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BALANCED MEASURES STUDY
KAISER PERMANENTE – CORPORATE HQ

SITE: Conference Call with Kaiser Permanente - Corporate

DATE: May 5, 1999

TIME: 2:30 – 3:30 PM

PARTICIPANTS: Deb Lowry, Director Market Performance Appraisal Group, Kaiser Permanente, Oakland California

NPR Team: Betsy Currie, Amy Hertz, Curt Marshall, Kathy Monahan

OVERVIEW:

• Kaiser Permanente (KP) is one of the nations leading health care organizations. It is a non-profit, group-practice health maintenance organization (HMO) with headquarters in Oakland, California. Kaiser Permanente serves members in 18 states and the District of Columbia. Kaiser Permanente has more than 90,000 technical, administrative and clerical employees and 10,000 group-practice physicians representing all specialties. There are 8.6 million voluntarily enrolled members, most of whom join through their employer.
• KP has been involved in a formal performance measurement process for about 5 years. The corporate wide scorecard is undergoing some redevelopment and is currently not in use. Each region also uses their own scorecard based on various indices.

• From a broad "Scorecard" perspective, the focus is on
  • Quality of Services
  • Satisfaction with service and care
  • Outcome of Services
  • Affordability
  • Accessibility
  • Availability

ESTABLISHING A BALANCED SET OF MEASURES:

• KP’s mission is to provide care of the high quality health care and to improve the health of its members and communities. Quality is measured by effective individual clinical treatment, patient and customer satisfaction with services received, efficiency at all levels, and appropriate use of resources to improve the health status of its membership
• KP is working on alignment and standardization of these measures and incorporating them into the budgeting and planning
• Criteria for use of measures into the balanced corporate view:
  • Data is available and consistently available across the organization
• External numbers for benchmarks or comparisons exist (i.e. HEDIS quality measures)
• Balance between local and national measures; and leading and lagging indicators
• Timeliness
• Moving toward more outcome based measures
• Focus on consistent use of measures that conform across the organization, increase sharing of information.
• Focus on metrics that represent policies of performance

ACCOUNTABILITY:

• Identify measures and data in collaboration with Regions

• Rely on the local data
• Outside auditors review HEDIS performance measures. Compliance with outside accreditation organizations
• Quarterly Performance Management meetings are held with the senior leaders in each KP Region. Provides a better understanding of issues and trends across the country (similar/unique). Fosters a dialogue around performance and metrics
• Some incentives tied to quality, service and financial performance includes some labor unions; some medical groups; some management levels. This varies by location.

DATA COLLECTION AND REPORTING:

• Monthly reporting
• Monthly teleconferences with the regions to ensure data consistency
• Each KP region has their own information system. Collection of data occurs electronically or by facsimile from the Region to the corporate office.

ANALYSIS AND REVIEW:

• KP continues to repackage the performance results and information to catch people’s attention. Keep it fresh
• Internal reporting to employees
• Introduce performance measures to management – conducting monthly and quarterly monitoring process
• Intranet used to share results

EVALUATING AND UTILIZING AND REPORTING TO CUSTOMERS AND STAKEHOLDERS:

• Partner with Communications Dept. to promote performance improvement testimonies
• Public opinion important to KP
• Customer Surveys –
  • Individual members and non-members – quarterly surveys
  • Private purchasers and non-purchasers– less frequently
• Employee surveys measure satisfaction and quality in work environment

STRATEGIC PLANNING:

• Benchmark with other HMOs and NCQA

BEST PRACTICES:

• Established labor/management partnership two years ago to develop performance metrics from the labor point of view
• Each Region selects what works well (i.e. Northeast Region sent out a quarterly scorecard along with each employee’s paycheck)
• Established patient registries to focus on special patient populations

LESSONS LEARNED:

• Happy workforce means happy customers
• Critical to employee that they be asked their opinion regarding the quality of service and care that KP provides
• Perfect the measurement process to reflect achievements and changes in performance
• KP repackages the performance information to keep it fresh
• Business evolves rapidly. KP must be responsive and on the cutting edge
• The challenge to share what works well in one Region across the entire KP organization
• Reengineering efforts are influenced by the broad set of performance measures
• First isolate and prioritize problems, then FOCUS on those areas
• Culture changes do not happen overnight