How the integrated model is changing health care delivery

Health care is changing, and the path to accountability requires health care organizations to transform the way care is delivered.

“Our mission to provide high-quality, affordable health care to our members and the communities we serve will not change under health care reform,” says Belva Denmark Tibbs, vice president of medical operations with Kaiser Permanente.

She says more and more organizations have begun using integrated care delivery models, in which physicians partner with the health plan insurer to provide patient-centered care that uses evidenced-based medicine to identify the best treatment for patients.

Smart Business learned more from Denmark Tibbs about how integrated systems are transforming how health care is delivered.

What are the challenges of transforming health care delivery?

The biggest challenge is that money is tight. All of us are being asked to do more with less. In addition to economic pressures, we are also dealing with an aging population that has unique health care concerns. In the Cleveland area, we have high numbers of overweight individuals who have diabetes, asthma, etc. We have more individuals with multiple sclerosis in this region than some of the other areas in which Kaiser Permanente is located.

When you combine these health care issues, the economic pressures and, of course, the health care policy changes that are occurring, you have this confluence of pressures that cause all of us in the health care industry to realize that we have to change. Our reality will change; health care as we know it will change in the next few years.

What solutions are out there?

Companies should look at a variety of solutions. The first is the relationship between the primary care physician and the patient. You’ll hear terms such as patient-centered ‘medical home.’ That means we are putting patients in the driver’s seat in terms of their health care. We’re talking about forming partnerships with the doctor. There was a time when people looked at the physician as being all-knowing. But with the influx of information that is available through the Internet and TV, patients are becoming more informed.

We have to respond to that. Via our website,, patients have access to information about many of the diseases that I mentioned earlier. Patients know, for example, that by making simple lifestyle choices, such as eating healthier, being active, knowing certain key indicators (e.g., cholesterol level, blood pressure, glucose level and BMI), they can have a positive impact on their health.

How does an integrated system work?

In a broad sense, integrated systems reward care coordination and collaboration among providers, particularly for patients with chronic conditions. In the integrated delivery system, we talk about one-stop shopping. In many cases, when you come to the doctor’s office, you are able to get many services under one roof. Lab, pharmacy, radiology and specialty care — all in one location.

In addition, in an integrated system, all of the members’ care experiences then become part of their electronic health record (EHR), which is another important tool. The integrated delivery system connects all physicians, so no matter where you receive care, everyone has access — in a secure manner — to up-to-date health information. If you are in an emergency room, a specialist’s office, or your personal doctor’s office, each provider can access your medical information. This is great for the patient and the provider because it reduces duplication, allows physicians to provide better care, and it can reduce costs.

It also allows patients to get lab results, e-mail their physicians, get prescription refills online or over the phone, and review or print immunization records. Those things are available to our members via the Internet because of the EHRs.

How do you get buy in?

When you are trying to make change of this magnitude, it’s very important to get all the stakeholders on board. With an integrated delivery system, the physicians and the health plan insurance company work together to provide the best care and service to members, so the buy in comes early.

We didn’t have to spend a lot of time convincing our physicians to adopt and use EHRs. That’s one plus. The other is financing. To finance EHRs, Kaiser Permanente spent $4 billion nationally to connect 8.7 million members, 160,000 employees and 17,000 physicians into its system (KP HealthConnect). That cost was shared by all of the entities, not just one doctor’s office.

The other challenge is when you transform your health care system, you want to implement best practices. So we research and find evidence; we analyze patient information among Kaiser Permanente members and scan the medical journals to find the best ways to care for patients’ conditions. Based on this evidence, we are able to use best practices across our entire continuum to ensure clinical outcomes. Every physician knows the best way to manage the diabetic patient, or the patient with high cholesterol or high blood pressure.

What is the return on investment for integrated systems?

The ROI is longer term, but it’s tangible. You must set expectations that results will be seen over a few years, not over a few months.

But the way to get buy in is through getting results, like achieving successful clinical outcomes. For example, by implementing evidence-based practices, we know our diabetic members have fewer hospitalizations, fewer of them are going blind, and there have been fewer amputations. That means we’re saving very costly hospital dollars. More importantly, our patients have a better quality of life, and that is our greatest satisfaction. For us, it’s important to save health care dollars but our cause continues to be the health and wellness of our members.

Belva Denmark Tibbs is vice president, medical operations with Kaiser Permanente. Reach her at [email protected].