TECH/CONSUMERS: Kaiser and Renaissance, the big and the small

David Sobel runs Kaiser Permanente Northern California’s attempts to provide patient information therapy — to him there are professional providers and lay providers of health care!

The opportunity is in self-care management.  Ought to be easy for Kaiser–as the incentives are in the right place– but there are "information implementation disorders".

  • Noise overload disorder
  • Professional dominance disorder (medical Hemianopsia — google it)
  • Not invented here
  • Disease specific syndrome
  • Office visit tunnel syndrome (tyranny of doctor visits as a metric)
  • Mindless body syndrome
  • Technophobia

How to get around this? Need to go to the expensive places (chronic disease). Need to get cost-effectiveness data and compare it to other stuff that doesn’t demand data (no business case asked for office visits). Need to tell stories, such as the Healthwise handbook story about a guy who’s wife made him go in to get an arterial blockage taken care of instead of blowing off the pain. Saved an amputation and tens of thousands of dollars.

Need to rename, retrain, integrate Information therapy into everything the doctors do, and into physician continuing education. So KP doctors are asked when they are doing CME, What questions are available to KP members for information about disease XYZ?  But more than that they had to redesign the program about how to make physicians feel better by communicating better with their patients, and 4,000 docs have gone through the program on their own time because it works. Got to re-frame the language.

And of course relationships, champions, values, persistence and proving yourself matter — In other words don’t try to sell to Kaiser! (Oasis, Oceania, anyone else?)

Rushika Fernandopulle runs Renaissance Health, the attempt to set up a model small practice in Boston.

He thinks that despite he’s in a small practice, we need to think big, and we need to change what we’re doing.  We can’t manage the patients condition, because they do it mostly themselves. They’ve kludged together various IT systems. They ask their patients to pay $20-40 a month to keep their panel size down and their extra work (non-reimbursed) up. The most important thing they’ve done is to change the culture so that widget production is not the goal of the practice. They pay patients if they make them wait more than 15 minutes. And their practice works. He loves working there–his patients love coming.

But with that number of patients per docs we’d need 375,000 primary care docs in the US, and they we’d have to take $250 per patient per year away from somewhere else in the system to pay for it.  Worth thinking about though.

2 replies »

  1. The biggest problem with information is the interests of hoarding/secrecy vs. transparency. While I admire attention to physician “disorders”, I think there are more logistical problems than issues of mud-stickedness. Often the first thing that is required is a simple managerial reality check, moving managers away from hype and toward understanding the reality of technology use in, for example, a patient encounter. How will the patient perceive the time the doctor needs to input data or consult the Evidence Based Database web app?
    My solution to solve 90% of all patients rights problems is to automatically issue the patient a copy of *all* records generated by the visit. Everything that goes in the chart, every note, every instruction. Can’t afford the paper? Offer an email option (with strong advice for the patient to print it out). Looky there! No more misunderstandings about whether the doctor actually diagnosed you. No more worry about secret notes on your medical record. No more waiting for months while your medical records are vetted (or distorted) by HMO lawyers. No more waiting for the HMO to submit your records to oversight agencies.
    If this society is about personal responsibility, then why can’t the patient be custodian of their own records? (Of course the new Conservative parlance is to accuse people of playing The Blame Game, should it prove that they were themselves responsible instead of those shifty, bad people on welfare…)
    This should be a law with swift and steep sanctions if doctors are found to be conveying surreptitious extra information. There should be some sort of omsbudsmen to go to in case of dispute over the paperwork. Did the doctor forget to note your six months of nosebleeds? – request that it be added. Did the doctor fail to diagnose or take steps in that direction? -request a diagnosis if you need one for, say, disability paperwork.
    I think I’ve mentioned before that none of this information should be made available to insurance agents, or even the plan-sellers of HMOs. As a bridge to universal healthcare, that process should just be blind. Sure, insurers might end up with sick people. But they will also end up with healthy people, and the model for insurance will be moved back to its communal origins where people pooled their resources to help each other few tough times (instead of manipulating the insurance market to make maximum profits).