How Kaiser Permanente 'affordability tool' influences PCPs

Providing patients with feedback about the costs of care is becoming increasingly important, though cultural and logistical challenges abound for doctors in providing patients with this information.

Recognizing the role of Kaiser Permanente primary care providers in directing most of the care costs for the roughly 600,000 patients, officials at Colorado Permanente Medical Group (CPMG) created an affordability tool that measures each provider's expenditures on his or her patient panel, according to an article from Harvard Business Review.

The affordability tool, rolled out to three clinics in the Denver area in 2013, provided each clinician with the following information:

  • A breakdown of his or her patient panel's insurance profile
  • The categories of patient expense (e.g., pharmacy, emergency services)
  • The total annual expenditure per member per month for the panel, with risk adjustment for capitated payments
  • Inpatient, emergency department, and ambulatory surgery utilization and costs
  • Benchmarks comparing individual primary care physicians to regional practices

Individual physician engagement was critical to getting providers to use the tool, wrote Margaret Ferguson, M.D., executive medical director of the CPMG. Thus, PCPs meet monthly with their practice managers to review what the tool reveals about the provider's performance and how they might address potential problems.

A provider whose patients have higher hospital readmission rates than regional practices, for example, might have patients who miss post-discharge follow-up visits or have difficulty accessing appointments, according to the article.

Since launching the tool, CPMG has seen inpatient utilization decrease and use of preferred (cost-efficient) facilities increase, noted Ferguson. In addition, physicians have responded positively to being able to help with patients' financial health.

To learn more:
- read the article