Access

“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.” 

Brandon Johnson was close to giving up on his dream of becoming an X-ray technician.

Born with sickle cell disease, a genetic blood disorder that primarily affects African-Americans, the 35-year-old Southern California man was forced to drop out of school for semesters at a time.

But thanks to the sickle cell care team at the Inglewood Medical Offices, Johnson is now on medication that reduces complications. Last fall, he was able to complete his studies, and he has started looking for a radiology job.

“They got me on a plan to keep me out of the hospital,” says Johnson, who drives 60 miles one way from his Riverside home to see his doctor in Inglewood, even though other providers are closer. “If I didn’t have my health, I wouldn’t be where I am today.”

Johnson’s success is not uncommon for the Level 5 unit-based team, a group of physicians, managers and employees that provides personalized care for nearly 500 sickle cell patients in Southern California. About 300 of the region’s adult patients are treated directly by the team. Its approach is working—only five of the 300 needed frequent hospitalization and emergency care in the past year.

“Our goal is to keep sickle cell patients out of the hospital by giving them the care they need,” says Pippa Stewart, Inglewood’s department administrator.

Stigmatized as drug addicts

Nationwide, about 70,000 people have sickle cell disease, which can cause chronic anemia, acute pain, infections and stroke. Although most are African-American, the disease also affects people of Indian, Middle Eastern, Hispanic and Mediterranean heritage. Patients often get stigmatized as drug addicts when they ask for narcotics to deal with their pain.

The current UBT grew out of a team that was established in 1999; before that, there was no comprehensive treatment program for KP’s sickle cell patients.

“Ninety percent of patients were getting their primary care in the emergency room,” says Shirley Brown, RN, a UNAC/UHCP member and the team’s care manager. Patients saw as many as 17 doctors as they went from appointment to appointment.

Now, the 12-member UBT—which includes four physicians, two registered nurses, a physician assistant, a pharmacist and a social worker—helps patients control symptoms by offering pain management care, providing resources such as a case manager, and urging them to keep appointments, which help minimize visits to the emergency room and hospital.

Team members coordinate with and help train the KP providers who care for the region’s remaining 200 patients. Last fall, Brown helped lead a session for 70 registered nurses from around the region. Osbourne Blake, MD, an internist and the team’s lead physician, provides regular updates to fellow physicians. “We’re trying to get everyone on the same page,” says Dr. Blake. A recent test of change focused on reducing the number of patients who miss appointments. For three months, Brown and a co-worker called patients every day to remind them about upcoming visits. The calls helped. The team’s “no-show appointment” rate dropped from 20 percent in May 2015 to 14 percent in August 2015.

Dramatic improvement

“They all know you personally,” says Ryan Hull, a 27-year-old TV production assistant and film student. A few short years ago, he suffered frequent crises that required immediate medical attention. After he and his physician co-created a pain management program, his health improved dramatically.

“They did everything they could to find out what regimen works for me,” Hull says of staff members, who greet him by first name and offer walk-in appointments to accommodate his sometimes unpredictable schedule. “They figured out the perfect way to treat me.”

It’s not every day you hear of physicians offering to step in and help out staff in their assigned duties, but at the Primary Care department at Englewood Medical Office in Colorado, that’s exactly what happened.

The nursing staff, short-staffed due to medical leaves, “was overwhelmed,” says Kate Frueh, DO. Messages from patients were piling up in the electronic inbox in KP HealthConnect. Patients who might have been helped by phone or via email were coming in for appointments—making it hard for those who truly needed the in-person appointments to be seen.

“We think we’ve got some of the best nurses in the region,” says Larry Roth, MD. “We just thought, how can we help the nurses and, at the same time, help both ourselves and the patients?”

Physicians dive in

So the team brainstormed ideas, and the physicians offered to help clear the backlog.

“The nursing staff was flabbergasted,” says Linda Sawyer, RN, a member of UFCW Local 7 and the department’s labor co-lead. 

After testing a couple of time blocks and working together, the physicians began setting aside 30 minutes every morning to help triage messages and call patients back directly without getting the nurses involved—and they do it again in the afternoon.

As a result, the team consistently closes encounters within an hour more than 40 percent of the time. With more problems being resolved by phone, appointment slots have opened up and access for patients needing in-person appointments has improved. Morale in the department has improved, too—and the team recently won the Colorado region’s quarterly “Value Compass” award.

Meantime, team members have been working with Linda Focht, their UBT consultant, to boost their Path to Performance ranking—which was only at Level 2 late in 2012, despite functioning at a high level in most dimensions of the Path to Performance.

Common challenges

Focht says some of the challenges that held the team back are common across the program—a department reorganization (including a reduction in staff), new work procedures and gaps in team training. And there were new co-leads who were unfamiliar with the process for assessing team performance.

With some of those issues addressed in the first months of 2013, the team moved up to a Level 3 in the most recent ranking.

“The team members kept their focus on the goal of more streamlined work processes,” says manager Mary Watkins, RN, “and all of the staff of the Primary Care Department are helping each other to become more successful.”

 Watch a video about this team on the KP intranet.