The words in the title of this post came from Shabana Haxton, RN, who I shadowed with a group of colleagues, as she demonstrated how she works with primary physicians to keep populations healthy.
As I noted in my visit to Kaiser Permanente Northwest at the end of last year, next generation data systems have made it possible not only for physicians to know what every patient on their panel needs to stay well, but to know the hurdles of each individual patient who’s behind on their preventive care.
Photos below, click any to enlarge
The next step is now harnessing the power of teams, with each member having different skill sets. In the case of Shabana, where a physician has not been successful in arranging for needed care, she can use her skills as a nurse to assess and support completion of needed interventions.
Myself and a group of colleagues saw this impressively as we shadowed Permanente physcians at Barranca Medical Offices, in Irvine, California, and then the Proactive Panel Support Program (part of KP Southern California Complete Care) at Yorba Linda Medical Offices.
At Barranca, I shadowed Alan Evans, MD, a family practitioner and also Physician Chief of these Medical Offices, and his medical assistant Elsa Torres. In the background of a comprehensive electronic health record (KP HealthConnect) coupled with efficient workflow, the Proactive Office Encounter happens. With this system, all of the care gaps of a patient are visible at the beginning of an ambulatory visit, addressed beginning with the medical assistant encounter, and appropriately prepared for closing during and after the physician encounter.
As our host, Tim Ho, MD, Southern California Permanente Medical Group, told us, “Getting the best numbers (in prevention and chronic disease care) is hard work – now we’re making it easy and more efficient for patients and care teams to get them.”
If you look at Kaiser Permanente Southern California’s quality measures, you can see the results; specifically, I saw hypertension control numbers in the 80% range – this is unheard of in the rest of the United States.
I always try and shadow as many different members of the team, and watch as Elsa Torres showed me how she addresses needed care gaps with patients, from mammography screening to smoking cessation. This was formerly done in a less organized way, and without the information systems to support it. Now, medical assistant skills are regularly supported (“Kaiser Permanente doesn’t let us forget anything,” Elsa says, as she shows me her upcoming medical assistant training curriculum). I could see it in the blood pressure technique that she uses, making sure patient is relaxed, both feet on the floor, appropriate sized cuff at appropriate height. This requires discipline.
In the afternoon, at Yorba Linda, we observed the operation of Proactive Panel Support. Here, physicians are paried with either an ARNP, a PA, or an RN, or a Clinical Pharmacist, who comb their panels and sit with their physician each month to go over a set number of patients and create action plans.
They also go over the physician’s individual performance on prevention and chronic condition care management, and even do some academic detailing. In the session we observed today, hypertension control was up, lipid control was up, and information was provided about what was known about statin prescribing and emerging trends in keeping lipids under control and arteries open. One of the challenges being faced here is that of member growth, which is up, so each month’s percentages are showing larger denominators, and require greater responsiveness from an integrated system.
What’s interesting about this system is that it isn’t “carve out” disease management. It is as it’s called, complete care support, because the system makes sure that the entire panel is covered over time – it’s not just the patients with illnesses are brought into this process. All in, not carve out.
It’s also interesting to me that in several conversations the concept of competition was brought up, and how data is leveraged to help physicians and nurses be the best in their medical office, medical service area, region. We talk about #gamification for people for behavior change, I see much greater potential for #gamification for doctors and nurses, who are already motivated to keep people healthy. Why not?
What people say who are part of the team – a few quotes
“Each individual does less, but we go more miles together” – Carol Young, Pharm. D.,
“Some people work to cure people, we work to keep them from getting sick” – Elsa Torres, medical assistant
When I asked Elsa what she would tell a person who didn’t know how Proactive Office Encounter is different, maybe a person who is new to Kaiser Permanente member she said,”I don’t tell them, they notice it.”
Tomorrow we will observe more layers of the Compete Care system deployed here. With great thanks to the teams at Barranca Medical Offices and Complete Care, Yorba Linda, for showing us how integrated care is complete patient care.
For more information about Proactive Office Encounter, I’ve added some links below from the literature