I arranged to meet Prof Chris Ham, Advisor to the Strategic Policy Unit at the Department of Health. He is leading the Department of Health work on Kaiser Permanente and was named by the Guardian as “number 13 of the 15 most powerful people in health”.
Kaiser Permanente is a non-profit managed care organisation that provides an integrated approach to service delivery and covers 8 million people across the USA. It aims to minimise the use of acute hospital beds by strong focus on the management of people with chronic disease and by breaking down barriers between secondary and primary care. Perhaps surprisingly, for the United States, more care is delivered in a community setting, including the use of intermediate care, home care and self care by patients, than the is the case in the National Health Service. The initiative for this work was a paper in the BMJ, showing better outcomes and reduced use of resources with Kaiser Permanente than apparently provided for in the NHS. Initially, the work of the unit sought to discover if, using more detailed data on twelve common conditions, e.g. COPD and Stroke, and focusing on the over 65 year olds, these original findings could be replicated. The research so far, finds that for these twelve common conditions, there is up to a four-fold increased use of bed days in an acute hospital in the UK, compared with United States. |
Dr David Black |
There has
subsequently been visits to the US by a considerable number of managers,
PCT members and doctors, including at least a couple of geriatricians,
to explore why this is apparently the case in the Kaiser Permanente
model. What they have found so far have been:
- A much more integrated model of care, where finance and budgets do not get in the way of patients moving through the system. There is also more integrated primary and secondary care delivery.
- There
is a greater availability of skilled nursing in intermediate care type
facilities.
Much of this is planned usage at the time of admission. - There is much greater explicit use of care pathways, and members of the team are enabled to make decisions at crucial points.
- Compared to the UK there is a greater number of discharge planners actively working on all patients from the point of admission.
- There is a strong focus on chronic disease management - a culture that if a patient has been admitted to hospital, the community has somehow “failed”. They put a lot of effort into shared care and self care.
- It is the doctors who own and run all these processes and organisations. They will often be shareholders in the business, and have annual incentives linked to targets, in particular quality targets such as patient satisfaction.
Prof Ham emphasised that there is no intention at all that Kaiser Permanente be asked to come in and run a primary care organisation or other health care organisation in the UK. The intention is that there will be a lot more information about the models of care, and the changes that seem to be important, available in the UK, and certainly PCT’s are being encouraged to start up projects looking at aspects of “good practice”, particularly from the perspective of PCT’s.
Prof Ham would be happy to talk to the BGS and I have written to the meetings secretaries asking them to consider this.
David Black