Quality Improvement Interview: Kaiser Permanente of the Mid-Atlantic States

Kaiser Permanente of the Mid-Atlantic States has been demonstrating high performance on NCQA’s annual health plan rankings for several years; due to a combination of quality improvements and high patient satisfaction ratings, the plan rose a total of 18 ranking places from 2011 to 2012. This year’s increase – up to number 15 in the commercial rankings and number 12 for the Medicare rankings – was a continuation of the plan’s high performance for the past three to four years.

We spoke with Bernadette Loftus, M.D., the Permanente Medical Group associate executive director for the Mid-Atlantic States, about what the plan has been doing recently to drive improvement. Dr. Loftus cites two key aspects as responsible for their exemplary performance: access and communication.

She emphasizes that the importance of access for patients, whether to primary, specialty or ancillary diagnostic care cannot be overstated. Due to a relentless diligence to improving access times and stringent requirements that patients must see their own physicians whenever possible, the plan maintains excellent access for patients so physicians spend more time listening to and engaging with the patient, not on extraneous issues.

According to Dr. Loftus, this simple focus has greatly impacted the way the plan interacts with patients: When patients see a doctor that they know, there is an instantaneous jump in patient satisfaction ratings.

Effective communication is the second key aspect to Kaiser Permanente – Mid-Atlantic’s steady improvement on the rankings. This refers to communication among physicians, the health plan and patients. In terms of the former, physician and staff buy-in is key, says Dr. Loftus.

The health plan has provided a comprehensive electronic medical record to the physicians, and supports staff and providers in its utilization. The plan’s leadership, along with Dr. Loftus, also maintains focused communication with all practices. She points out that evidence confirms that effective communication between physicians and a focus on patient access improves health outcomes and patient experience.

To facilitate communication with patients, the plan has implemented what Dr. Loftus calls “obsessive” outreach – continual prompting comprising “back sweeps” and “forward sweeps.” The “back sweep” report requires that all patients get scheduled for their needs (such as screenings, check-ups or physicals) during each visit. The “forward sweep” requires staff to look to future patient visits, and schedule any additional upcoming appointments for which patients are due on that same day, so the patient makes only one office visit.

These protocols have elicited particularly positive feedback from patients, some of whom credit the outreach with saving their lives, due to early diagnoses and treatment.

Kaiser Permanente – Mid-Atlantic now tops the rankings for three measures: Breast Cancer Screening, Acute Bronchitis Treatment in Adults and Diabetic Nephropathy Medical Attention. Dr. Loftus is also particularly proud of the plan’s hypertension control rate, which stands at number six in the nation – a remarkable achievement given that the demography of the Mid-Atlantic states shows the patient population to be vulnerable to hypertension.

The plan’s performance on this measure is an instance of both effective communication and greater patient access, as well as a rapid performance improvement cycle. The methods of effectively treating hypertension are well known: They call for a layering approach, tinkering with dosages and medications to find what works best. However, the plan realized that decision points needed to be more frequent, requiring blood pressure to be checked every few weeks. They quickly modified follow-up measures, and aided by aggressive outreach, the plan now boasts a control rate of over 80 percent. Dr. Loftus says that a widely accepted recognition of common standards regarding these measures enabled a quick and straightforward transition. The “HEDIS measures are based on evidence. No one argues that it is not the right thing to do,” she points out.

It is clear that quality improvement is not a unilateral effort, nor is it a goal that requires complex strategies and arcane technology. On the contrary, the process is fairly simple: By making it easy to do the right thing, says Loftus, these priorities and practices will naturally spread, and garner staff buy-in. Achieving quality performance demands relentless dedication on the part of the entire plan, as Kaiser Permanente – Mid-Atlantic has demonstrated.

“Quality is everyone’s job,” Dr. Loftus concludes.

Photograph courtesy of The Permanente Medical Group.

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