at the highest performance level in Medicare’s five-star rating system will not only receive the biggest quality bonuses, but they’ll also be allowed to enroll members anytime—not just during open enrollment.

What do we need to do to achieve stardom? Whether individually or collectively, we all impact the regions overall Medicare 5 Star score through the quality of care and services we provide our members. Our scores on the surveys and performance measures can directly determine our future growth and financial health. Now more than ever let us remember our vision: “Every touch, every member, every time.”

Its rating system will give us a competitive advantage by making our health plan

For the high priority Medicare Star measures click here

HOS Improvement Strategy Clinical/Operations Plan  Development of KPHC Tools Including: o AVS Messages o Physical activity and depression screening questions in the Member Navigator o BPAs with links to SmartSets/dot phrases  Screening for HOS conditions by case managers  Inreach/Outreach  Targeted process to get non-engaged members in to be seen  Development of strategy to combine Medicare Refresh work with Medicare star measure needs  Prioritize HOS measures for physical activity, bladder control and risk of falls over mental health  IVR messaging with HOS health tips Master Communication Plan  Outreach letters to SA members  Development of an “HOS Season: with member communications about HOS topics prior to survey fielding  PIH/Medicare Newsletter articles about HOS topics  Provider letters Internal Communication Plan  All staff newsletters  Follow-up Newswire articles about Medicare star rating topics. HOS measures to be first focus topic  Population Pearls and other targeted communications as needed to care delivery

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By Homer Chin, MD | AMD Medical Informatics I would like to highlight just five of the many activities in the area

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HealthConnect Bytes

of information systems: 1. All office-based clinicians should have larger 22 inch monitors in their offices. If you have any issues with font size, text fuzziness, mouse movement, etc., call 50-6667 (or 503-499-5400) for assistance. The monitors should be an improvement in every instance. Contact me if you are not seeing an improvement. 2. Our digital radiology rollout is 80% complete. Radiology images, including plain films, can be accessed by clicking on the link that is embedded in the radiology report in KP HealthConnect. For help with using our radiology viewer (DxView) view the short video clip and download the job-aids from our MyHelp website. Call 50-6667 if you need help. 3. We will be holding multiple peer-taught all day "KPHC Skill Builder" sessions. A preand post-test survey of attendees shows significant improvement in proficiency with KPHC, and a measurable improvement in work-life satisfaction. Attendance at these sessions is limited, so sign up now! Later in the year we will be holding two 3-day off-site “Pathway to Proficiency". These more comprehensive in-depth sessions take clinicians to an even higher level of proficiency in the use of our systems. 4. Many clinicians are actively working on KPHC until 6 PM and beyond and have asked for extended hours for our support center. The support center (50-6667) is now staffed from 8 AM to 6 PM (previously staffed only to 5 PM). Please take advantage of the extended hours till 6 PM! 5. As part of our effort to better integrate medical and dental care, we are now providing our Permanente Dental Associates and Dental Hygienists limited access to KPHC. They have access to labs, radiology reports, medications, and staff messaging. This will allow better integrated care and communication between dentists, physicians, and other medical professionals.

Click here for all KP HealthConnect Alerts

View CLE Leadership / Education Master Calendar

Tips for Leaders: OM/MOV New Survey Tool By Rasjad Lints, MD | AMD Human Resources In order to utilize the bench-mark information and on-line administration from our new vendor, Press Ganey, a switch to their standardized survey tool was required. The new Press Ganey MOV survey has close to the same number of questions as our previous survey, but it fits on the front and back of one page of legal sized paper rather than the booklet style of our former survey. Surveys will now be administered through a combination of e-mailed and mailed surveys. Feedback from some of our physicians who have received surveys via e-mail has been positive. The new questions are more organized and categorized into eight sections: 1. 2. 3. 4. 5. 6. 7. 8.

Access Moving Through Your Visit Nurse/Assistant/Care Provider Lab/X-Ray/Radiology Pharmacy Personal Issues Overall Assessment Background/Demographic

A space for comments is provided under the Lab, X-ray, Pharmacy and Overall Assessment sections. The Care Provider section (AOM questions) consists of thirteen questions including three "custom" questions unique to our region to address key strategic issues not included in core Press Ganey questions. Instead of having satisfaction questions on a nine-point scale, questions will be based on a five-point scale from Very Poor to Very Good. The survey will continue to be visit specific for an individual physician, location and department. Physical Therapy,

Audiology, and newly surveyed areas such as appointed imaging (Ultrasound) will have a modified survey that Press Ganey administers for departments considered more diagnostic/procedures/therapy or testing in nature. There will also be modified survey versions for Mental Health/Addiction Medicine, Urgent Care and Emergency Department. Utilizing the standard surveys for each of these areas allows for benchmarking. Here is an example of our new survey Bench-mark Information Now, for the first time, we will have bench-mark data at the regional, department and individual levels, giving us the ability to compare our performance to national and local databases. These databases are updated on a monthly basis. Using the standardized Press Ganey out-patient services survey instrument allows bench-marking against approximately 36,000 nonhospitalists physicians and over 1,600 physicians in Oregon and Washington (including Providence Medical Group). If we choose supplemental (custom) questions that at least ten other clients have selected, we will be able to see comparative information. Preview our new personalized physician home pages for members on kp.org and find out how to get yours updated

Selected Article of the Month Treat the Patient, Not the CT Scan by Abraham Verghese The New York Times VIEW ARTICLE

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Communications Village By Steve Renwick, MD | Board Director What have we done and where are we going? Our communication work is just beginning. I hope you are seeing a decrease in e-mail. We want to decrease the e-mail volume so e-mail can become a more useful communication channel, rather than another task that needs to be done before one goes home. What have we done? • Created a monthly NWP newsletter to tie together the bigger picture of what we are doing to the emails you are receiving •

Removed non pertinent e-mails

Improved targeting of e-mail (send e-mails to the right audience)

Combined and stored e-mails that you know you might need, but now is not the time. (KP Health Connect)

Pushed back on those sending mass distributions

Created the e-mail of the week with abstracts and links for those that want more information.

Some e-mails will slip through the cracks, so please send me a note with a copy of the email you don’t think you should be receiving. We have been following up with the senders of these messages. We are

Continual improvement of our newsletter. This includes meatier articles and the ability to comment. We are considering an external web site. This would allow us more freedom from an IT standpoint. The big question is: What information do you need, and how is the best way for you to get it? We can make a sexy and jazzy web site, but if you do not get any value from your visit to the site, what is the point? So how do we create a web site that you want to visit? I know Orthopedics and Emergency Medicine Departments have started their own external web sites and time will tell if they are valuable for their department members. We are looking at ways to improve face to face communication and 2 way communication with you the Frontline docs and your leaders. Some ideas are leveraging technology through: video conferencing, internet chatting with a Board Member on call and blogs by your interim Executive Medical Director. Others include old fashioned face to face handshakes and conversations. However, what we are hearing are these face to face encounters need to occur at all hours that the docs are working (Saturday night at midnight in the ER or Sunday morning in the Beaverton Urgent Care), not just when it is convenient.

So we have made some baby steps, and we will keep pushing forward. As always, please let us know what is working, and what is not working. Our goal is to create an environment where communication is transparent and open so you can get the information: • Where you want it. • How you want it. • When you want it. Thanks for reading. Keep the feedback coming. This is your organization! stephen.renwick@kp.org

The Northwest Permanente Communication Advisory Committee Strategies and Charter 1. 2. 3.

Reduce the burden of e-mail Increase face to face communication between senior leaders and practicing physicians Improve two-way communication up and down the organization.

To access the full committee charter and tactics please click here. - Steve Renwick MD

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your spam filters!

Where are we going? E-mail on your phone if you want it. The PCMs (primary care managers) and everyone above them have it in Health Plan, why not the docs?

CLICK HERE TO SEE OUR NEW NWP PHYSICIAN BIO’S

CLICK HERE TO FIND OUT HOW TO UPDATE YOURS . . .

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Department Spotlight - Rockwood Medical Home By Richard Odell and R. Steve Jones, MD (Area Physician Director)

In describing the medical home, I made the mistake of drawing a schematic flowchart and was quickly corrected by Dr. Jones. “The circle at the top of the hierarchy is not the physician . . . it is the patient. The patient is in the center of everything.” That is what I felt in the atmosphere at Rockwood. Area Physician Director R Steven Jones, MD. Attended medical school at OHSU, residency Kaiser Permanente Santa Clara. Board certified in Internal Medicine. Staff internist with “The Permanente Medical Group” 1989 to 2000. Area Physician Director at Rockwood Medical Office since 2005. The Office Physicians in Medical Office: 26, Physician Assistants: 3 Nurse Practitioners: 6 adult and 2 peds (including cross coverage and paneling) in four modules: FM, IM, Peds and mixed. Average MD tenure is 8 years. What is that you want NWP to know about your team? Everyone at Rockwood is engaged in designing, testing and implementing the components of the medical home. We remain focused on the patient in the midst of constant day to day change. The reality is that we are motivated and comfortable to try something different to improve things. We know that there are some that look at our success as the Page 6

result of the resources invested. Since May, we have hired an additional 2.3 physicians and 2.5 affiliated clinicians, which has in turn reduced the panel size. They may think we have it easier at Rockwood now because of that. But I want others to understand that the providers here are working just as hard if not harder than before. They are doing their regular jobs, as well as designing, testing, re-testing the various changes until it is right. Our providers know the region is counting on us to create a good product and to reach our business care targets, so this good work can be brought to all the clinics in our region. We take this responsibility seriously. The investments at Rockwood (and at Longview as well) have motivated us all to work very hard. What is it that you want NWP to know about your department services? In addition to the clinicians in our modules, our office is supported by four medical home case managers. One for each module of 7-12 providers, plus RNCMs with expertise in diabetes and CHF. The medical home case managers do post-hospital DC coordination and help us manage patients with complex needs. There are other RNs and LPNs who are taking to direct to team calls and giving patient advice, a medical home pharmacist on each team and 12 patients who sit on our patient advocacy counsel to provide feedback on what we are doing. What are your core services? Providing primary care services with the central focus of the care team on the patient and their end to end care. What is new and exciting or on the forefront of your medical home implementation? We are seeing an improvement in physician work life, which I would define as “having the resources and support to be able to provide for my patients the kind of service they should have, and not saying I don’t have the time.” The outcomes of our hard work are having a positive impact on clinicians and patients. For patients, we are seeing significant reductions in ED and inpatient utilization, lower outpatient drug use and fewer referrals to specialty care while significantly improving our HEDIS quality composite. For clinicians, we have seen

huge jumps in our MOV and MD work life scores. What are your department’s clinical priorities? Working to implement the work streams of each component of the medical home; total panel ownership; message-, call-, virtual-, visit-, and chronic diseasemanagement, and outreach. What are your department’s business priorities? To demonstrate that a $2-3M investment in the Rockwood PC medical home site returns a savings of up to $6M/yr and at the same time results in higher quality care in our population. If you could have one wish for your department it would be: To fill open PC positions right away in an environment where there are few PC physicians available. For NWP it would be: Get to a point where there is stability in senior leadership with an executive that connects with physicians, is eloquent and visionary, and makes things happen. How does your team celebrate successes? Many ways, including individual, team and building wide celebrations (potlucks, gift cards and team huddles, etc.) for extraordinary efforts. What is it that makes you proud to be in this medical office APD? Physicians at Rockwood have stepped up and are working hard to improve access, participate in making the medical home work, providing creative/ constructive energy to our support staff to improve the care we provide to our patients. We no longer feel like victims, rather we are leading our support staff with feedback and education. What is really cool is that we moved our patient care manager offices into our modules. What is your team’s biggest challenge? Ill calls in the medical assistant group.

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Preface I had the pleasure of spending an hour with R. Steve Jones MD in his office in “Module A” in the Rockwood Medical Office. The theme that emerged in our interaction was the idea of “investments”. One definition of investment is “the commitment of something other than money (time, energy, or effort) to a project with the expectation of some worthwhile result.” This is exactly what is happening at Rockwood. Rockwood got an investment in resources with the hope of improving the usual: access, service, quality and affordability. Clearly this investment in people and systems is paying other dividends as it trickles down. Clinicians are engaged and making their own investments in their clinic culture, in their support staff, and in each other to have the whole team make an investment in patients.

View KPNW Medical Home article in the Portland Scribe


By Richard Odell | Director of Communications and Assistant to the President When you are “Up Close” with Stu Levy there are obvious things that are hard to miss. For example, one day he was walking past a KP exam room and overheard the elderly patient in the room saying, “I hope that’s not my doctor!” And yes, his hair and beard are long and grey, but they are the only things hiding the spiritual and intellectual depths of a man that is as deep as the universe is wide. Oh yeah, the elderly man is now Dr. Levy’s loyal patient and friend. So, where do I start? I can tell you that Stu Levy is an accomplished and renowned photographer who has invented something called “Grid Portraits.” Or tell you that consistently his Art of Medicine pushes 100% because as he says it, “When I walk into the exam room the rest of the world stops . . . and I listen to everything ‘they’ have to say.” Or I can tell you he wanted to be a musician and cut a record, but decided to go to medical school instead. Oh, it gets better. Stu Levy is also know around KP circles as the preeminent expert and Permanente Medical Group leading innovator related to anything with Apple computers. Stu Levy does not work, as he says, “Work is something you do for money that you would not do for the hell of it.” And just as amazing as Dr. Wentzien was in lost months Up Close, so, too is Stu Levy “Up Close.”

First job: Photographing his high school colleagues and selling them their pictures for 25¢ each. Selling pictures he took of musicians at live concerts (Dylan, Rolling Stones, etc.) First car: 1964 Nash Rambler Place to see before you die? Asia and the Himalayas Most famous person you have ever met? Ansel Adams (American photographer and environmentalist), Graham Nash (musician), Annie Leibovitz (photographer for Rolling Stone Magazine), many others. In 1970, Stu invited and later picked up the band The Grateful Dead at the airport and brought them to the University of Cincinnati to play in concert. Last vacation? New Zealand Next vacation? Canadian Rockies or New Mexico Favorite movie? “2001: A Space Odyssey” Favorite food or dish? Fresh Salmon Last book read? Just Kids by Patti Smith

Position in NWP: Family Medicine physician with NWP since 1979. Currently practicing in Vancouver Medical Office and KPHC clinical content lead for Family Medicine in Department of Medical Informatics. Distinguished NWP Physician 2010.

If you open the trunk of your car right now you would find? Nothing

Training: University of Cincinnati, OHSU. Board certified in Family Medicine

How do you relieve stress? Dealing with what causes it “head on” and following up with favorite activities to “recharge his batteries”

What made you decide you wanted to be a physician? Wanted to become a psychiatrist after imagining that he could develop a brain–machine that could record dreams and speed up the psycho-analysis process.

Three of your favorite activities: Photography, hiking or listening to music (Stu is a “Deadhead”) and too many to list here

Favorite quote: Medical school professor said, “Some people make mistakes for 25 years and call it experience, and learning is not making the same mistake twice.”

Born: Cincinnati, Ohio

See some of Stu Levy’s world famous photography here

Parent’s occupation: Father: accountant; Mother: secretary/artist

Check out his recently published picture book

Comings & Goings in NWP Welcome to Northwest Permanente: Rachel C. Fischer, MD, MPH Occupational Medicine, Beaverton Christopher D. Andre, CRNA, Anesthesia Sunnyside Medical Center Kellen Taverniti Martyn, CRNA, Anesthesia Sunnyside Medical Center

Thank you and goodbye: Jay S. Campbell, DO Family Medicine | 06-08-2011 Keith E. Grau, MD Internal Medicine | 05-31-2011 Rene W. Macharia, MD Internal Medicine | 06-03-2011 Joseph Obadiah, MD Dermatology | 08-08-2011 Jeffrey S. Pierson, MD Occupational Medicine | 04-01-2011

Retirements: Kate Beland, MD Internal Medicine | 02-25-2012 Steven M. Levine, MD Internal Medicine | 06-30-2012 David H. Ruud, MD Mental Health | 05-29-2012 Shirley L. Welch, PhD Pathology | 06-03-2011

Congratulations to: Atanu Prasad, MD Reappointed | Chief of Radiology Rahul Rastogi, MD NWP New Director | Quality Value Management in addition to his current role as Clinical Director of Regional Telephonic Medical Center.

learn more

Up Close with Stu Levy, MD

To see the full profiles and pictures of new NWP physicians / clinicians please click here. Page 7


Historical facts & more facts . . .

Q&A

This section of the newsletter is about our NWP history is from the book “Henry J. Kaiser -

This section of our newsletter is to post any questions physicians and employees have along with a response. The newsletter will only have space for a few highlighted questions, and those that don’t fit we will provide a link where they can be viewed on our intranet. Please submit any questions you have to richard.m.odell@kp.org or call 503-449-5479. Please leave your name and whether you wish to remain anonymous in our response.

Builder of the Modern American West” by Mark S. Foster (University of Austin Press, 1989)

“Was Kaiser Permanente the first Prepaid Health Plan?” Henry J. Kaiser and first offered prepaid health care to workers at the Grand Coulee Dan in 1938. Many believe Kaiser was the first prepaid health plan in the United States. In fact, the first private prepaid health plan was organized by La Société Française de Bienfaisance Mutuelle in San Francisco in 1849. In the 1860’s, railroads, lumber, and mining companies offered company-funded health care, usually for employees only. In the 1880’s the Homestead Mining Company of South Dakota claimed that it offered complete health care for families as well as employees, at company expense. By 1888 several coal operators in the Lehigh Valley of Pennsylvania offered prepaid group plans to workers and families for 75¢ per month; single men paid 50¢. By 1900 the concept was widespread, covering workers at New York City’s Consolidated Edison Corporation,

Northern Pacific Railiroad employees in St. Paul, and thousands of others. Between 1914 and the mid-1920’s, America’s most famous industrialist, Henry Ford claimed that he ran a “poor man” hospital under a prepaid group health plan. By the early 1930’s, in California alone there were several hundred unregulated small health insurance plans More Facts . . . Kaiser Permanente is “big” Kaiser Foundation Health Plan/ Hospitals (our national Health Plan) is a not-for-profit company with reported 2010 revenue of $44.2B. Based on reported revenue in 2010, if Kaiser Foundation Health Plan/Hospitals were a for-profit corporation it would be listed at #46 on the Fortune 50 list of America’s largest companies between Dow Chemical (#44) and Sears (#47). 2010 Fortune 50 Revenue (in billions) for Health Care Related Companies: #17 #18 #21 #24 #33 #35 #40

Cardinal Health CVS Caremark United Healthcare Amerisource Bergen Johnson & Johnson Medco Health Pfizer

$99.6B $98.7B $87.1B $71.8B $33.0B $59.8B $50.0B

This week in e-mail (March 28 to April 1) Click here to get to the page where you will find all the mass distribution e-mail that NWP Communications filtered from your Lotus Notes inbox. Please feel free to scan the e-mail topic list and if you want more info, click on that topic link.

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Highlighted e-mails this week March Board of Directors Hot Topics—topics include variable compensation Update from the NWP Executive Medical Director Search Committee Shake off the ‘Willies of Coding” by reading the first in our new series of planned documentation & coding updates in “This week in Email” KSMC Physicians News– features include KSMC in the top 5% of U.S. Hospitals for patient safety and Saturday OR’s to start in April Regional Health Plan leadership receives a 72-hour notice of a work action from SEIU - wearing “buttons” and collecting signatures NWP Now Welcoming Nominations for NWP Annual Teaching Awards - on-line nomination submissions now open


NWP April Newsletter vol1 issue2 4-2-11