Bertelsmann Expert Meeting in cooperation with Kaiser Permanente

Successfully integrated healthcare requires a number of factors, including innovative information and communications technology, healthcare teams led by physician managers and patients assuming responsibility for their own health. Those are some of the key findings from a US-German healthcare conference entitled "The road ahead: Population-oriented integrated healthcare" taking place in January 2007 in Berlin. The two-day gathering under the auspices of the German Federal Ministry of Health, was organized by the Bertelsmann Stiftung in collaboration with Kaiser Permanente, the leading provider of integrated healthcare in the United States. One of the conference's key objectives was providing German organizations with a unique opportunity to learn from the American provider's experience.

Management and information tools to make healthcare provision more efficient

"Although the German healthcare system is on the right path when it comes to integrated care, we still need new ideas and approaches in order to overcome the fragmentation as to how the system is financed and how it provides care," said Brigitte Mohn, member of the Bertelsmann Stiftung Executive Board, in her opening remarks. She added that valuable experience can be gained in this area by looking abroad -- for example, to providers such as Kaiser Permanente in the United States. The US-based healthcare organization combines three key aspects: In addition to using effective communications and technology, it ensures success by including medical professionals when designing structures for healthcare provision and by motivating patients to take responsibility for their own health.

According to Mohn, Kaiser Permanente's numerous management and information tools are of particular interest to Germany's integrated healthcare providers. For example, the company uses web-based materials to keep patients informed, sends out automated e-mail reminders and deploys home-based electronic tools for collecting patient data. In addition, the provider makes data available to members via a number of channels: through printed guides, audio files, online videos and video games.

As Francis J. Crosson, executive director of the Permanente Federation explained, e-mail and telephone communications between patients and medical staff have made many in-person appointments unnecessary while saving time and resources on both sides. Patient-doctor contact used to be 80 percent in-person visits and 20 percent telephone contact, Crosson said, but has now inverted to 20 percent in-person and 80 percent electronic contact -- without any loss of quality and with a high degree of satisfaction on both sides.

Active participation of physicians and patients

Doctors participate in Kaiser Permanente's management structures, for which they receive special business training. Their compensation packages and added incentives are designed to reward quality and improve performance. "Making sure medical professionals are included is the key to a successfully integrated system," Crosson said. "Doctors feel they are receiving optimal support, which allows them to concentrate on their medical tasks -- and that in turn increases their level of satisfaction."

Patients are not just recipients of care, but are considered partners when it comes to treatment. As Kaiser Permanente's experience has shown: Clear and comprehensible information, joint decision-making and a system that establishes realistic, individualized goals for maintaining personal health all lead to better clinical results, lower costs and more satisfaction for patients.

Lawrence Casalino, healthcare researcher at the University of Chicago, also provided examples of how integrated care can increase quality. "In individual medical practices, quality is assured through the practitioner him- or herself," he said. "Integrated healthcare can coordinate support across individual patient visits or hospital stays to produce higher levels of quality." In addition, Casalino said, healthcare provision is becoming much more efficient in general.

Some 110 participants from the healthcare sector took advantage of the opportunity to learn from the US-based experts. Attendees included policymakers, medical professionals and health service researchers, as well as managers from Germany's integrated care pilots and from both public and private health insurance funds.

The experts

Research evidence

Lawrence Casalino, MD, MPH, Ph.D., 
today teaches health studies at the University of Chicago, with a background of 20 years as a physician in private practice. For his research in integrated care, disease management, and the effects on quality and costs of varying types of care magement, he has received the Robert Wood Johnson Foundation's "Investigator Award in Health Policy Research" in 1999 and a "Changes in Health Care Financing and Organisation (HCFO)" grant by AcademyHealth in 2005. He will present research evidence on key success factors of an ideal integrated care system, and outline how to achieve better health care for populations through change management, team work, communication, and evaluation.

Physician testimonials

Experienced physician managers and practitioners from Kaiser Permanente will share their expertise and enthusiasm with German integrated care managers and physicians. They will demonstrate what makes working in an integrated delivery system rewarding for physicians, beneficial for patients and their families, efficient in times of rising health care costs and ever tighter budgets, and superior in quality and patient safety.

Francis J. Crosson, MD,is the Executive Director of The Permanente Federation, the governing organization for the nine Permanente Medical Groups nationwide, and serves as co-chair of the Kaiser Permanente Partnership Group (KPPG), the Kaiser Permanente joint management body. He is Chair-Elect of the Governing Board of the American Medical Group Association (AMGA). In 2002, Dr Crosson founded and now chairs the Council of Accountable Physician Practices (CAPP), an AMGA affiliate. CAPP is an alliance of 23 of the nation's largest multispecialty group practices which promotes delivery system improvement in the United States. In 2004, Dr Crosson was appointed to a three-year term on the congressional Medicare Payment Advisory Commission (MedPAC).

Sharon Levine, MD, is an expert on health policy, drug use management, and the design and delivery of health care services. As Associate Executive Director for The Permanente Medical Group of Northern California, Dr Levine has responsibility for the recruitment, compensation, clinical education, management training and leadership development of the group's physicians; government and community relations, health policy and external affairs; and pharmacy policy and drug use management. A a pediatrician, Dr Levine has practiced with The Permanente Medical Group since 1977 and has held multiple leadership roles. In addition, she has held academic appointments at Tufts University School of Medicine and Georgetown University School of Medicine.

Rachelle Mirkin, MPH, 
is Managing Director of Regional Health Education for Kaiser Permanente Northern California. She oversees the integration of health promotion and disease prevention, population management, and behavioral health into all aspects of the health care delivery system. Before joining Kaiser Permanente in 1995, she previously worked with the Care Management Institute, the University of California at San Francisco, the National Center for Education in Maternal and Child Health and the U.S. Centers for Disease Control and Prevention.

Murray Ross, Ph.D.,is Director of Health Policy Analysis and Research at the Kaiser Permanente Institute für Health Policy. He helps plan and execute the Institute's research on a range of health care topics, including insurance coverage and market stability, technology assessment, and quality of care. Furthermore, Dr Ross advises KP leadership on Medicare and other health financing issues. He serves on the leadership team of the KP Aging Network and on the Board of Advisors to the Center for Health Services Reserach in Primary Care at the University of California, Davis.

W. Warren Taylor, Jr., MD,
joined the The Permanente Medical Group in 1984 as a family physician working in the clinic of Napa, California. While serving as Chief of Medicine in Napa Clinic between 1994 and 1999 he was active in a number of projects to re-design primary care and address chronic conditions management. In 2000, he became the Medical Director for Chronic Conditions Management of The Permanente Medical Group, working in the areas of obesity, patient education, IT development and implementation for population management, and pharmacy and therapeutics policy. Dr Taylor continues his clinical work as a hospitalist part-time.