Push and pull: How Kaiser Permanente is bringing innovation to scale

If you ask Benjamin Chu, MD, what is at the core of innovation, he will tell you it is a societal shift.

"Any innovation is a social phenomenon," he said in his keynote address at the National Healthcare Innovation Summit in Chicago Tuesday. "If you want to break out of the mold, you have to think completely differently."

Dr. Chu serves as executive vice president of Oakland, Calif.-based Kaiser Foundation Hospitals and Health Plan, group president of Kaiser Permanente's Southern California and Georgia regions and president of Kaiser Permanente Southern California.

Kaiser Permanente is one of the biggest health systems in the country, serving more than 10 million members in eight states and in Washington, D.C. The health system's key objective is bringing the triple aim to its patient population, Dr. Chu said. "It's not the health system imposing our will on the population; it's about how do you create the environment where our members actively participate," he said.

The key, Dr. Chu said, is identifying and employing pull strategies versus push strategies.

While push strategies are characterized by a person having one great idea and pushing everyone to adopt it, a pull strategy works to draw people in. In a pull strategy, Dr. Chu said, "you appeal to the intrinsic desire of the people who are actually on the frontlines, trying to carry out the overall mission to [get them to] want to do it because they see it as transformative and a valuable tool in order to get to the results."

Pull strategies are ideal, but they aren't always easy, Dr. Chu said. He outlined factors through which Kaiser Permanente has found success in its mission to reach the triple aim.

Arming physicians with actionable information (not just data)
First, full alignment and integration of the delivery and payment system is key, especially for Kaiser Permanente, which operates under the capitation model and receives a set amount of money per patient per month. "In Southern California, it's $24 billion a year to take care of 4 million people. You're not tied to the volume. You can actually spend where you think it gets the most value," Dr. Chu said.

He also mentioned the importance of meaningful, real-time and actionable quality performance data, clear leadership involvement and the willingness to work toward results.

Transparency of performance, especially for physicians, is fundamental, Dr. Chu said. "There's nothing like being open about our performance that drives people like doctors to want to do a better job."

To facilitate this, Kaiser Permanente launched the POINT system, an acronym for Permanente Online Interactive Network Tool, where every provider can look at the performance of physicians, department and medical centers. But merely supplying providers with clinical information isn't sufficient, Dr. Chu said.

"You can't just dump all this information and responsibility on doctors, because what it points out is where [we are] not meeting the needs of our members," he said.

On top of providing transparency, the information needs to be made available throughout the system for all providers to see and then use to mobilize. As such, Dr. Chu said these responsibilities don't solely align with the primary care providers, who are largely seen as the coordinators of care. He said that when analyzing Kaiser Permanente members with the highest number of care gaps, 60 percent of them never went to their primary care physicians. This makes sense, Dr. Chu said, because when thinking of who does go to primary care physicians, it's generally individuals who are ill, not those who are well.

"To put that burden [of addressing care gaps] on PCPs was not only depressing for them, but it was unfair," Dr. Chu said. There's just no way that somebody who sees a patient less than an hour a year — the average number of outpatient visits for a member to a doctor is no more than four a year, generally, and most visits are 10 to 15 minutes — and how do you expect that primary care doctor to address all those issues?"

Dr. Chu said this realization helped Kaiser Permanente gain insight in how to make information actionable. "It's not just transparent information, but it has to be transparent information that everybody sees and it has to mobilize the entire system," he said.

Changing the way Kaiser plans and builds
One of Dr. Chu's initiatives at Kaiser Permanente was to decentralize the healthcare campus. Instead of having all of the health system's facilities in one area, leadership decided to spread facilities out to be more connected and accessible to the communities they serve.

As Kaiser Permanente decentralized, the system rebuilt medical office buildings, but similar to the way it had in the past. To incite change, Dr. Chu said leaders asked themselves how they might go about designing the medical office building of the future.

"Instead of thinking about what it would look like in the future, the idea is to think about how might we design the future," Dr. Chu said. "If you start with the medical office building and you're going to replace it and try to tweak the design, you're probably not embracing the full power of innovation we could bring to bear."

In developing the new medical office buildings, Kaiser Permanente first sought insight from members on what they would like to see.

"If you ask doctors and providers, they just would want bigger offices, more convenient access," Dr. Chu said. "We didn't want to build faster horses. We actually wanted something different."

Dr. Chu said asking members directly for input demonstrates a commitment to the triple aim and being consumer- and member-centric. Kaiser Permanente then brought administrators, physicians and nurses to the table to arrive at conclusive ideas about how to move forward.

"It turned out to be more than just about the buildings," Dr. Chu said. "You talk to members and you think about all the new technology that's coming down. It's not about the bricks and mortar anymore. It's about how do you utilize all the different ways you can touch people and interface with people in order to get the results that we want with them."

Kaiser Permanente is building a handful of these medical office buildings, called Health Hubs, using the input gained from all these stakeholders. All future medical office buildings (Kaiser Permanente plans to build between 20 and 25 over the next five years) will be designed with these key elements in mind.

The process of receiving input and thinking about designing the future took approximately two years, but Dr. Chu said the work done in those two years is instrumental to bringing innovation to scale and making serious, measurable change in the community.

"Taking the two years to get the buy-in has been an amazing boom. It's created this desire for people to want to build it this way," Dr. Chu said. "If you take the time to really think about a framework that taps into the hearts and minds of the frontline people, you can really accelerate transformation in a big way."

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