Quality Improvement and Population Health

Quality Improvement and Population Health

Supporting our community-based safety net partners is a major stream of work that we are engaged in every day.

Certainly part of our efforts are through our grants and investments, but the more engaging work comes by expanding those partnerships and deepening our commitment by sharing our quality improvement and chronic disease management strategies. For example, our life-saving cardiovascular care programs are being implemented in safety net clinics across the country. To date, over 124,000 safety net patients have been touched by Kaiser Permanente created evidence-based clinical protocol.

We also learn from the best practices developed in safety net settings. By looking outside of our own organization, we learn about strategies communities around us are creating to address their own needs, beyond medical care, to improve the health of their communities. This includes learning strategies for engaging hard-to-reach populations, including lessons in providing care to non-English speaking patients and pro-actively connecting patients to social and financial support that impact the management of their clinical conditions.


People with diabetes or heart disease are 2-4 times more likely to have a heart attack or stroke. And about 65% of those individuals will die of these events.

Imagine the benefits if we could prevent heart attacks or strokes.

Since 2006, Kaiser Permanente’s “ALL” initiative (also referred to as “PHASE” or Preventing Heart Attacks and Strokes Everyday) has been targeting patients most prone to cardiovascular death and achieving remarkable results. This simple bundle of low-cost medications, combined with a beta-blocker and healthy lifestyle, reduces heart attacks and strokes by 50 to 60 percent for at-risk populations, like people with diabetes. “ALL” originally was an acronym referencing the triad of Aspirin, Lisinopril, and Lovastatin, which has been the pharmacologic core of effective cardiovascular risk reduction. But to our members and those we serve in our communities, ALL represents a clinically proven treatment in protecting them against a heart attack or stroke. Taking ALL the right medications ALL the time for ALL people – regardless or race or gender – is saving lives.

Since launching the program in 2005 with community clinics, public hospitals and health systems, over 124,000 patients have been served in over 153 safety net settings across the country. Kaiser Permanente provides guidance to health care workers throughout the implementation of ALL/PHASE and opportunities to study Kaiser Permanente practices on-site.

In 2010, The Care Continuum Alliance honored Kaiser Permanente’s ALL/PHASE initiative with the Quality Impact Award for the “Greatest Impact on Health.”

Health Equity

Equity is a core principle of a high quality health care system. Kaiser Permanente is committed to health and health care equity regardless of race, ethnicity, national origin, gender, socioeconomic status, disability status, and sexual orientation/identity.

By providing equitable care to our members and by targeting resources in areas of need, we are moving the needle in eliminating disparities in health status and health care delivery to the communities we serve.As part of Kaiser Permanente’s ongoing commitment to eliminate health care disparities, the organization is invested in improving gaps in Hypertension control between African-American and White members and reducing the colorectal cancer screening gap between Hispanic members and White members. Engaging communities to design new outreach opportunities, Kaiser Permanente is committed to becoming the “Best in the Nation” for colorectal cancer screening for all populations.

We are also proud to partner with organizations who address the complexities of health disparities, and who represent the diversity of backgrounds needed to tackle these issues. Our collaboration with the National Council of Behavioral Health has enabled a group of leading edge safety net providers to launch new programs to account for psycho-social trauma which hinder optimal outcomes for individuals dealing with common chronic diseases in the primary care setting.