CAPP Physician Group: KAISER PERMANENTE
Project: HEALTHY HEART PROGRAM

Summary: Heart disease rates at Kaiser Permanente Northern California (KPNC) have dropped so dramatically that it is no longer the leading cause of death among the group’s patients, thanks to Kaiser Permanente’s Healthy Heart program. KP has now made the program available to all California physicians. If adopted, the state and its employers could save millions in health care costs.

Coronary heart disease costs an estimated half-trillion dollars in expenses every year. But Kaiser Permanente’s patients are contributing less to that expense because of Kaiser Permanente’s Healthy Heart Program. Heart disease rates at Kaiser Permanente Northern California (KPNC) have dropped so that it is no longer the leading cause of death among the group’s patients. In fact, adjusting for age and gender, death from heart disease is 30 percent lower in the KPNC population than in the non-Kaiser Permanente population in California.

Over the last ten years, the group developed and fine-tuned its comprehensive Coronary Artery Disease Program. KPNC also initiated a process to integrate clinical guideline use into the daily care and treatment of patients with cardiovascular conditions. Carefully designed programs were created to integrate care, such as a cardiac rehabilitation program, a cholesterol management program, and a heart failure program (now the largest in the country). Each program is supported by software systems that track and manage the patients.

Today, every patient identified as having coronary artery disease (CAD), acute myocardial infarction, or hypertension is logged into a patient registry. The registries have a preventive health prompt, so, for example, if a patient is in the CAD registry and hasn’t had a cholesterol check in more than six months, the system will alert the doctor at the patient’s next appointment, even if the visit is for something totally unrelated. These registries are vital to patient outreach and education, and effective population management. Doctors are also given regular reports from the CAD registry that list their patients’ current LDL levels and beta-blocker, ACE inhibitor and aspirin use. This allows them to be proactive with patients about their care.

The results of the “Healthy Heart” program are so impressive that Kaiser Permanente has, for the first time, made its program information available to all California physicians and the general public via a public website. Kaiser Permanente also is providing—at no cost—consulting services to public hospitals and community caregivers to bring its innovative lifesaving cardiovascular care program to underserved populations. Predicative calculations reveal that if people follow three or four of the five prevention steps, 6,000 heart attacks and 5,500 strokes can be prevented every year. This would not only be great news for patients, but also for the employers and the state of California, which would save $250 million in costs, while employers could see significant reductions in absenteeism and increases in productivity.

For more information about this project, please contact Nancy Taylor, The Permanente Federation, at (510) 271-6995.

Integrating Services for Low-Income Seniors Shows Health Care Benefit, by Claire Sowerbutt, Contributing Writer, MedPage Today, December 11, 2007.

INDIANAPOLIS, Dec. 11 -- For low-income seniors, the likelihood of providing the recommended standard of health care services could be enhanced by integrating home-based and institutional services, found researchers here.

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“From High Tech to Soft Touch: The Everett Clinic uses innovative ways to control health care costs,” by Bryan Corliss, Washington CEO, November 26, 2007.

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“CAPP’s 35 MSMGs [multispecialty medical groups] share a common vision as learning organizations dedicated to the improvement of clinical care. Their features include physician leadership and governance; commitment to evidence-based care management processes; well-developed quality improvement systems; team-based care; the use of advance clinical information technology; and the collection, analysis, and distribution of clinical performance information. These features are congruent with the [Institute of Medicine’s] recommendations on key elements needed to redesign delivery systems.”

From Chapter 5, “Developing the Test Bed—Linking Integrated Service Delivery Systems: Council of Accountable Physician Practices,” by Michael A. Mustile, MD. The Learning Healthcare System: Workshop Summary (IOM Roundtable on Evidence-Based Medicine), edited by LeighAnne Olsen, Dara Aisner, and J. Michael McGinnis, National Academies Press, 2007.

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“A shift from the current care model to a more coordinated care model centered on primary care is one potential way to help stave off the healthcare dilemma.”

“It's too expensive to be a primary-care doctor,” by Debra A. Geihsler, president and CEO of Harvard Vanguard Medical Associates & Atrius Health. Boston Globe, July 25, 2007.

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