Click on the image to see a much larger version…just 1 page.

Issue & Focus

1. The California Healthcare Foundation is dedicated to the improvement of the lives of Californians managing chronic illnesses.
2. There are many community stakeholders involved in supporting this goal; their work could be improved by making connections to each other that are meaningful for patients.
3. This is part of a broader strategic plan to support the objective of involving patients and families in all aspects of their care. This is the identified gap to be closed through this work.
4. California Healthcare Foundation is seen as catalyst and partner for patient engagement in California. It’s scope is 36,000,000 Californians

Current Condition

1. All chronic conditions can benefit from better patient engagement
2. Hypertension is a good example of one - recently published studies demonstrate both the gap and the opportunity with non-office-based approaches

Problem Analysis

1. Divided into three areas : Clinical Gap, Technology Gap, Partnership Gap, that California Healthcare Foundation can connect partners to assist with
2. Clinical Gap: Patient role in recognizing blood pressure out of control; currently this rests with the physician, in an office-based setting
3. Technological Gap: Chronic disease assessment is typically performed in the office or medical setting
4. Partnership Gap: Stakeholders (patients, payers, providers, connectivity providers) are not connected to patients and one another at the same time
5. The societal costs of inadequate management are spread diffusely; few organizations are able to to see the total harm from this perspective

Target Condition

This pilot seeks to create a functioning ecosystem that supports chronic disease management across the lifecycle, with the best candidate being hypertension

Action Plan

We began by interviewing example employers, health care providers, and technology providers to understand which approaches and components appeared most promising. At this time, it seems most reasonable to approach this first from the employer perspective.

Next step will be to convene a group of potential partners in July, 2008, at California Healthcare Foundation, to discuss how pieces would fit together.

A presentation would be made to the CHCF Board in the fall, with funding and activity to begin in 2009.

Cost / Cost-Benefit / Waste Recognition

There are recognized wastes, which include unnecessary visits for blood pressure monitoring, inadequate medication therapy, and inadequate use of the health system, for patients who have not been seen in the past 12 months.

There are costs including, technology costs (although the goal is not to build anything new), and realignment of incentives to support non-visit-based care.

Followup / Unresolved Issues

Points of concern and planned countermeasures

1. What is the metric for patient access? (Pacific Business Group on Health is working on an employee engagement survey; metrics for patient access to their health data may need to be developed)
2. How can this complement the launch of both a P4P measure for blood pressure management, and a HEDIS “Relative Resource Use for Uncomplicated Hypertension” measure for 2008?
3. Data for presenteeism and productivity loss does not seem intuitive (I have reviewed this in depth and we can bring in clinical champions to verify)
4. Partners and aligned interests (will do due diligence to support cooperative business models of partners)
5. How to engage patients in things like biometric monitoring and blood pressure control (there is data supporting patient interest in this monitoring, but most importantly will go to the factory floor, and will bring an employee/patient advisor on to the team)

That’s the latest script that goes with the story, more or less. Comment away, and keep in mind that each comment will change the A3 a little every time.

A3 Project plan, PDF Format

Note: There is a more recent plan published. Click on this link to be taken to it.

As I have discussed previously, I am trying something I have never done before, floating a project plan in development (ie before it signed off) for community comment.

The plan is still one page, with multiple improvements along the way. My last post on this topic talks about how and A3 works if you want to brush up there.

The specific improvements

1. Very concise summary at the very top
2. Tightening of the Current Condition Section
3. Rewrite of the problem analysis to incorporate some of the latest data about managing blood pressure. Restating the [a] Foundation’s role in assessing benefits and harms of chronic illness in the aggregate and being a good partner and catalyst.
4. Defining of the target condition for multiple audiences - a “general” target, which is overall infrastructure and connectivity for all chronic illnesses, a “specific” one for the Foundation, which is a target condition, hypertension, to stay focused on one thing.
5. Addition of another milestone, a partner summit, this summer, to go over workflows and technology feasibility
6. Rapid management of follow-up / countermeasures, including defending the “presenteeism” hypothesis (which I believe I can), and the “patient engagement” challenge (see this post for discussion on this).
7. Cleanup of formatting using a new Apple Pages template - I am finally wrangling this great word processor into shape. If anyone would like my A3 template using Apple Pages, let me know and I’ll send it to you.

As usual comments welcome. Each one makes the story tighter and repeatable across stakeholders. Thanks for indulging in the experiment. More participation is better. And if you know of partners interested in participating, comment away as well.

A3 (Project Plan). Click here to learn more about what an A3 is

This post contains the A3 Document, or the Project Plan, for Connectivity for California Consumers. I have been posting some of the data that supports this plan on this blog (click here to see them all). In addition, I have been working with staff at California Healthcare Foundation and potential stakeholders to improve the plan.

For those of you unfamiliar with the A3 format, it is designed to (a) tell a story and (b) incrementally improved to the point that the actions are clear at the time a project is launched. It may be revised once a day or even more often. The process of discussing the project and making improvements is called “nemawashi.” I am using this blog for extended nemawashi, so please post your comments.

Since an A3 tells a story, starting on the left, going down, and then on the right, I will summarize the story here. Feel free to print out the A3 and follow along (A3 means “11 x 17″ paper. You may have to shrink to fit on letter size).

Issue & Focus

1. The California Healthcare Foundation is dedicated to the improvement of the lives of Californians managing chronic illnesses.
2. There are many community stakeholders involved in supporting this goal; their work could be improved by making connections to each other that are meaningful for patients.
3. This is part of a broader strategic plan to support the objective of involving patients and families in all aspects of their care. This is the identified gap to be closed through this work.
4. California Healthcare Foundation is seen as catalyst and partner for patient engagement in California

Current Condition

1. There are well known gaps the care of people with high blood pressure
2. The impact of these gaps is distributed across stakeholders differently compared to other chronic illnesses, which includes a strong productivity-loss component, due to the high prevalence of the condition in employed populations (see charts).
3. There are examples of employers and technology companies approaching these gaps in hypertension and other chronic illnesses that can be studied.

Problem Analysis

1. Lack of access to care accounts for only 10% of poor blood pressure control; there is a physician component in setting goals, and a patient component in operationalizing those goals, that may not be accomplished in physician visits alone.
2. Patients who are not seen at least every 12 months are at greater risk for non-adherence
3. The societal costs of inadequate management are spread diffusely; few organizations are able to to see the total harm from this perspective
4. There are few models outside of integrated care systems of using non-visit-based approaches to managing chronic illness.
5. We are just entering an era of interoperability, with many solutions not yet integrated into the value chain of patients and payers

Target Condition

This pilot seeks to create a functioning ecosystem that supports chronic disease management across the lifecycle, with the best candidate being hypertension

Action Plan

We began by interviewing example employers, health care providers, and technology providers to understand which approaches and components appeared most promising. At this time, it seems most reasonable to approach this first from the employer perspective.

Next step will be to convene a group of potential partners in June or July, 2008, at California Healthcare Foundation, to discuss how pieces would fit together.

A presentation would be made to the CHCF Board in the fall, with funding and activity to begin in 2009.

Cost / Cost-Benefit / Waste Recognition

There are recognized wastes, which include unnecessary visits for blood pressure monitoring, inadequate medication therapy, and inadequate use of the health system, for patients who have not been seen in the past 12 months.

There are costs including, technology costs (although the goal is not to build anything new), and realignment of incentives to support non-visit-based care.

Followup / Unresolved Issues

Points of concern and planned countermeasures

1. What is the metric for patient access? (Pacific Business Group on Health is working on an employee engagement survey; metrics for patient access to their health data may need to be developed)
2. How can this complement the launch of both a P4P measure for blood pressure management, and a HEDIS “Relative Resource Use for Uncomplicated Hypertension” measure for 2008?
3. Data for presenteeism and productivity loss does not seem intuitive (I have reviewed this in depth and we can bring in clinical champions to verify)
4. Partners and aligned interests (will do due diligence to support cooperative business models of partners)
5. How to engage patients in things like biometric monitoring and blood pressure control (will look at plan design options, but most importantly will go to the factory floor, and will bring an employee/patient advisor on to the team)

So that’s the script that goes with the story, more or less. Comment away, and keep in mind that each comment will change the A3 a little every time.