Case Study: Proactive Office Encounter and Employee Performance Sharing Program Better Care through Coordinated Teams and Health Information Technology

March 27, 2009

Kaiser Permanente’s Southern California region has increased the use of preventive cancer screenings and effectively encouraged improved maintenance of cholesterol by coordinating care across all who touch patient’s lives and integrating incentives and information technology. The proactive office encounter program fosters cooperation among providers: Clinical care teams composed of doctors, nurses, medical assistants and other staff work together to identify opportunities to engage patients and provide support and encouragement for positive action across the continuum of health care services. In addition, front-line union employees are financially rewarded through a performance sharing program when quality care goals, many affected by these types of screenings and preventative measures, are achieved.

The Challenge: Increasing Use of Preventive Care

Individuals in the U.S., regardless of insurance status, receive only about 55 percent of recommended health care, according to a 2004 RAND Corporation study. From preventive health screenings to routine monitoring and maintenance of treatable chronic health conditions, U.S. citizens under-utilize available basic care services.

Recognizing the need to improve delivery of health prevention services, Kaiser Permanente’s Southern California region created the proactive office encounter program to identify and target patients with chronic medical conditions and encourage them to be active participants in their own care. The program uses all members of the clinical care team in a coordinated and collaborative effort to engage, encourage and support patient health. The information and tools provided have helped increase preventive screenings and improve treatment adherence.

The Solution: A Total Team Effort Supported by Information Technology

The program’s proactive engagement begins for patients before they visit the doctor’s office. The process starts with the automated creation of care checklists for all patients whose records indicate gaps in care. Clinical care teams review the checklists which include recommended preventive care and suggested actions to support patient use of that care.

Based on the identified gaps in care, medical assistants initially contact patients to discuss the need for preventive screenings and routine care, such as cancer screenings and tests for abnormal blood sugar or cholesterol levels. When patients arrive at their scheduled visit a doctor, medical assistants or nurses review the pre-visit discussion and provide additional information based on physician recommendations. Following their appointment, patients are provided with an after-visit summary, patient education materials, prescription refills as appropriate, and follow up appointments are scheduled. Clinical care teams can determine whether members are adhering to their prescribed medication by analyzing refill trends.

Further, improvements in quality outcomes are encouraged through specific reward programs that provide financial bonuses to front-line when regional and annual goals are met. This system, established through an agreement with Kaiser Permanente and its partnering unions, invests in the workforce and the collaborative teamwork it takes to meet these quality goals. Care teams are encouraged to turn each patient encounter into a "successful opportunity" to increase appropriate use of preventive and basic care. Success is measured not by how many people are scheduled or referred for screenings, but based on how many patients actually get the recommended screening. "Successful opportunities" now account for 10 percent of the total performance sharing bonuses available to care providers.

The Results: Significant Improvements in Screening for and Treating Disease

Kaiser Permanente’s Southern California region has improved disease screening and treatment rates, which lower long-term health costs by preventing or successfully managing problems. Most importantly, these improved health outcomes save lives.

Along with other concurrent improvement initiatives, the proactive office encounter has contributed to a 30 percent increase in colon cancer screenings, an 11 percent increase in breast cancer screening five percent increase in cervical cancer screening, and a 13 percent improvement in cholesterol control. If the program continues to advance at its current rate, it is projected that more than 10,000 lives will be saved per decade.

Implications for Health Care Policy and the Future of Care Delivery

These early results illustrate how coordinating activities between various health providers throughout the care delivery system, and equipping caregivers with real-time information, can support patient care and improve outcomes. Maximizing information for the clinician means optimizing care for the patient. Done well, a computerized system supports clinicians’ efforts to spend more time with patients, have better information about their care and spend less time with traditional paperwork. Health information policy for the United States must include incentives not only for implementing electronic medical records in provider offices, but also for developing the skills of the people who use the tools and for coordinated use of information systems between providers. The value of information technology is directly related to how caregivers and staff use it and whether it supports sharing information between settings of care.

The right information systems and the right delivery system reform will create care teams that are able to coordinate care across every point of service—the physician’s office, laboratory, pharmacy, hospital, on the phone, and even online—thus providing patients with affordable, well-informed, customized and compassionate care.

At Kaiser Permanente, we’re well on our way to achieving this vision. To learn more about Kaiser Permanente’s use of electronic health information, visit http://kp.org/future.

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