northwest
Permanente
VOLUME 1 | ISSUE 1 | MARCH 2011
Board Chairs Blog . . . By Colin Cave, MD | Chair of the Board Changing a culture is hard work. Changing a culture is impossible if you don’t start somewhere. Your Board of Directors began to have conversations about improving our communication two years ago. But we learned that for us to be successful in changing the culture around our communications, we needed to resource the effort appropriately and have champions to move it along.
Executive Medical Director Straight “Talking”
The Board created the Communications Committee, and Steve Renwick and Richard Odell have moved things along at what, for this organization, can only be described as lightning speed. They are working with a committee of really smart and involved people.
By Chong Lee, MD | Executive Medical Director From time to time we will pick an unifying topic for the NWP newsletter. I have asked that the unifying topic for this inaugural issue be the medical home. Why? Because the leadership of our medical group believes that this is the critical cornerstone of how we need to organize ourselves to take care of our patients.
Rockwood and Longview to share their experiences. Re-centering around medical home is as much an aspirational goal as it is an intentional goal.
This newsletter is a direct result of their effort. Emails are becoming more focused. Chong Lee has also calendared a series of his own communications to address operational and EMD issues. We are now asking that a communication plan accompany every major operational plan.
Success is no surety, but if any medical group can make this happen it is Northwest Permanente. For 65 years we have, and will continue to show and lead the way to the future.
At this year’s Board Retreat, one of our sessions will be devoted to experimenting with new technologies around communication, so that we can see what might work better. And we want to expand our face-to-face visits. We will continue to improve. We will try new things. Some will work, and likely some won’t. Thank you for your input, patience, guidance and suggestions along this journey. Keep them coming as we work to improve our two-way
I have invited members of the leadership team to briefly describe the medical home from their leadership viewpoint in the organization, and to comment on its critical relationship to our future.
Keeping physicians and employees in touch Quality Corner
Tips for Leaders
Communications Village
Allergy - “In the Light”
History facts & more facts | Q&A
Operation’s Running
HealthConnect Bytes
Jim Wentzien MD - “Up Close”
“Comings and Goings”
This week in email
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In future issues of the newsletter , we will invite physicians and other care team members at the pilot sites at
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 at-
tend so that we can take care of logistics in-
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cluding ordering lunch. - Colin Cave MD
Quality Corner: Medical Home By Maureen Wright, MD | AMD Quality Systems The medical home is a place where we can help our members stay healthy, regain their health when they are ill, strive for a high quality life when they suffer the burden of chronic care and provide compassion and comfort in a trusted, reliable setting. We all know that the current state of the health care system is fragmented, costly and frustrating to many citizens. The medical home is a solution to these problems. First and foremost, how the medical home achieves our members goals, is to ask them how they define quality health care. We hear and understand the need for helping people stay healthy through targeting disease prevention, assuring people with acute illness have timely access to competent care, helping those with chronic disease to manage their illness and maintain a high quality lifestyle, and coordinating care for those who have multiple health needs.
The medical home incorporates the care team as part of our members approach to health and illness. The primary care physician and team of nurse, MA, social work (and ultimately mental health) pharmacists, care and case managers coordinate care for patient and family members. The electronic medical record and our kp.org are key connectors in assuring important information is shared and acted upon.
How the medical home achieves our members goals first and foremost by asking our members how they define quality health care.
did you know? bariatric surgery Last November the criteria for bariatric surgery for our commercial members was significantly changed. Members with a BMI > 45 no longer require specific treatment resistant co-morbidities to qualify for surgery. KPNW provides fee for service bariatric surgery at KSMC for members without coverage. For more information click here or call case manager Mary Lou Greenwood 503-571-3082. - Keith Bachman MD
Operations Running’s: Medical Home By Mark Kleinman, MD, Rick Strauss, MD and Tom Hickey, MD (AMDs Operations) Primary Care Home: The Medical home represents an organizational commitment to focusing on how patients see and navigate the medical system. Embracing the concept of patient centeredness drives our work to meet patient needs, and not our own system needs. The medical home is too complex to detail here, but I want to give you all a sense of its key components in KPNW. The medical home model transforms NWP into a patient focused primary care centered practice. To do this, the patient is always in the center of our field of vision, in planning and in execution. And, primary care must be resourced adequately and must deliver on changes critical to our success, in quality, service and financial stability.
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Foundational: Total panel ownership, message management, and staff competencies. Call management: Streamlining processes for managing patient calls to their healthcare team and nurse advice. Virtual medicine: Shifting to more non-visit based care when clinically appropriate and desired by patient. Visit management: Standardizing what is done before, during, and after the office visit. Chronic disease management: Evidence-based approach to designing cost effective care. Outreach: Proactively reaching out to specific populations of patients to coordinate care.
(and ultimately mental health)
Overlay the medical home with the Complex Medical Home, changes in referral practices, and improved staff support and we have the critical components of success.
pharmacists, care and case man-
Continued on page 3
The primary care physician and team of nurse, MA, social work
agers coordinate care for patient and family members -Maureen Wright, MD
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There are six segments to our medical home work:
KPNW featured in The Oregonian Click here to view the editorial on the KPNW medical home Click here to view the front page story on the medical home
Tips for Leaders: Medical Home
HealthConnect Bytes
By Rasjad Lints, MD | AMD Human Resources
By Homer Chin, MD | AMD Medical Informatics
Rockwood (RKW) was the first primary care clinic to implement the Medical Home in mid 2010. Their MOV year end results from 2009 to 2010 shows a number of statistically significant increases in multiple areas; Time to appointment, Nurse/MA caring, MD/AC knew history, Nurse/MA interest and attention, Receptionist courtesy and respect, Overall check-in process and Exam room wait. In addition, members were more like to see their own MD/AC and were more likely to have an email exchange with their provider. Most striking – no MOV metrics decreased by a statistically significant amount! This sure points to an overall improved member experience. How does the medical home affect our physicians? The results from the 2010 Worklife survey shows that adult PC at RKW had 14 metrics that were statistically higher than overall adult primary care in the same time period. Looking at RKW specific data for adult medicine from 2009 to 2010 showed that 7 metrics had a statistically significant improvement, while none dropped. Most encouraging: “I look forward to the day ahead” increased from 7% to 56% and “I would choose NWP again” went from 50% to 78%. It sure looks like this is a win-win for our patients and our providers! Overlay the medical home with the Complex Medical Home, changes in referral practices, and improved staff support and we have the critical components of success. Operations Running’s continued from page 2 Specialty Care and the Medical Home The medical home needs to be a culture, a state of mind as much as a way to do business. It's not necessarily always a physical place or even always an organized structure (though a certain amount
The work of the medical home is dependent and enabled through the effective use of our information systems.
of organization such as staffing models for PC are necessary). I think it's embodied in several of our vision statements including "every touch every time" and "we treat you like family" (at least family you like). It makes a patient (and their family) feel like they "belong". If we do what is right for the patient, each and every time, we do what is right for each other. e.g. if we always took care of as many needs as we could with every patient encounter the cumulative work (and $ overhead) of our physician group (and our entire organization) would actually be less. This is particularly true for the chronically ill high utilizing patients but from a membership strategy just as true for the "otherwise healthy". The true medical home blurs the distinction between primary and specialty care and between specialists. Resource Stewardship and Hospital Care
Our regional strategy is to sustain membership growth by being the affordable choice. We achieve that by continually improving quality and operational efficiency. The Medical Home is the hub of our medical care system and provides longitudinal care. The Medical Home is our commitment to ensuring that patients get the right care at the right place at the right time.
Because of our information systems, we are able to identify those patients that have specific needs and reach out to them in ways provide high service, high quality, and at a lower overall cost to our system. This service covers: •
Patients that have chronic conditions and who are in need of closer management
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Patients with care gaps
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Patients recently seen in the ED, currently hospitalized, or recently discharged home to ensure that they have adequate followup
Through our information systems, we are also able to determine our overall quality and service performance, and to measure, modify, and optimize our systems of care. Because of our information systems, we are able to provide a comprehensive and complete view of the care that is being provided to a member, and to effectively coordinate our care delivery.
How does the medical home affect our patient’s perception of the service they received? Does this model positivity engage providers? For insight into our member’s experience, we can look to our Medical Office Survey (MOV), and for physician engagement, the annual Physician Worklife Survey gives us some idea.
Dr. Atul Gawande's article, The Hot Spotters, in the January 24th edition of The New Yorker is masterful. He reports on an
The collaboration between the resource stewardship department, population care and the medical home team will allow us to prioritize our resources to best meet the individual care needs of the member based on risk stratification (healthy, at risk, chronic, complex). The stratification will guide us to optimize specialty care consultation and case and care management proactively for members.
effort in Camden, NJ to use a medi-
KSMC and our other hospitals will focus on providing an exceptional inpatient experience. The transition from the inpatient setting back to the Medical Home is a critical moment and we are committed to ensuring the best transition for the patient and to ensuring the patient, the family and the caregivers are prepared for success and that there is an optimal handoff to the medical home team.
model is a work-in-progress with
cal home approach for the most costly patients. He shows that the medical home improves health outcomes while reducing costs. He looks beyond how we've been conceiving it. It's clear that "the medical home"
huge potential. Very exciting! - Rasjad Lints MD
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Communications Village
Up Close with Jim Wentzien, MD
By Steve Renwick, MD | Board Director
By Richard Odell | Director of Communications and Assistant to the President
As Chair of the Communications Advisory Committee, I want to welcome you to our first newsletter! This is exciting for me as we have actually changed something for the better! But this is a work in progress. We will always be trying to make things better. So please keep the comments coming. Another thing that excites me about this newsletter and motivates me to continue the work on the Communications Advisory Committee is that we have great people in this organization. The energy that I feel is fantastic. We are working in a frustrating and changing environment, but when push comes to shove, and we know we have important work to do, we have people that want to roll up their sleeves and do what is right for our organization. Bravo and thanks. I am far from a communication expert, but I have read a few books, yes with lots of pictures as I am a orthopedist, but really what communication gets down to in an organization is: • • • • • •
Tell me the problem Give me the unbiased facts Give me time to digest and reflect Listen and respect my input Be willing to compromise A better solution will result.
Thanks for reading. Keep the feedback coming. This is your organization! stephen.renwick@kp.org
Communication Advisory Committee Strategies and Charter
When you meet Jim Wentzien the first thing you notice is that he is tall, fit and has a light dusting of gray in his hair. After chatting for a few minutes, you get the sense that his roots in the Midwest are part of the reason for his positive outlook on life. He is confident, strongwilled and at the same time humble; almost shy about going about his way. He has a passion for helping others and doing everything he can to make Kaiser Permanente the best place for patients to get care. So, it is not surprising that over our beers he listens to me share a few stories of my athletic prowess and then quietly mentions that he has run 12 Hood to Coast Relays, and is now thinking about getting back into triathlons. Wow! Not knowing what to say, I ask why triathlons? “Because my wife does them and she is pretty good, usually finishing strong in her age group.” Here is a bit more info about Jim. Position in NWP: Ophthalmologist with NWP since 1997. Previous chief six years. Distinguished NWP Physician 2006. Training: University of Iowa, Residency OHSU, Board certified Ophthalmology. What made you decide you wanted to be a physician? I have always felt that is what I should do. Born: Fort Madison, Iowa
1. Reduce the burden of e-mail 2. Increase face to face communication between senior leaders and practicing physicians 3. 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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Parent’s occupation: Dad: Physical Therapist; Mom: teacher and domestic engineer. First job: Detasseling corn. First car: Ford Escort wagon. Hero: Whoever invented Ibuprofen.
If you could have dinner with any person who ever lived it would be: My dad as a young man. If the whole world were listening, what would you say? Respect the opinions of others. If money were not an object, what would you do with your life? Try to set a good example for my son. What is the dumbest thing you have ever done? Not choosing a non-science college major, like Art History or something. Your tombstone would say: Is that it? Place to see before you die? Paris for the fifth time. Most famous person you have ever met? Chris Farley, Comedian and onetime eye patient. Last vacation? RV trip down the Oregon and California coast. Next vacation? Maui for Spring Break. Favorite movie? Animal House Favorite food or dish? Anything grilled. Last book read? New Kings of Nonfiction If you open the trunk of your car right now you would find Scattered YuGiOh and Pokemon cards, candy wrappers & tire chains. Three of your favorite activities: Swim, Bike, Run. How do you relieve stress? Stress? What stress? Favorite quote: “It depends on what the meaning of “is” is.” - Bill Clinton, probably paraphrased.
By Richard Odell and Robert Lawrence, MD (Department Chief) Chief: Robert Lawrence, MD. Attended medical school at Medical College of Wisconsin and residency/ fellowship at Children’s Hospital Los Angeles. Board certified in both Pediatrics and Allergy/Immunology. Started with NWP in 1980. Distinguished NWP Physician 1985. Developed the NWP Immuno-deficiency clinic in 1986. Chief of department multiple times totaling seven years; immunodeficiency chief seven years, and Board Director for three years; All other physician department members have also been prior chiefs. The Department: Six physicians and one physicians assistant. What is the average MD tenure in your department? Greater than 20 years; all but one physician will retire within the next 5 years. What is it that you want NWP to know about your team? Consistently, across the board, our physicians have focused on proactive care and providing the highest standard of care in asthma and immunology. Individuals in the department are constantly striving to keep up with the latest literature and developments in the field, as well as maintaining current board certifications. Practice locations? East Interstate; Mt Talbert Annex (trailer on Sunnyside campus), Longview (4-5 days per month; North Lancaster Salem (1-3 days per month). What is it that you want NWP to know about your department services? We are the go to team for asthma and available around the clock - 24/7 and 365 days per year. We always try to respond rapidly to our NWP colleagues about cases. What are your core services? Outpatient department dedicated to the treatment of primary disease related to asthma, non-HIV immunodeficiency, food and drug allergies, rhinitis and chronic sinusitis.
What is new and exciting or on the forefront of your field? Potential oral de-sensitization for inhalant allergies and food allergies, as well as new treatments for hereditary angioedema. What are your departments clinical priorities? Providing access to members and cost effectively managing patients with chronic problems. What are your departments business priorities? Providing access and staying within our budget. If you could have one wish for your department it would be . . . A new abode for our Sunnyside Allergists/Immunologists; leaving the Allergy Trailer in the dust. If you could have one wish for NWP it would be . . . Two wishes . . . to see the end of the structural division of primary and specialty care. An understanding on the part of administrative leadership that the idea of “one size fits all” does not fly. What should be considered equal are outcomes, not processes to achieve them. How does your team celebrate successes? To say “congratulations on a job well done” then, move on to the next problem. What is it that makes you proud to be in this department or to be the chief? The integrity of the individuals that make up the department and the high level of performance that we are able to produce. Our department's average RVU generation is higher than the median and mean RVU production of Allergists/Immunologists outside our system, while still providing care grounded in improving health outcomes. What is your teams biggest challenge? How not to get depressed with the constant pressure to do more with less.
Comings & Goings in NWP Welcome to Northwest Permanente: Dawson B. Cabbage, CRNA, Anesthesia Sunnyside Medical Center Susan E.S. Dierauf, MD, Urgent Care South Interstate Kim A. Dugger, MD, Family Medicine Longview Kelso Natalie Ku, MD, Radiology Sunnyside Medical Center James R. O’Brien, MD, Family Medicine Mt Scott Kimberly A. Tornabene, CCP, Perfusionist, Sunnyside Medical Center Ying Z. Zhang, CRNA, Anesthesia Sunnyside Medical Center
Thank you and goodbye: Frank Y. Chen, MD Hospital Medicine | 6-1-11 Thomas E. Lee, MD Emergency Medicine | 3-31-11 Nazhat F. Taj-Schall, MD Internal Medicine | 3-1-11 Earl Van Volkinburg, MD Internal Medicine | 3-29-11 Chris Nobis, MD Internal Medicine | Retires 5-31-12 Donald H Tilson, MD Occupational Medicine | Retires 4-20-11 Daniel Twombly, MD Family Medicine | Retires 5-31-11
In Memory: John A Anderson, MD, Retired physician, Internal Medicine (1973-1995)
Congratulations to: John Steeh, DO Interim Chief of Emergency Medicine Richard A. Varan, MD Chief of Family Medicine
learn more
Department Spotlight - Allergy/Immunology
To see the full profiles and pictures of new NWP physicians/clinicians please click here. Page 5
Historical facts & more facts . . .
Q&A
This section of the Newsletter about our NWP history in coordination with Ian MacMillan, MD (Rheumatologist 1961 to 1996; NWP
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.
HELP WANTED
emeritus physician) and his book “Permanente in the Northwest”.
Hospital Medicine before there was such a “thing.” ”In 1988 a KPNW nursing strike closed KSMC forcing innovation in hospital coverage for Health Plan members cared for in community hospitals. Some NWP internists were assigned to provide care in cooperating hospitals on a weekly rotation and were relieved of outpatient duties. After the experience during the strike, Bess Kaiser Hospital internists devised a schedule to improve consistency of care whereby members of the department served a 2 week rotation providing hospital care only. In 1990 the KSMC IM department established a core group under the leadership of Tom Lorence MD, dedicated to hospital care only. This was before the term hospitalist was proposed by Goldman and Wachler in a 1996 NEJM and was the first such program in the nation
Internal Medicine PA hired in September 1970 was the first PA hired in the nation by an HMO; Ben Berger under direction of Paul Lairson MD Obstetrics Nurse Midwife hired in August 1971 and 3rd hired in Oregon; Carolyn Stadler under direction Harold Cohen MD Internal Medicine ANP hired in May 1975; Mary Horton, Donna Imus, Shirley MacMillan, Jeanette Steen, Margaret Taylor all trained by NWP and OHSU under the direction of Ian MacMillan MD
More Facts . . . 2010 volume for kp.org in KPNW Members registered—191,800 Total visits—1,103,800 Visits/day—12,000 Emails to MD team—141,000 Labs reviews—287,200
NWP was first in the Northwest to hire affiliated clinicians. Pediatric NP hired in July 1970; Lois Grufke under direction of Peter Hurst MD and Fred Nomura MD
Prescription refills—206,600 Prescription refill orders—118,700
For all 2010 kp.org info click
This week in e-mail (Feb 18 to Feb 25)
The NWP Newsletter is recruiting comedians to submit a cartoon of the month for inclusion in the newsletter Please send any submissions to: richard.m.odell@kp.org
This is 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. Want to remove unwanted e-mail senders to your Lotus Notes inbox? Click here to set it up in <1 minute and after set up it will take 5 seconds to delete any messages you don’t want to see in the future.
Highlighted e-mails this week NWP Executive Medical Director search committee update to the medical group Variable compensation communication to NWP will be occurring every week. Read the latest update here Bariatric surgery updates - Members with a BMI > 45 no longer require specific treatment resistant co-morbidities to qualify Your cooperation in refraining from annotating diagnosis descriptors in KPHC - send a KPHC (P Code) staff message instead Page 6