Affordability/Money - Color

Our members and patients count on Kaiser Permanente for affordable, quality care — and more unit-based teams than ever are focusing on ways to improve efficiency as well as service and quality. In fact, service or quality care improvements often lead to more cost-effective care, which benefits KP, our workforce and, most of all, our members and patients. Use these tips to jump-start your team’s thinking about the financial impacts of your improvements.

1. Think about potential financial impact from the start of your project. This will help you identify early on the data to collect and monitor so the financial impact can be calculated later. Keeping the financial impact in mind can also help refine your SMART goal.
2. Get a good grasp of what you’re trying to improve. Then think about the cost associated with that thing. For instance, if your goal is to streamline scheduling, think about the potential costs, such as excessive overtime, associated with an inefficient schedule.
3. Have a clear understanding of your baseline metric. Once you know what your goal is, determine the associated costs before any changes are made. This will help you translate the improvement into money saved.
4. Work with your local finance team. If you don’t have a relationship with your local finance department, ask your UBT consultant or improvement advisor to connect you with the right person to help you determine the dollar value of a project.
5. Find out if there’s a team in your facility or service area that is working on something similar.
6. Another team may already have figured out ways to calculate the financial impact your project might have or may have different ideas for measuring its financial benefit.
7. Look beyond the hard dollar savings. “Soft dollars” can be equally important. These are avoided costs or improvements that don’t reduce the money spent but allow us to do more with the resources we have. Examples include improvements in re-admission rates, number of no-show appointments or time spent looking for supplies.
8. Value the financial impact of small improvements. If an improvement and its estimated financial impact seem small, remember to figure out the potential savings over time or add up what happens if the practice spreads to other departments or facilities.

Keeping the affordability point on the Value Compass in mind, unit-based teams are taking a hard look at the obstacles to collecting copayments and conducting small tests of change around proposed improvements. New practices like these are generating hundreds of thousands of dollars in new revenue.

1. Educate employees about the importance of copay collection.
2. Train employees in how to ask for payment. Use role playing to help them become more comfortable with asking for payments, and create and distribute talking points or scripts.
3. Provide visual reminders for members to check in at the front desk, so a receptionist can determine if a copayment is due.
4. Post a sign with a telephone number directing patients with questions about co-payments and financial concerns to a financial counselor.
5. Call patients a week in advance of a scheduled procedure to advise them a copay will be due and, if possible, to collect it before they are admitted.
6. Add the copayment amount to patient’s outstanding balance and ask for the total amount. If balance is $100 or more, ask for payment on the account.
7. Refer patients who can’t afford to pay to facility-based financial counselors.
8. Station a full-time financial counselor in the Emergency Department.
9. Make sure financial aid applications are processed promptly by having co-workers share the load. Report workload status at weekly huddles.
10. Create a uniform note-taking system for financial forms and assign a counselor to every patient referred to financial services.

In the early 2000s, Blockbuster ruled the video rental roost.

Now it’s all but gone.

Blockbuster didn’t adapt to customer needs and technology trends. Netflix did.

Kaiser Permanente and the Coalition of Kaiser Permanente Unions recognize that if you don’t change with the times, you can get left behind.

The National Agreement addresses the importance of preparing for the future in partnership; section 1D of the agreement covers workforce planning and development.

Under the 2015 agreement, two educational trusts — Ben Hudnall Memorial Trust and SEIU UHW-West & Joint Employer Education Fund — received additional funding to provide workers represented by a coalition union with a variety of services, and training and education programs. Joint work on addressing experience barriers, which have sometimes prevented newly trained workers from being hired into KP jobs, is also under way.

The agreement details the structure for coordinating workforce planning and development. A national team aligns, integrates and coordinates workforce development and training efforts in partnership with the regions. Each region has a workforce planning and development committee chaired by labor and management co-leads.

The five key components of this work are:

• workforce planning and development
• career development
• education and training
• redeployment
• retention and recruitment

“The goal is to prepare union workers for changes to jobs,” says LeAnda Russell, the coalition’s national coordinator for job innovation. “We support the lifelong learning and career development of our workers.”

It’s paying off. Use of the educational trusts has increased to record levels.

Russell encourages employees to keep learning to build the job skills needed as health care evolves. In other words — don’t hit the rewind button. It’s time to press play.

“Technology is here,” Russell says. “Don’t be afraid.”

“My union members’ biggest passion is providing good service and high-quality care,” says Nate Bernstein, health care director of UFCW Local 7, which represents about 2,000 of Kaiser Permanente’s Colorado employees. “And we also know the company needs to be sustainable financially.”

But frontline staff can’t do it all on their own. Unit-based teams need leaders who share goals and strategy, helping them connect the dots between quality, service and affordability. 

Knowing the difference such information can make to frontline workers, KP Colorado Health Plan President Roland Lyon provides regular, in-person updates on membership numbers, service scores, financial results and more.

He emphasizes a few key business goals, and he provides a vision: “The best way to deliver affordable care is to deliver high-quality care.” 

Providing that high-quality, affordable care is everyone’s job, at every level. Local, regional and national KP leaders are, for example, revamping purchasing practices and taking advantage of tech innovations to keep a lid on the rising cost of care. In 2016, 4,800 UBT projects reduced expenses by more than $48 million, savings that help keep costs down for members. The sum may seem small in a $65 billion organization, but it speaks to a deeper commitment. 

Leading change

“Workers know where the challenges are,” Bernstein says, “and have led change over the years to improve the patient experience and reduce costs.”

The challenges often directly affect workers. Colorado saw an influx of new members in 2014 and again in 2016. The region still is growing, but a big chunk of the new members left after a year because of changing market dynamics as well as internal service, access and cost issues. 

“The ups and downs of membership growth create strains on our system—and it’s hard on ourteams,” Lyon acknowledges.

Lyon’s updates and other regional communications provide UBTs with information on the types of projects to take on to support Colorado’s strategy. To solve some of the access issues, for example, the region is making greater use of digitally enabled services, some of which were developed by frontline teams and some by leadership.

But success requires the know-how of the teams and, says Lyon, “engaged, enabled and empowered” team members to identify and remove barriers to service, pilot new approaches and help take waste out of the system.

The result is that UBTs in Colorado reduced waste or captured lost revenue to the tune of more than $9 million last year. And they’ve helped the region reduce its expense trend by nearly 1 percent.

But “you can’t cut your way to long-term success,” Lyon tells managers and workers. “You can’t really do more with less. And you can’t do it alone. But we can do more with a little bit more. It’s about providing more access to the best care to more people.” 

I am reminded of the old joke about the holiday ham:

A young bride is preparing her first holiday ham as her adoring husband watches. She slices off one end of the ham and sets it aside and puts the remainder in her roasting pan. “Darling,” her husband asks, “why did you lop off the end of the ham?”

“Why—I don’t know. My mother always did,” she replies. Curious, they call her mother, but her answer echoes her daughter’s: “My mother always did.”  When grandma is called, she has the same answer.

Happily, great-grandma is still on the scene. Her answer to the question is quick: “Why,” great-grandma says, “so it will fit in the pan!”

The obvious point being that sometimes we need to question whether old routines still serve us well. A more subtle point for anyone involved in improving performance is to recognize a workaround for what it is. The more than 3,500 unit-based teams at Kaiser Permanente have daily opportunities to question “the way we’ve always done it.” And as team members become skilled at problem solving and create a culture where asking questions is encouraged, they can create systemic solutions to recurring problems.

In these and other ways, they will create more efficient, cost-effective and safer ways to deliver quality health care. It is essential work, as the cover story of this issue, “Affordable Health Care for All,” makes clear. And the work already is well under way: Every story in the Winter 2013 issue if Hank highlights a different way that teams are improving quality while working to keep Kaiser Permanente affordable.

Kaiser Permanente is the model for the future of health care. Check out this issue's stories and be inspired.