Kaiser Permanente Center for Total Health evolves as healthcare changes

The Kaiser Permanente Center for Total Health opened in Washington, D.C., in 2011, at an important time in healthcare transformation.

Just a year earlier, Congress had passed the Affordable Care Act and Kaiser Permanente had completed the rollout of KP HealthConnect, the 10-year, $4 billion Epic Systems electronic health records project. It’s probably fair to say the jury is still out on both — though some would disagree.

What’s not at issue is that the healthcare landscape is vastly different now than it was five years ago. With this in mind, Kaiser renovated the Center for Total Health in 2015 and has been making incremental changes all along.

“It was created to be a place to talk about health,” said Dr. Ted Eytan, medical director of the Center for Total Health and a practicing family physician. The facility has evolved to be somewhat of an innovation center, though it still is “a place where we stimulate discussions about health,” Eytan said.

What has not changed is the focus on “total health,” a term that comes from Kaiser Permanente founding physician Dr. Sidney Garfield. He believed in promoting physical, mental and social well-being, and Oakland, California-based KP still follows Garfield’s blueprint throughout the entire organization.

MedCity News recently paid a visit to the Center for Total Health, in the shadow of the U.S. Capitol. It’s in the same building as a Kaiser clinic and 24-hour urgent care center. (Kaiser doesn’t have its own hospitals in the Mid-Atlantic region of D.C., Maryland and Virginia.)

After a quiz on a giant, interactive video wall by the entrance to the center, the tour goes though a gauntlet of personas based on the different types of people who use healthcare services at Kaiser Permanente.

Here’s a senior with multiple chronic ailments who takes several medications and uses connected remote monitoring devices.

This blue-collar construction worker is interested in mobile health as well as KP’s childcare benefits, as the video screen illustrates. (The late shipbuilder Henry J. Kaiser was among the first major employers to offer a childcare benefit to employees.)

The center demonstrates many lifestyle-focused services KP offers or promotes in its seven regions nationwide, including farmer’s markets and bike sharing. “Food is a really big deal to Kaiser Permanente,” Eytan said.

There just happens to be a bike-share station in front of the building. The back entrance connects directly to Washington’s Union Station, making the location super convenient for transit riders.

The center also shows off many of the technologies and design innovations Kaiser now employs or is considering, though all new technology must be tested at KP’s Garfield Innovation Center in San Leandro, California, before the organization will buy it, Eytan said.

After arriving a few minutes early, I tried a self-service vitals kiosk that showed I was slightly less overweight than I had thought. My body-mass index had gone down since my last physical exam a year ago, so that was good news.

At the bottom of the kiosk’s results printout was a message to “visit thrive.kp.org for tips for healthy living.”

Eytan explained that said Garfield wanted to follow the ancient Chinese model of medicine, where doctors only got paid when patients got well. To this day, KP remains a combination medical group and health insurer, with financial incentives aligned with clinical incentives.

In other words, it’s exactly where national policy-makers hope to go with value-based care to replace the inefficient fee-for-service model.

“Our business model is really simple,” Eytan said. “People get sick, we lose money.” Some have accused the organization of being cheap, but the model has worked pretty well for KP, its employer customers and its patients since 1945.

KP tries to reduce administrative and capital expenditures by templating its buildings and leveraging its purchasing power to convince vendors to meet its environmental and safety standards, with an eye toward keeping people healthy.

Kaiser teaches its clinicians generic drug names, not brand names. The organization bans pharmaceutical sales reps and does not have sample closets, Eytan said.

“What we do is prescribe the right drug at the right time,” Eytan said.

Each exam room throughout the entire KP organization has a translation phone so clinicians can get a direct line to a language interpreter to serve patients who aren’t proficient in English. KP also is experimenting with video translation services. Of course, the Center for Total Health has an example of both the translation phone and the video link to interpreters.

KP is testing out a new design of ambulatory clinic in Southern California, and the Washington center has a mock-up of that type of exam room.

There are touch-screen displays on the walls, and physicians carry tablets. Patients climb up on adjustable chairs that take up less floor space than traditional exam tables, allowing Kaiser to downsize its square footage and save money.

The check-in area is meant to be less sterile — and demoralizing — than traditional waiting rooms, and clinics feature community spaces aimed at encouraging wellness.

The Kaiser Permanente School of Medicine, scheduled to open in 2019 in Pasadena, California, will teach about the impact of place on health, Eytan said.

Photos: Neil Versel/MedCity News