Successful Kaiser Permanente Opioid Management Leverages Physician Leadership, Customized EMR, and Prevention

Results of How the Nation’s Largest Integrated Health Care System Successfully Reduced Opioid Use Presented at the 2018 World Health Care Congress

Washington, DC – In remarks at the 2018 World Health Care Congress this week, Imelda Dacones, MD, president and CEO of Northwest Permanente, shared how a customized electronic medical record, physician leadership, and a system-wide approach to prevention and rescue led to significant decreases in high-dose opioid prescriptions, among other improvements. Her remarks at the Washington, DC, international meeting were made as part of an expert keynote panel on the opioid crisis.

The Permanente Medical Groups, which provide care to 12.2 million Kaiser Permanente members, reduced high-dose opioid prescriptions of 90 morphine milligram equivalent or more across all regions, between December 2014 and February 2017. Components of their approach are reported in a study in the Journal of Evaluation in Clinical Practice.

“One of the reasons the program is so successful is because the Permanente Medical Groups are empowered, both as independent physician-led companies and as ‘owners’ to customize the EMR to make it work for them. Surgeons and physicians program prescription options and other order entries, create best practice alerts, automate decision-making tools and include links to guidelines and other resources,” said Dr. Dacones. “We also have great multidisciplinary teams of pharmacists, nurses, and behavioral therapists who help support the physicians and patients.”

The concept is based on a four-pronged approach that includes patient education, physician education and support, a focus on patient safety, and community protection. Within Kaiser Permanente’s integrated system, the entire care team works together under one roof, including mental health professionals, behaviorists, social workers, nurses, pharmacists, and community resource locators.

The program also includes interventions through the emergency departments (EDs) where many opioid prescriptions are written or renewed. Dr. Dacones explained, “Within our EDs at Northwest Permanente, we have the lowest rate of prescriptions for narcotics in the state. We make doing the right thing easier to do by setting up the EMR preference list, which requires simple, technical changes, and engaging and educating our physicians.”

Dr. Dacones also discussed the organization’s emphasis on preventive care. “We aim to avoid the ‘rescue phase’ when the patient is opioid dependent, and focus on preventive care. An example of a preventive approach would be limiting the number of opioids prescribed post-surgery to avoid the potential of the patient ever becoming dependent.”

Kaiser Permanente also considers the social determinants of health, such as adverse childhood events, that can affect a person’s likelihood to abuse substances or need additional social support. Using predictive analytics, the organization can also anticipate which patients are more likely to become addicted to opioids or return to the emergency department.

“At the end of the day we are doing what is right for the patient and managing their pain more appropriately,” concluded Dr. Dacones.

About the Permanente Medical Groups

The Permanente Medical Groups are composed of more than 22,000 physicians dedicated to the mission of improving the health of our patients and the communities in which we provide care. We practice in eight self-governed, physician-led, prepaid, multi-specialty medical groups that work with the Kaiser Foundation Health Plans and Kaiser Foundation Hospitals to provide care for more than 12.2 million Kaiser Permanente members. We work collaboratively, enabled by state-of-the-art facilities and technology, to provide preventive and world-class complex care in eight states – from Hawaii to Maryland – and the District of Columbia.

About The Permanente Federation

In 1997, the Permanente Medical Groups formed The Permanente Federation LLC to represent their shared interests. The Federation serves as the key partner on behalf of the medical groups with Kaiser Foundation Health Plan and Kaiser Foundation Hospitals on national initiatives.