The Kaiser Permanente Community Health Initiative: A Decade of Implementing and Evaluating Community Change

Schwartz, Peter H.; Kelly, Cheryl; Cheadle, Allen; Pulver, Amy; Solomon, Loel

doi:10.1016/j.amepre.2018.02.004

Cited by 14 publications

(13 citation statements)

References 23 publications

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“…2 3 In the USA, the Kaiser Permanente Community Health Initiative saw the establishment of an integrated healthcare delivery system, including both primary and secondary care, for 12 million members. 4 The Odense University Hospital cooperation model in Denmark introduced the colocation of primary and secondary care services, with an on-call GP facility located alongside the accident and emergency department. 5 In England, acute hospitals are run by public organisations known as NHS Trusts and NHS Foundation Trusts (hereafter 'Trusts'), of which there are approximately 150.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Vertical integration of primary care practices with acute hospitals in England and Wales: why, how and so what? Findings from a qualitative, rapid evaluation

2022

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ObjectivesTo understand the rationale, implementation and early impact of vertical integration between primary care medical practices and the organisations running acute hospitals in the National Health Service in England and Wales.Design and settingA qualitative, cross-comparative case study evaluation at two sites in England and one in Wales, consisting of interviews with stakeholders at the sites, alongside observations of strategic meetings and analysis of key documents.ResultsWe interviewed 52 stakeholders across the three sites in the second half of 2019 and observed four meetings from late 2019 to early 2020 (further observation was prevented by the onset of the COVID-19 pandemic). The single most important driver of vertical integration was found to be to maintain primary care local to where patients live and thereby manage demand pressure on acute hospital services, especially emergency care. The opportunities created by maintaining local primary care providers—to develop patient services in primary care settings and better integrate them with secondary care—were exploited to differing degrees across the sites. There were notable differences between sites in operational and management arrangements, and in organisational and clinical integration. Closer organisational integration was attributed to previous good relationships between primary and secondary care locally, and to historical planning and preparation towards integrated working across the local health economy. The net impact of vertical integration on health system costs is argued by local stakeholders to be beneficial.ConclusionsVertical integration is a valuable option when primary care practices are at risk of closing, and may be a route to better integration of patient care. But it is not the only route and vertical integration is not attractive to all primary care physicians. A future evaluation of vertical integration is intended; of patients’ experience and of the impact on secondary care service utilisation.

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Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Vertical integration of primary care practices with acute hospitals in England and Wales: why, how and so what? Findings from a qualitative, rapid evaluation

2022

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“…l The Kaiser Permanente Community Health Initiative is an integrated health-care delivery system that provides care for more than 12 million members in the USA. 45 Odense University Hospital co-operation model between the hospital and general practitioners, including co-location of primary and secondary services (2013-16)…”

Section: South Somerset's Symphony Project (2016 To Present)mentioning

confidence: 99%

“…42,43 The Kaiser Permanente Community Health Initiative integrated health care at all levels to tackle local public health issues, such as reducing obesity in low-income communities. 45 In Denmark, the Odense scheme focused on improving co-ordination between hospital A&E services and GP services. 46 Overall, the rationales we found to be most commonly cited for integrating acute hospitals and primary care services were concerned with expectations, or hopes, of providing better quality and more effective health care, with better patient experiences of care being delivered at lower, or at least no higher, costs to the health-care system as a whole.…”

Section: Rationalementioning

confidence: 99%

“…This focus differs, to some extent, from international examples (e.g. Kaiser Permanente and the Alzira model) 42,45,64 where rationale and implementation were focused principally on closer integration of primary and secondary care to improve quality of care and increase efficiency, with no explicit reference to sustaining primary care in the face of growing recruitment/retention and workload pressures.…”

Section: An Overall Theory Of Change For Vertical Integrationmentioning

confidence: 99%

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Vertical integration of GP practices with acute hospitals in England and Wales: rapid evaluation

Sidhu

Pollard

Sussex

2022

Health Soc Care Deliv Res

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Background Vertical integration refers to merging organisations that operate at different stages along the patient pathway. An organisation running an acute hospital and also operating primary care medical practices (i.e. general medical practitioner practices, also known as ‘general practices’) is an example of vertical integration. Evidence is limited concerning the advantages and disadvantages of different arrangements for implementing vertical integration, their rationale and their impact. Objectives Our aim was to (1) understand the rationale for, and early impact of, vertical integration in the NHS in England and Wales and (2) develop a theory of change for vertical integration. Design We carried out a rapid qualitative cross-comparative case study evaluation at three sites in England (n = 2) and Wales (n = 1), which comprised three work packages: (1) a rapid review of literature, telephone scoping interviews and a stakeholder workshop; (2) interviews with stakeholders across case study sites, alongside observations of strategic meetings and analysis of key documents from the sites; and (3) development of a theory of change for each site and for vertical integration overall. Results We interviewed 52 stakeholders across the three case study sites; however, gaining access to and arranging and completing non-participant observations proved difficult. The single most important driver of vertical integration proved to be the maintenance of primary care local to where patients live. Vertical integration of general practices with organisations running acute hospitals has been adopted in some locations in England and Wales to address the staffing, workload and financial difficulties faced by some general practices. The opportunities created by vertical integration’s successful continuation of primary care, namely to develop patient services in primary care settings and better integrate them with secondary care, were exploited to differing degrees across the three sites. There were notable differences between the sites in organisational and clinical integration. Closer organisational integration was attributed to previous good relationships between primary and secondary care locally, and to historical planning and preparation towards integrated working across the local health economy. The net impact of vertical integration on health system costs is argued by local stakeholders to be beneficial. Limitations Across all three case study sites, the study team was unable to complete the desired number of non-participant observations. The pace of data collection during early interviews and documentary analysis varied. Owing to the circumstances of the COVID-19 pandemic during project write-up, the team was unable to undertake site-specific workshops during data analysis and an overall workshop with policy experts. Conclusions The main impact of vertical integration was to sustain primary medical care delivery to local populations in the face of difficulties with recruiting and retaining staff, and in the context of rising demand for care. This was reported to enable continued patient access to local primary care and associated improvements in the management of patient demand. Future work The patient experience of vertical integration, effectiveness of vertical integration in terms of impact on secondary care service utilisation (e.g. accident and emergency attendances, emergency admissions and length of stay) and patient access (e.g. general practitioner and practice nurse appointments) to primary care requires further evaluation. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 17. See the NIHR Journals Library website for further project information.

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“…Many of the foundations that have a facilitative leadership orientation focus on collaborative problem-solving (Fawcett et al, 2018;Albert et al, 2011;Schwartz, Kelly, Cheadle, Pulver, & Solomon, 2018, Jenkins et al, 2004Anderson et al, 2015;Easterling & McDuffee, 2018). The basic idea is to convene different organizations that are in a position to influence a major community issue that both the foundation and the community regard as crucial.…”

Section: Reflective Practicementioning

confidence: 99%

The Cultivation Approach to Place-Based Philanthropy: Evaluation Findings from the Clinton Foundation’s Community Health Transformation Initiative

Easterling¹,

Gesell²,

McDuffee³

et al. 2019

The Foundation Review

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The Kaiser Permanente Community Health Initiative: A Decade of Implementing and Evaluating Community Change

Cited by 14 publications

References 23 publications

Vertical integration of primary care practices with acute hospitals in England and Wales: why, how and so what? Findings from a qualitative, rapid evaluation

Vertical integration of primary care practices with acute hospitals in England and Wales: why, how and so what? Findings from a qualitative, rapid evaluation

Vertical integration of GP practices with acute hospitals in England and Wales: rapid evaluation

The Cultivation Approach to Place-Based Philanthropy: Evaluation Findings from the Clinton Foundation’s Community Health Transformation Initiative

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