Kaiser Permanente Wins Top National Disease Management Award

The Disease Management Association of American (DMAA) has awarded Kaiser Permanente the American Healthways Health Plan Disease Management Leadership Award, the most sought-after award for managed care organizations.

The award is designed to recognize a health plan that has demonstrated leadership and innovation in disease management on a level that has significantly helped to shape the industry.

"The American Healthways Health Plan Disease Management Leadership Award is the most sought after award for managed care organizations granted by the DMAA," said Warren Todd, DMAA Executive Director. "The Awards Committee unanimously recognized Kaiser Permanente's Care Management Institute as a program that has raised the standard of excellence across the country through the integration of physician and non-clinical staff collaboration driven by evidence-based guidelines to develop an outcomes-oriented program that continues to improve the lives of patients with heart disease and diabetes."

The award is given for innovation, leadership, outcomes-based orientation, and impact in the industry.

"This award is a credit to the many people across KP who have dedicated effort and insight to improving the care of individuals with chronic conditions," said Paul Wallace, MD, the Care Management Institute's (CMI) Executive Director. "It reflects both collaboration and local attention to those details that enable successful implementation. Thanks go to all of the people who are truly "making the right thing easier" for our clinicians and members."

Joel Hyatt, MD, assistant associate medical director/clinical services for the Southern California Permanente Medical Group, and a CMI regional associate, agreed: "The DMAA award for leadership in disease management is, we hope, one of many recognitions of the leadership and distinction that the people and systems of Kaiser Permanente bring to our members with chronic conditions through our approach to population care management. Many in the health care industry are trying hard to emulate what we do."

Innovation

The award recognizes KP's innovation, both clinically and technologically. Two particular areas that exemplify that are Permanente Knowledge Connection (PKC) and Archimedes.

The Permanente Knowledge Connection, sponsored by CMI, is Kaiser Permanente's national clinical information web site. The site gives health care professionals online access to a vast warehouse of medical information, including: clinical guidelines, successful practices, models of care, patient education tools, outcomes studies, and over 250 medical journals, reference texts, and clinical libraries.

Archimedes, also sponsored by CMI, is a state-of-the-art, bio-mathematical model that creates a virtual world in which CMI can explore and project the effects of care interventions. It is a full simulation, with every person, every doctor, and every piece of equipment being represented and interacting as they do in reality. Archimedes helps Kaiser Permanente knowledgeably plan what works best, in which setting, and at what cost. The American Diabetes Association has contracted with CMI to vet and develop further modeling opportunities with Archimedes for diabetes practices around the world.

Leadership

Kaiser Permanente's leadership in disease management through CMI has been recognized by national organizations:

• Kaiser Permanente is the first non-profit HMO in the United States to earn disease management organization (DMO) certification from the National Committee for Quality Assurance (NCQA). Awarded in 2002, the two-year NCQA DM Certification was given in program design for four areas: diabetes, asthma, heart failure, and depression. CMI was one of 18 "early adopters" to apply for the NCQA certification/accreditation. NCQA DM Certification recognizes CMI's evidence-based approach and leadership in developing population guidelines for care.
• In recognition of KP's outstanding practices in the management of diabetes, the American Association of Health Plans and the Employers' Managed Health Care Association awarded KP-CMI the National Exemplary Practice Award in 2000.
• CMI has recently received grants from the Robert Wood Johnson Foundation (e-technology) and the AAHP (culturally competent care).
• Through CMI's leadership, KP is partnering with the Centers for Disease Control and Prevention, HealthPartners, the National Institutes for Health, the Geisinger Clinic, the Robert Wood Johnson Foundation, the American Dietetic Association, the American Academy of Family Practice, AAHP, and other leaders in health care, to lead a new national effort on weight management.

These programs and awards are the result of collaboration: between KP and outside organizations, between the KP Regions and CMI, between the health plan and the medical groups, and between the clinicians and the members.

Outcomes Based Orientation

From its inception, KP has recognized the critical importance of credible measurement to the success of disease management programs. Measurement can be used to assess performance on key clinical indicators, to measure the implementation and uptake of evidence-based guidelines, and to help identify successful performers.

Working with regional clinical and measurement experts, CMI has developed broad sets of process and outcomes measures in each of its clinical priority areas. In developing these measures, CMI has incorporated and expanded upon existing national measures, such as NCQA HEDIS, as well as the Diabetes Quality Improvement Project. Based on the data available within the KP system, the measurement sets are comprehensive in their inclusion of relevant source data indicators.

CMI uses a collaborative, evidence-based approach to define, implement, and evaluate measures for KP's disease management populations. CMI's Clinical Outcomes Reporting and Evaluation system (CORE) includes individual-level data on each member in each of CMI's clinical priority populations. These data are used to generate annual reports for each condition that include a breadth of process and outcomes measures that are relevant to the care of that population. In addition, CMI produces quarterly reports on a selected subset of measures to assess more current performance, and conducts member-based assessments to capture important self-reported aspects of member health, such as functional status and quality of life.

CMI conducts large-scale national outcomes studies and member surveys to learn how to best focus investments and resources within Kaiser Permanente to make people better and improve their quality of life. These national outcomes studies are conducted for each of CMS's clinical priority areas. Unique both for their size (up to several hundred thousand patients per study) and their level of detail, these outcomes reports serve as internal Kaiser Permanente benchmarking tools.

Nationally, KP has taken a lead in further developing the discussion around appropriate and effective measures:

• Dr. Paul Wallace, CMI Executive Director, Matt Stiefel, CMI Associate Executive Director, and other KP leaders have presented to the Washington Business Group on Health on several occasions. The most recent presentation focused on "Demonstrating Value."
• CMI has been working closely with NCQA on the 2002 NCQA Asthma Measure. The current NCQA measure actually improves as clinical management of asthma deteriorates. CMI brought this to the attention of NCQA and has been working with NCQA to remedy this.
• NCQA has invited CMI to help develop new measures on cancer outcomes.
• CMI, in conjunction with NCQA, the National Quality Forum, and others will be establishing a round table on clinical quality indexing in the near future.

Impact

KP's disease management programs have had a significant impact on our members' lives. In our Northern California Region, members are 30% less likely to die of a heart attack than members of other health plans or insurance programs. In fact, the overall heart disease programs in Northern California have reduced heart disease from being the primary cause of mortality for our members, to the secondary cause (cancer is now the primary cause.) This kind of active reduction of a chronic disease within the populations we serve, and the impact that it has, has not been duplicated in any other known programs.

Across Kaiser Permanente, improvements over the last five years have been broad based. On many of the measures, the average of all of the Kaiser Permanente Regions has exceeded the top performing Regions of the previous years. Glycemic control in diabetes care is one example illustrated by the graph below.

KP's work in disease management targets all of our 8.4 million members through one priority or another, as evidenced by the table below:

© 2009 Care Management Institute