# Presentation: 915894

## Kaiser Permanente’s Response to the DPP

**Joe V. Selby, MD MPH**
**Division of Research**
**Kaiser Permanente, Northern California**

## Other Likely Health Plan Repondents

**American Association of Health Plans**
**Represents majority of US managed care plans**
**Coordinates research with CDC**
**Sponsors initiatives in many chronic illnesses**
**Promotes clinical trial participation among its member plans**

## Other Likely Health Plan Respondents

**The HMO Research Network**
**Research centers from 14 large health plans**
**More than 20 million enrollees**
**More than $30 million in NIH, CDC, AHRQ research funds**

## Kaiser Permanente

**America’s oldest and largest private, non-profit, integrated health care delivery and financing system - founded in 1945**
**Exclusive partnership between a health plan and multi-specialty group practice organizations**
**9 separately incorporated Permanente Medical Groups, operating in 10 states and Washington, D.C.**
**8.2 million members, 90,000 employees, and 11,000 physicians **

## Care Management Institute

**A Program (national) office responsible for :**
***supporting development of evidence-based, population disease management across the entire KP program***
***identifying and disseminating best practices ***** **
***measurement and demonstration of  improving outcomes***** **

## 9 Current CMI Priority Areas

**Asthma**
**CAD (Secondary Prevention)**
**Cancer (adjunctive therapies)**
**Chronic Pain**
**Depression**
**Diabetes**
**Elder Care (including Dementia and Palliative Care)**
**Heart Failure**
**Self-Care and Shared Decision-Making**

## Population Disease Management

**Identify the affected population**
**Develop evidence-based treatment guidelines**
**Support clinicians in implementation **
**identify and share best practices**
**build information systems, decision support**
**integrate specialized support staff**
**Monitor treatment / outcomes, feedback to providers**
**Risk stratify population and tailor intensity of treatment to level of risk **

## Excess Costs of Care for Diabetic Members, 199485,209 members, by complication

**Total Excess: $282.7 million**

## Age-adjusted Prevalence of Diabetes Mellitus, Coronary Artery Disease, and Congestive Heart Failure, KP Members Age 20+, 1996-2000

## Number of Diabetic Members End of 2001, KP Nor. Cal.

## Approximately 50 bariatric surgeries 

**per week throughout the KP program **
**nationally**

## Input received at recent inter-regional conference of KP Bariatricians:

Short Term Themes
Develop strategies for prevention of obesity
Develop metrics:  how can we quantify the burden and effectiveness of treatment?
Provide clinical tools and education
Optimize and standardize program components
Develop evidence-based risk stratification  approaches

_**Short Term Themes**_
**Develop strategies for prevention of obesity**
**Develop metrics:  how can we quantify the burden and effectiveness of treatment?**
**Provide clinical tools and education**
**Optimize and standardize program components**
**Develop evidence-based risk stratification  approaches**

- Inter-regional Obesity Meeting, Portland, OR 12/6/01

## Input received at recent inter-regional conference of KP Bariatricians:

Long Term Themes

Establish the management of overweight and obesity as an organizational priority
Promote prevention/healthy life styles
Include the member voice
Ensure enhanced skills of staff and clinicians

_**Long Term Themes**_
**Establish the management of overweight and obesity as an organizational priority**
**Promote prevention/healthy life styles**
**Include the member voice**
**Ensure enhanced skills of staff and clinicians**

- Inter-regional Obesity Meeting, Portland, OR 12/6/01

## KP’s Weight Management Initiative

**Begins with convening the National Advisory Group on Overweight & Obesity**
_**Composition**_**: academia, government (CDC, ODPHP, CMS, NIDDK (unofficial)) and all KP regions**
_**Aim**_**: to gain a broad understanding of current knowledge regarding:  **
**primary prevention of obesity**
**medical management of obesity **
**surgical treatment in morbid obesity**
_**Format**_**: series of three conference calls with national experts and KP providers**

## KP’s Weight Management Initiative

**Continue Work by Establishing **_**KP Clinical Network**_**:**
_**Composition**_**: KP clinicians, quality improvement, research staff from all regions, led and supported by CMI**
_**Aims**_**:**
**assessing current activities - “best practices”**
**introducing measurement**
**revising clinical guidelines**
**focusing on implementation**

## Probable Strategies

**Primary prevention and self-management of weight:**
**Changing culture among KP employees**
**Developing partnerships with schools, employers**
**Collaborations with other health insurance plans and care delivery systems**
**Partnerships with government on research, demonstration projects**

## Probable Strategies	

**Population approach to treatment/ management of obesity:**
**revise & disseminate clinical guidelines**
**support clinicians with training  in brief, effective interventions (e.g. smoking cess.)**
**collect and monitor BMI as vital sign**
**risk stratify overweight population, directing   more intensive efforts toward those at higher risk (e.g., HT, ******** HDL-C, IGT, GDM)**
**standardize weight management services  across KP toward most effective programs**

## Probable Strategies

**Measurement:**
**“****BMI as a vital sign”**
**Use of medication for weight mgmt/ diabetes prevention**
**Use and outcomes of bariatric surgery**

## Attention to Disparities

**Membership nationally is approximately 40% racial/ethnic “minority” populations**
**KP has substantial history of research into racial/ethnic health care disparities**
**KP has a national office on cultural competence,  active training programs for clinicians, and several specific programs providing culturally sensitive care through bi-cultural, bi-lingual clinics and services**

## Strategies for Ongoing Improvement

**Rapid dissemination of new findings**
**Ongoing conduct of effectiveness research**
**internally funded RFA’s**
**externally funded projects  **