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Scott Shreeve, MD

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I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me



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Primary Care Possibilities – Kaiser Leads the Way (again)

Leadership (lē’dər-shĭp’) n.

  1. The position or office of a leader
  2. Capacity or ability to lead
  3. Guidance; direction

I have written extensively about Kaiser Permanente in the recent past (here, here, and here) – not only for their notable achievements but even more impressive to me is their genuine interest to share their results with others as model for global health improvement. The recent issue of Health Affairs has two impressive articles from Kaiser regarding their EHR implementation as well as their Online Portal efforts. Great material.

As part of the same issue, Health Affairs newest contibutor Carleen Hawn highlighted the work of Ted Eytan in an article discussing the new social media delivery model. The article was a campy, highly conversational piece introducing some Millennial Vibe into what has always been the hushed tones of the highly academic/policy focused Health Affairs. Ted continues to do alot of interesting work, and in his role at Kaiser travels the country looking at new models of care delivery, new technologies, and the beautiful symphony that occurs when patients/physicians are working together in partnership to optimize health. A recent blog post of his highlights some of what he is seeing within Kaiser in terms of delivering more valuable primary care to patients. I thought it was worthy of re-posting large sections:

Because the innovation in primary care they are helping create involves all members of the care team, they created an experience for me that included shadowing physicians as well as nurses and clinical pharmacists. We should understand how every member of the team contributes, and this was great.

So what did I see?

  • Data systems and the workflow to support it are maturing to the point that primary care teams can understand how to keep patients healthy whether or not they actually come in for appointments. Teams are alerted about patients with chronic illness proactively, not reactively, more quickly than ever before. Medical and Nursing staff are responding to this new ability by creating new workflows and partnership around supporting patients, families, and populations.
  • Physicians are comfortable with the comprehensive electronic health record in practice: quote from an Ohio Permanente physician, “I don’t want the computer to get in the way (of the visit) but at the same time it’s a wonderful opportunity to share with the patient.”
  • Participation of a wider array of team members including nurses and clinical pharmacists, to leverage their skills, whether it’s coaching/teaching, medication management, all connected electronically (now).
  • Rethinking of the primary care practice altogether – including the idea that primary care physicians may see higher acuity patients as population management is spread across more staff, that they will use non-traditional communication methods including secure e-mail and telephone as part of what they do, and that managing a panel is work integrated into the day.
  • My favorite After Visit Summary workflow – every member whose care I observed got one – physicians and nurses work together to create and go over information with patients, it is not just a task of one or the other. They use the electronic health record to signal each other consistently for the handoff, which happens reliably. This helps accuracy and efficiency for the member and the system.

I think this work is not only useful for Kaiser Permanente, but for all of health care, because Kaiser Permanente’s financing model allows for this type of innovation, and sharing of such.

At the same time, there are major challenges here. The primary care provider shortage has affected Kaiser Permanente as much as the rest of health care. The good news is that this shortage is driving many of the innovations above, which I actually think will be portable to all of health care.

Wow. High performing health systems do more with less, do less for each patient (because the patients do more themselves), and involve a team approach given their aligned incentives all focused around a patient centered experience. I also love that they are willing and wanting to share their experience, to help others see the possibilities, and working together to improve our health as a nation. Isn’t that the essence of leadership?

Bravo, KP!

2 comments on “Primary Care Possibilities – Kaiser Leads the Way (again)

  1. SFGary says:

    Forgive me for not getting breathless about Kaiser’s innovations in healthcare delivery. Its only good if you are on the inside. I was a member for over 14 years and got fairly good care, using the service sparingly. However after I lost my last job and the COBRA ran out my Kaiser membership jumped to over $550 a month – for one person. The lesson here is not to be unemployed and try to do a startup or be prepared to mortgage your home to pay your policy.

    I am willing to pay a reasonable amount for healthcare but the current policy of linking care to employment and the lack of portability – like a driver’s license makes healthcare unaffordable to a lot of people. I hope Obama takes this issue seriously and is a catalyst for changing how the system works in this formerly wealthy country of ours.

    1. Gary,

      Thanks for reading.

      Fair enough . . . my intent was to highlight some of the things that Kaiser is doing that can and should serve as a model for others. $550 for an individual seems excessive at first blush, but perhaps there is a reason for that rate(?) given the type of “insurance” you are selecting. I pay $282 for my entire family of six on a Blue Cross plan ($7,000 deductible) and would have paid $400 with Kaiser (they did not have as high a deductible option – $5,000). I have been very happy with the cost but am not so sure that I am getting the best care.

      Regardless of your specifics, having access to affordable health care for smaller companies, individuals who choose alternative employment arrangements (like you and me!), or individuals who have health conditions is a priority. As a point of interest, I am wondering what you consider to be a “reasonable amount” for health insurance? I think it is a great question to ask – is it 10% of your income? 2% of your income?

      Finally, I could not agree more with you regarding the whole employer based system. It is an artifact of World War II, and we need to jettison it immediately. In fact, having the employers in there ccompletely screws up the incentives in hundreds of ways. Of all the Obama proposed policies, the one tax increase I totally support is “taxing of health benefits”. I believe the removal of this single policy would open the floodgates of innovation as employers transitioned to a defined contribution which would ultimately just be rolled up into your total compensation package. Employers could still serve as aggregators by virtue of their size but we eliminate the perverse incentives.

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