At athenahealth,
we know your ambulatory practice wants healthier,
a healthier business, healthier care teams, and healthier
patients.
But the complexities of modern health care tech
make it hard for you and your care
teams to focus on what matters most.
That's where athenahealth can help.
Our AI native all in one solutions reduce
administrative burdens,
streamline billing and payments, and deliver critical insights
when clinicians need it most.
That means fewer clicks, more time for patients,
and stronger bottom lines. Practicing medicine is complex,
but running a practice can be that much
simpler with athenahealth.
See how simpler is healthier@athenahealth.com.
Hello, everyone. This is Scott King with the
Becker's Healthcare podcast.
I'm thrilled today to be joined by a
very special guest in doctor Nolan Cheng, executive
vice president corporate development strategy and finance with
the Permanente Federation. Doctor Cheng, how are you
doing today? I'm great. How are you today,
Scott? I'm good. You know, it's actually kind
of a nice sunny day in Chicago. We've
had some good luck with, weather the last
few weeks here. But, yeah, excited it's Friday
as we record to get to the weekend.
And that's interesting that it's sunny in Chicago,
but it it's overcast and a little bit
drizzly out here in Southern California.
It's quite the opposite of what you would
think on any given day. I definitely agree
with that. Exactly.
Maybe it'll switch up soon. But as we
wait for the weather to get good for
everyone, there is a lot going on in
health care, doctor Cheng. So we have a
lot to get to. I I really wanna
get your opinion on some of the kind
of the big topics and trends in health
care. But before we get started, can you
please just tell us a little about yourself
and your work in health care? Yeah. Thank
you, Scott, and thank you for having me.
So by training, I'm a family medicine physician.
But like Scott said, I get to serve
as the executive vice president in the Permanente
Federation. It's the national arm of all the
Permanente medical groups in Kaiser Permanente.
And in that role, I have a broad
set of responsibilities, including strategy, corporate development,
finance, a lot of the business functions.
And I really pursued this role because I
think affordability
is going to be, if not the biggest,
one of the biggest challenges of our generation
of health care
professionals. And so it's something that I wanted
to be able to jump into to make
a difference and really improve care that we
deliver across the country for our patients.
That's fantastic. And doctor Chiang, I think we
were talking before, and I think you said
you came into this role during the pandemic.
Is that correct? Yeah. Maybe a few months,
in this specific role, few months before the
pandemic hit. And and jeez, it became a
storm pretty quickly. I remember asking my colleagues
that were in their roles longer. It's like,
this is this normal? And they said, absolutely
not. And since that day of five years
before,
I'm just wondering when it's gonna get back
to normal.
Right. Right. And and, you know, you can
argue that it didn't. It didn't get back
to normal, and the things are are much
different now. How
how interesting was that time for you to
kinda take on way more than you probably
bargained for? And do you do you think
that's kinda set you up to to deal,
kinda troubleshoot things and come up with solutions
maybe quicker than you would have?
Yeah. For sure. It it definitely, the role
is different, especially early on than when I
expected it to be. For me, the focus
in coming to this role was how do
I translate finances
into ways that are meaningful for physicians? Because
for physicians, we go we spend many, many
years, decades, if not, training how to be
the best clinicians.
But if we're trying to solve affordability, how
do we see that not as a negative,
but as a positive? Because we've taken this
oath as physicians to be able to take
care of our patients. And if one of
their big pain points is affordability, how do
we recognize that as a barrier to the
care that we can deliver?
So but taking a step back then
when the pandemic hit, it was more thrust
into how do we mobilize around a patient,
keeping the patient and the needs at the
center in a very resource limited environment as
we know whether it be protective equipment,
ventilators, all these devices.
If all of a sudden this hospital census,
inpatient census went up dramatically, were we gonna
have the beds,
the the technological platforms to be able to
take care of them? It was a scramble
in a limited resource kind of world. But
in many ways, I think that
it really helped prepare me for where we
are today.
We still have to provide those business functions,
but how do we translate what we're seeing
into financial performance? Because it really isn't the
finances that drive the strategy of the organization.
It should be the other way around. What's
your strategy? What's the current environment? And how
do the financial outcomes determine whether or not
we're being successful? In the midst of the
pandemic, it was a raging fire. I think
most people in health care right now say
that the fire hasn't died down and maybe
a little bit more smoldering.
But there is a lot of uncertainty now,
and it continues to be resource limited.
So how are we solving for these things?
How are we adapting our systems as an
organization
to be able to empower
our clinicians, our physicians, our health care teams
to be able to take care of our
patients who are in their
own experiences and in their own world in
a very tumultuous period of time.
Absolutely. And and, doctor Chang, I think, you
know, something that that had really kinda hit
hit its stride
or started to at least, and now it's
kinda in full force
for now is is AI. And, you know,
health systems use
AI. They have so many uses for it.
We we're seeing, you know, under other industries
obviously use AI. But, you know, it's reported
that nearly half of medical practices reported using
AI in some capacity in the last year.
It remains a key topic for health IT
leaders. From your perspective, what are the use
cases that are now making a difference, and
how are you leveraging them in your organization?
It's a it's a fantastic question, and it's
one I think that's oftentimes pivotal for organizations.
Because when we talk about artificial intelligence,
it's technology which should be part of your
solution. It shouldn't replace your strategy. Technology, in
my mind, is not the strategy. It's how
do you apply technology to your strategy. And
we started this conversation talking about the pandemic,
and it was great. And Kaiser Permanente that
we already had a significant amount of investment
in the infrastructure.
So during the pandemic, we went from maybe
90% in person
and 10% virtual to flipping that to almost
98% virtual and 2% inpatient.
And luckily, we had a lot of the
technologies in place. And so the ability to
text patients to let them know that we're
ready because during that period of time, remember,
people weren't willing to come in the building.
And so we'd have people wait in the
parking lots in their cars and be able
to predict wait times and text them to
let them know, yeah, now it's safe to
come in and be seen.
Having the technological
platforms to be able to do deal visits,
to be able to make sure that we're
able to connect with patients because our organization,
we're not just value based care. I like
to say we're longitudinal value based care. To
see me as a permanent day physician, you
have to have KP insurance.
So our patients stay in the system for
a lot longer. So that way, we're able
to deliver on outcomes
and drive quality and affordability through that. And
so what I oftentimes mean by that, if
if a patient's switching helplines every two to
three years,
it leads to more fragmented care. But if
you stay in the system for seventeen years
or more, then you really can't understand the
return on things like investing,
in treating hypertension
or a vaccine or preventative screening. And so
that really aligns my interest with those of
the patients. And why I say that is
because that really highlights how we
apply technology.
So during the pandemic, being able to see
somebody
through a video visit
was really powerful to see the fears that
they have in their eyes and the frustrations
that they're experiencing allowed me to address their
clinical need, but also the needs that they
may not be aware of. But then you
fast forward it to what we're doing today.
So I say we're longitudinal value based care,
but we are a relationship based organization, primarily
that relationship between a physician and the care
team and a patient,
but even between
us and our regulators,
us and our payers. So we've applied technology
over the past couple of years to be
able to augment that. I mean, one of
the big things that that we've really highlighted
out there is our ambient AI technology.
So we know that there's pain points. There
are problems that our physicians are asking us
to solve in regards to burnout and not
having that connection with the patients. But we
also hear that from our patients.
We ask them about the experience. Like, how
was your time with your physician?
It was frustrating for me to hear that
sometimes my patients would say, doc,
you're spending more time on the computer than
you are with me. And that's heartbreaking. Right?
Because everything I'm putting into that computer really
is to take care of that a patient.
But using
ambient AI dictation systems
allow me to sit need in a face
to face with my patient and have a
really
connected conversation
where I'm not worried about the time of
the day. Am I gonna be able to
capture everything by by keystrokes?
Allowing the technology
to do that for me, not only improve
the documentation,
but also improve the experience with our patients
so that they have more confidence, more understanding
what we're trying to do.
On the front end of a lot of
these things, something that we're really excited about
is we were able to come up with
something called the KP intelligent navigator or the
Kaiser Permanente intelligent
navigator.
When I first started practicing
over twenty years ago, the predominant interaction with
face to face visit. But through some of
the technology that I just mentioned, there's so
many different tools that we have available now
to be able to meet our patients' needs,
whether it be face to face visits, mid
visits, telephone, email, chat, you name it. This
can be overwhelming for our patients because most
of them are not medically trained.
So when they interact with us, whether it
be through our portal or one of our
call center agents,
they just tell us what's going on with
them. But how do we connect them with
the right resource? Because they don't know if
this is something they need to go to
the ER for or if this is something
that can just do an EVA zip for.
Right? But using large language models, we were
able
to leverage the experience of our physicians in
getting our patients to the right resource. And
so we've been excited because for our 4,900,000
members in Southern California, we've deployed this technology,
and it's able to get the patient to
the right place at the right time with
almost a 98%
accuracy and also also almost a 9% increase
in patient satisfaction
when we look at these things. And it's
caught some pretty scary things
for patients that are
really interacting the portal virtually and just typing
things in. We've been able to catch things,
minding the patient's chart and saying this patient's
at high risk for a cardiac event. We
need to get them to the ER. And
so there's been really some wonderful things that
have come out in how we're applying artificial
intelligence really to augment the relationship,
let our patients know that we know them
even at the point of booking,
leveraging all their past data, what the words
that they're using to be able to make
sure that they're able to navigate the system
in a seamless fashion. Because we don't want
our patients spending their discretionary energy trying to
figure out where do I need to go.
We wanna connect them, make sure that we're
able to address the concerns that they have.
Yeah. I think that's great. A lot of
times when we talk with system leaders, you
know, their focus
in utilizing AI is kinda just system wide
for efficiency. So it's I I think it's
wonderful to hear how patient
focused, yours has been. And
as virtual
care expands from AI enabled tools and remote
monitoring to to broader digital health platforms, introducing
new technology
brings challenges. So what advice do you have
for leaders trying to navigate
everything from governance
to patient engagement? And can you share an
example of how your organization has balanced innovation
with operational constraints?
Yeah, Scott. That's wonderful question because I think
you articulated a lot of the challenges. Right?
So as you bring on all these different
address pain points, one of the things uniquely
for us is, you know, Kaiser Permanente, we're
an integrated system. So we have the health
plan. We have a hospital system and delivery
system and the physician groups. We're able to
look at that and say, how do we
integrate this into a unique patient experience?
Because it's not the technology
and the people and the facilities
and the experience that are separate. Right? All
these elements have to come together if done
well to create a cohesive
experience.
Because in as you bring in different technologies,
as we adopt change, everybody knows the hype
curve. There's a point where it gets more
complicated as you add more on and before
it becomes seamless,
And the patients can get lost in that.
So for us as an organization, we always
try to take a step back and say,
what's the problem that we're trying to solve?
And then go from there. And then what's
the role of each of the elements of
the solution, the facilities, the people, the space,
staff, the stuff, the technology,
and then we try to bring it together
cohesively.
The governance is critically important because we have
the technology arms in the organization, the clinical
arms, the health plan,
and you called out, like, if it's focusing
on efficiency or revenue or outcomes, it really
does dictate a different solution, but we try
to balance that. So
the seven principles that we really focus on
are transparency,
accountability,
safety,
equity, quality, privacy,
and clinician oversight, and we try to balance
that. So even right before this, I was
on our AI council. We're looking at some
different technologies and saying, how do we apply
this? And everybody got to give their perspective,
be able to find what's the right solution.
So I talked about the ambient dictation. There's
a quality element to that.
And so how long do you hold hold
these things? How do we check things? Because
as you introduce new technologies,
it oftentimes isn't a replacement. Hopefully, it's an
augmentation.
But if you're not thoughtful about how this
impacts cost, affordability,
quality, experience,
then it can go sideways pretty quickly. We
also leverage our patient advisory councils where we
ask our patients to give us input really
early on and say, help us understand what
you think about this. How would this be
received well or not? And also our care
teams as a whole. And so those are
some governance and operational principles.
But it oftentimes will come down to change
management.
Technology and we oftentimes when we talk about
artificial intelligence, we'd like to say that it's
augmented intelligence.
Because if you don't frame it right, it
can be something that's quite fearful.
You and I were talking earlier about, you
know, what what's the health care environment like?
And I said, when are things gonna get
back to normal? The people that are taking
care of our patients on the frontline are
feeling that same angst. I mean, we still
hear hear about burnout and a lot of
fear and anxiety.
And so you introduce more change that does
it heighten the fear and anxiety, or does
it leave it? If applied right, if they
know that we're trying to solve their pain
points, then hopefully should leave it, but also
get them allow them to be engaged. So
that's why we we shift oftentimes from saying
artificial intelligence, which can be sound scary, to
augmented intelligence because we wanna be able to
augment our people. But then we have to
be able to connect with them and understand
how much discretionary energy. If they're solving for
some other clinical implementation,
a quality program that we're trying to put
in place, do they have the discretionary energy
to implement something around technology?
Do they understand the long game? Because in
that high curve, there's a period where it's
gonna be inefficient before it gets efficient. And
we have to bring them along in that
journey, help paint that picture so they understand
the impact to them them. So
while it's about technology,
there's also a lot of elements about basic
management
at the individual team and also at the
organizational level.
Yeah. You know, you just had basically a
lot of great thoughts and advice on dealing
with emerging
tech just there. But if you had to
kinda zero in on your number one
piece of advice for health care leaders as
they prepare for further advancements in technology and
rising demands for care, what would that be?
Yeah.
I mean, I think there's so many different
things, but one of the things that's being
trained as clinician, one of the things that
we would learn in our training is when
you're running to a code, the first pulse
you check is your own. Right? So I
think it's important to know where we're at
individually as leaders as as an organization.
If we don't acknowledge the fear or anxiety
or the overwhelming challenges that we're facing, I
think we can be dazzled by the shining
new piece of technology
and just go down that road and lose
sight of what we're really trying to accomplish.
So are we using technology to solve for
the fears and anxieties that we have in
an increasing
volatile marketplace,
or is it really aligned around
the pain points
of applying our our organizational strategies and solving
for that because the marketplace is looking for
value. Right? We hear about the struggles in
decreasing rates. People want a better experience. They
don't understand why the cost is going up
and why they can't get in to see
somebody or get a medication or just get
an issue met. So I think the big
keys piece is really understanding
where we're at and the problems that we're
trying to solve and then applying the technology
because you don't want the technology leading. Because
as you go out there and meet with
all these great companies,
they oftentimes will have solutions looking for problems
versus understanding the problem and applying a solution.
So definitely understanding what we're trying to solve
and and how it moves the organization forward
is probably the key thing that I try
to keep central as we look at these
different solutions.
I think it's a a great number one
piece of advice for for dealing with for
further advancements in technology. And, doctor Chang, the
last thing I want to ask you that
we ask a lot of leaders on the
podcast is, how are you evolving as a
leader?
Yeah. That's a fantastic question.
Different
times require different leadership
skill sets, and,
we talked about before the pandemic, a lot
of it was you know, the solution hadn't
really changed over many years.
If we grew a 100,000 members, we knew
how many hospitals or examiners we need. A
lot of it was around efficiency.
There weren't a whole lot of disruptions that
came about, but the pandemic, if anything, was
an absolutely great accelerator.
Today is very, very different than it was
five years ago. So for me, evolving as
a leader is really not focusing or balancing.
We always are gonna need efficiencies,
but understanding how we focus on transformation.
And so it's really more about connecting with
the hearts and minds of people and storytelling
and bringing them along on the journey because
we will
go we will go much further together. I
think during these periods of uncertainty, it's easy
to splinter or divide as an organization,
divide as a team, and that's not going
to really help us accomplish our mission. In
Permanente Medicine, we are a large group,
practice with a social mission. I mean, people
join us for that mission. And so if
we stay true to that, I'm confident we
will be able to really augment the value.
Because I think during this period of time,
people need that that belief and that mission
and trust in that vision. So for me
as a leader really is how are we
engaging? How are we telling stories? How are
we listening is probably the most important element.
So I'm applying my time is critically important.
Having conversations like this and getting the message
out there and highlighting the opportunities is one
of the ways I look to do that.
And so it's not necessarily solving as many
problems as broadening the conversation for me.
Well, doctor Shane, thanks so much for joining
us on the podcast. I thought this was
a great conversation, very informative, and and looking
forward to working with you again soon. Likewise,
Scott. Thank you so much for having me.
I look forward to our future discussions.
Absolutely.
At athena Health, we know your ambulatory practice
wants healthier,
a healthier business, healthier care teams, and healthier
patients.
But the complexities of modern healthcare tech make
it hard for you and your care teams
to focus on what matters most.
That's where athenahealth can help. Our AI native
all in one solutions reduce administrative burdens,
streamline billing and payments, and deliver critical insights
when clinicians need it most. That means fewer
clicks, more time for patients, and stronger bottom
lines.
Practicing medicine is complex, but running a practice
can be that much simpler with athenahealth.
See how simpler is healthier at athenahealth.com.