Population care in the form of cookie cutter medicine will not work, says Jim Bellows, Ph.D., senior director of evaluation and analytics for Kaiser Permanente. Instead, care has to be dispensed “one member at a time,” the philosophy behind total panel ownership—physicians’ transition from being accountable solely for patients presented daily, to being accountable for all patients in their panel, which could be as many as 2,000.
Population care is one of our key levers in achieving total health. We sometimes summarize this aspiration as “population care, one member at a time,” representing the duality of it. We want to provide care that’s consistent and reliable and delivered to all populations at a wholesale scale and done efficiently. And yet, we know that it’s not going to work for our members if it feels like cookie cutter medicine. Or if they feel like they’re just being subjected to a machine. It’s about tailoring a consistent population approach with a personalized version.
The journey for us really started about ten years ago with a new philosophy that at the time we called total panel ownership. That’s when our physicians experienced the transition of being accountable for patients who presented for care on a particular day in their clinic setting to being accountable for all the patients in their panel; there could be about 2,000 patients in their panel. That means that every working day there is a responsibility not just for the 24 people who show up for whatever their combination of back pain and other things are, but for the other 1,976 patients who didn’t show up that day: what are their needs and how can we help support those needs, even when they’re not in the clinic?
And you can see the challenges that brings, which is that changing the focus and the accountability from the 24 patients who showed up today to the 2,000 patients who are out there is a daunting shift for primary care physicians and for everyone in the system. If our only tool for accomplishing that was in the primary care visit, it would be completely unsustainable. Don Berwick, the former administrator of Centers for Medicare and Medicaid Services (CMS), has told us so on many occasions, but that’s the emphasis of the systems approach. That’s a challenge. It’s all the populations but one member at a time, and how to do it one member at a time without burning everybody out.
How do we get there? The answer, of course, is partly in teamwork. We’re blessed not only with a great group of physicians, but with a strong partnership between labor and management in Kaiser Permanente and strong relationships between our physicians and nurses and support staff. It’s a lot of team-based care, but it’s also about embedding that team in the system that can support the physician and the patient, and especially the relationships among them.
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