Designing Patient-Centered Pathways at Kaiser Permanente

Mishellene McKinney, MHA, RN, OCN, Vice President of Cancer Care Services at Kaiser Permanente, presented on the ways in which Kaiser Permanente uses Human Center Design (HCD) to inform cancer care delivery and survivorship pathway design, giving a tutorial on HCD, and guidance on how viewers can incorporate HCD elements into oncology pathways design at their institution or facility.

Kaiser Permanente is an integrated care delivery system, meaning that they are both the payer and the provider. They utilize EPIC as their electronic health record (EHR), installed between 2005 and 2010. Their installation of the HER is called “Health Connect,” and is the world’s largest privately funded EHR.

HCD is an evidence-based methodology that put people and their needs at the center of all solutions, with a laser focus on experiences and outcomes. It’s a widely used and growing application, and it’s not just for products. Kaiser Permanente has been using the HCD approach to help create a cancer care strategy and manage change.

HCD at Kaiser Permanente uses a methodology called CoDesign. The CoDesign method utilizes a combination of methods from HCD and performance improvement.

“From HCD, we took journey mapping, rapid prototyping, and brainstorming, storyboarding,” said Ms McKinney, adding, “and then from the performance improvement side, we took things like making sure we’re measuring metrics and matter, building tests of change, and doing things like Plan-Do-Study-Act cycles.” This recipe helps to identify which part of a process matters most to people and how that process fits into their lives.

Patient partners are helping Kaiser Permanente to build their cancer care strategy. In 2019, a group of 51 members from Cancer and Regional Patient Advisory Councils across the US, and 63 physicians and staff held CoDesign sessions led by Kaiser Permanente’s care management institute. These CoDesign sessions gave members and staff a chance to discuss opinions on what they thought the future of cancer care should look like.

Some of the main takeaways from these sessions were first, the strength of an integrated care delivery system, where primary care providers are embedded in the system to help to make sure that prevention, risk reduction, screening, and diagnosis are all managed in the same system, that’s doing treatment, survivorship, and end-of-life care.

The next takeaway was prevention. “Our members told us loud and clear that excellent treatment is good, but not getting cancer is better,” said Ms McKinney.

The next takeaways had to do with guided transitions and lifelong care. Members are guided throughout their diagnosis and treatment journey, and that does not end when treatment is over. “The key components of survivorship care are prevention and detection, surveillance for recurrence or new primaries, interventions for long-term and late effects, and coordination between specialists and primary care,” noted Ms McKinney.

The next portion of Ms Mckinney’s presentation explored the survivorship landscape and The Case for Change. As cancer survivors continue to grow, novel ways to engage and track patients are needed to make sure no patients fall through the cracks.

Population management (protection, detection, and surveillance) was crucial for this design, in order to support members through the long-term and late effects of cancer. Kaiser Permanente aimed to provide anticipatory guidance for patients with cancer who have completed their treatment and ensure that care is coordinated between the oncologist, the primary care provider, and the whole team. For primary care providers, Keiser Permanente aimed to provide an organized outreach, ensuring care continuity for patients.

Kaiser Permanente has moved beyond “just consulting patients,” according to Ms McKinney, who said that patients are “true co-creators” of their pathway designs.

Ms McKinney notes that the first step in starting with HCD in pathway development is the “Understanding Phase,” which seeks to identify what patients’ needs are, and, she adds, “that begins with clearly defining the problem.”

The second phase of getting started with HCD in pathways development is the “Reframing Phase,” where a journey map is created. Journey maps help to clarify what is and isn’t working well, identifying “bright spots” and “pain points” in cancer care.

The third phase is the “Imagine Phase,” where it is important to look at all the possibilities of where the future state of care could be. It’s crucial to bring in diverse perspectives for this phase, preventing biased thinking.  

The final phase is the “Build and Test Phase.” This phase challenges assumptions about new idea through building prototypes that can quickly be tested with patients, field-testing new ideas in order to examine reactions, and gain feedback.

Ms McKinney concluded her presentation by providing a 6-step process for CoDesign that includes: Gathering Expectations, Framing Opportunities, Generating Ideas, Selecting Ideas to Test, Defining Metrics that Matter, and Planning Test of Change.