Jenna Li and Autum Tomlin serve in different specialties at opposite ends of the country. Yet each plays a central part in efforts to harness patient data to improve care and eliminate health disparities at Kaiser Permanente.

Li is a chemical dependency counselor with the Mid-Valley Addiction Medicine team in Salem, Oregon. Members of her unit-based team, represented by Alliance-affiliated unions, make standard practice of asking patients about their sexual orientation, gender identity and preferred pronouns.

Tomlin is an urgent care technician at Reston Medical Center in Virginia. She and her team – represented by Alliance- and Coalition-affiliated unions – collect information about patients’ race, ethnicity, and preferred language. She has seen, first-hand, the power of speaking to patients in words they can understand.

“Usually, you can see the patient is at ease and feels a sense of relief that they are able to communicate in their preferred language,” says Tomlin, the team’s labor co-lead and a member of OPEIU Local 2, part of the Coalition of Kaiser Permanente Unions.

Like others across the organization, the Level 5 unit-based teams are seeking to address disparities in health and access to quality care that persist across a range of dimensions – including race, language, gender, and sexual orientation. By asking patients about their backgrounds in a safe, respectful, and compassionate way, the teams are changing how they deliver care and service to members – and relate to one another.

“The effort is minimal, and the effectiveness can be really high when we help a patient feel seen and understood,” says Li, labor co-lead for the Mid-Valley team and a member of OFNHP Local 5017, part of the Alliance of Health Care Unions.

Making members feel welcome

To better understand patients’ health risks and needs, the Mid-Valley team began asking members about their sexual orientation and gender information. They asked the questions during the intake assessment and entered patients’ responses into their electronic health records, making important background information available to all KP providers.

The practice is already changing how the Northwest team delivers care to LGBTQ+ patients.

For instance, Mid-Valley is referring more members to a weekly group therapy session for LGBTQ+ patients to discuss their unique challenges. Misunderstandings about sexual orientation or gender identity are among the obstacles such patients face in accessing effective care. They also are at elevated risk from health threats including alcohol and substance abuse.

Recently, the team hustled to track down a teen-ager in crisis who had fled their clinic’s waiting room. Knowing the teen identified as nonbinary, staff members convinced them to return after expressing sensitivity to their fears and addressing them with their preferred pronouns.

Gestures to support these patients are especially important because they come to treatment reeling from the “double whammy” of stigmatization for their addiction struggles and LGTBQ+ identity.

“We can do a lot to make a member feel welcome by using language they are open to hearing,” says Carri McCrary, Mid-Valley clinical services manager and the team’s management co-lead.

At the Spine Center of Excellence in the Northwest market, team members strive to connect patients to treatment as quickly as possible.

But the Level 5 team struggled when it came to providing timely access to care for Medicaid members.

Before receiving treatment, Medicaid members must undergo a state-mandated pain evaluation administered by the team’s registered nurses. The nurses’ workload, however, meant patients sometimes waited as long as 37 days to be evaluated.

To improve access to care, everyone on the team began screening Medicaid members. In 4 months, they reduced wait times from referral to consultation by 35%.

“When you’re dealing with acute or chronic pain, quicker access to treatment means happier patients,” says Kali Dailey, RN, an OFNHP Local 5017 member and the team’s labor co-lead.

Coordinating spine care

The Spine Center, based at the Sunnybrook Medical Office in Clackamas, Oregon, is part of Kaiser Permanente’s coordinated approach to spine care. Across markets, spine centers help members with neck and back pain find the right treatment programs or surgeries in an expedited way.

In the Northwest, Spine Center staff are represented by the Alliance of Health Care Unions and the Coalition of Kaiser Permanente Unions. They gather information through questionnaire calls and follow an evidence-based treatment plan for members based on their responses.

Previously, only registered nurses were responsible for completing the questionnaires. They did so during the intake call they conduct with all members to consider which treatments – including injections and surgery – are appropriate.

But the nurses’ workload meant there was a lag time between referral and intake call. Before the team overhauled its evaluation procedures, the wait time averaged more than 37 days.

For members experiencing acute or chronic pain, that’s a long time to wait for a first intervention.

“Some of these patients were feeling like they had been forgotten,” says Jodi Lippmann, the team’s licensed practical nurse and a member of SEIU Local 49.

Fast tracking patients

To connect Medicaid members to care faster, the team obtained permission from Northwest practice leaders to allow its licensed practical nurse and medical assistant to complete the questionnaires.

The team’s new “fast track” system for Medicaid members meant wait times decreased by 35% -- from 37 days to 24 days – from March through June 2021.  This far exceeded the team’s original goal to reduce the wait time to 32 days.

The revamped approach continues to pay dividends – with wait times for all Spine Center referrals continuing to drop. Market leaders have taken notice, too. They recognized the team for improving service access, holding it up as a model for others to follow.  

“Everyone on our team came together on this project,” says Sophia Le, the team’s management co-lead. “The result is better service to our patients.”