northwest permanente healthy living program: a lifestyle medicine

Northwest Permanente Healthy

Living Program: A Lifestyle

Medicine Consult Clinic Craig McDougall, MD

Kaiser Permanente

• One of the largest HMOs

• Integrated health care delivery

system

• 9.5 Million members

• 6 Regions

• 17,425 physicians

• 38 hospitals

• 618 medical offices

Kaiser Permanente

Northwest Region

• Oregon and SW Washington

• 504,000 members

• 2 Hospitals

• 27 outpatient offices

• 880 physicians

Executive Medical Director

Senior Operations Team

Board of Directors

Program Manager

Established September 2013

Physician-led Lifestyle Medicine Consult Clinic

Cost to Members

• Monthly Premium for Kaiser health insurance

• Co-pay for seeing a provider

• Everything else included

Intervention • Whole food, plant-based diet. Emphasizing

unprocessed starches (complex carbohydrates) as

the primary source of calories. Avoiding animal

foods, refined oils, refined sugars, and processed

foods.

•We encourage our patients to be active, avoid

smoking, drink alcohol in moderation, get outside for

moderate sunlight exposure, be mindful, and get

restful sleep.

Program Structure

1:1 Visit Group Online

1:1 Visit

• MD visits

• Nursing Visits

Health Living

Workbook

• Recipes

• Goal Setting

• Food label reading

• Calorie density

chart

Group

• Weekly Group Introductory Visit

• 5-15 people per session

• Monthly Group Education

• 50-70 people per class

Online

• Web resources

• Lending library

• Nurse case manager ongoing

support using text, email, phone

• MD phone, email follow up as

needed

• Facebook private group page

Challenges

• Limited MD visits, (Bottleneck)

• 1:1 intro visit for everyone

• Long wait list

• Limited on going case manager support

(Adherence)

NWP Healthy Living Program

• June 2013- December 2013

• 82 patients seen

• 55% actively participating

• 5.6 BMI point drop over 12 months

• 1/2 day office visits, 1 case manager

NWP Healthy Living Program

• January 2014 - December 2014

• 321 Patients seen

• 65% actively participating

• 4.7 BMI points drop over 12 months on average*

• 1 full day office visits, 1 case manager

BMI Cost Savings

• $167 annual cost per BMI point

• 5 BMI point drop over 12 months

• $835 per patient per year savings

• N= 260 ( 65% of 400)

• $217,000 savings per year

Cost Savings

• Medication reductions

• Antihyperglycemics, Anithypertensives,

cholesterol lowering medications

• Health care utilization

• Decrease sick days and productivity

• Decrease cost of caring for DM and CAD per year

• N=44 (Sept 2013- March 2014)

• 75% reduced or discontinued diabetic medications

(n=31)

• Cost savings of $3,340 per month

Diabetes

Hypertension

• N=61 (Sept 2013- March 2014)

• 54% of members decreased or discontinued anti-

hypertensive medications.

• Cost savings of $478 per month

Hyperlipidemia

• N=54 (Sept 2013- March 2014)

• 13% discontinued a statin medication. (n=7)

• Cost savings of $150 per month

Conclusions

• Capitated payment system allows for financial gain

for keeping members healthy which decreases

health care costs

• Combining medical office visits with group education

and online resources provides support and

education for patients

• On going individual support helps with long term

retention and adherence

Contact:

• NWP-HealthyLiving@kp.org

• Clinic phone: 503-590-2256