1 00:00:00,000 --> 00:00:02,740 Evernorth brings the power of wonder and relentless 2 00:00:02,799 --> 00:00:05,599 innovation to create world class pharmacy, care, and 3 00:00:05,599 --> 00:00:06,580 benefit solutions. 4 00:00:07,200 --> 00:00:08,960 Barriers to care can lead to gaps in 5 00:00:08,960 --> 00:00:10,719 care, which can drive up the total cost 6 00:00:10,719 --> 00:00:13,839 of care. Our capabilities work seamlessly together to 7 00:00:13,839 --> 00:00:17,245 create innovative pharmacy care and benefit solutions for 8 00:00:17,245 --> 00:00:18,225 today and tomorrow. 9 00:00:18,765 --> 00:00:21,565 Our connected health services make the treatment, prediction, 10 00:00:21,565 --> 00:00:24,225 and prevention of health care's most complex conditions 11 00:00:24,685 --> 00:00:27,265 easier and more accessible as we drive organizations 12 00:00:27,484 --> 00:00:28,464 and people forward. 13 00:00:29,050 --> 00:00:31,230 Hello, and welcome to the Becker's Healthcare podcast. 14 00:00:31,289 --> 00:00:33,770 My name is Chanel Banger recording live at 15 00:00:33,770 --> 00:00:34,409 the Becker's 16 00:00:36,969 --> 00:00:38,909 and sitting down with Lawrence Hamilton, 17 00:00:39,289 --> 00:00:42,009 the executive vice president at the Permanente Medical 18 00:00:42,009 --> 00:00:43,835 Group. Lawrence, thank you so much for joining 19 00:00:43,835 --> 00:00:45,594 me today. It's my pleasure. Good good to 20 00:00:45,594 --> 00:00:47,034 be with you. Perfect. Well, to get us 21 00:00:47,034 --> 00:00:49,034 started out, can you please introduce yourself and 22 00:00:49,034 --> 00:00:50,494 share a bit about your organization? 23 00:00:51,274 --> 00:00:53,835 Sure. So the Permanente Medical Group is part 24 00:00:53,835 --> 00:00:54,895 of Kaiser Permanente. 25 00:00:56,155 --> 00:00:57,695 We care for in 26 00:00:58,210 --> 00:01:00,770 the Permanente Medical Group, we care for 4,600,000 27 00:01:00,770 --> 00:01:02,229 members in Northern California, 28 00:01:02,850 --> 00:01:05,250 and we do that through 55,000 29 00:01:05,250 --> 00:01:07,349 colleagues, including 10,000 physicians 30 00:01:08,049 --> 00:01:09,349 across 21 hospitals. 31 00:01:10,129 --> 00:01:12,209 Perfect. And moving forward into the meat of 32 00:01:12,209 --> 00:01:13,430 the podcast a bit, 33 00:01:13,734 --> 00:01:16,375 balancing affordability and quality is a constant challenge 34 00:01:16,375 --> 00:01:19,034 for health plans. How is your organization innovating 35 00:01:19,094 --> 00:01:21,094 to manage the cost of care while maintaining 36 00:01:21,094 --> 00:01:22,715 or improving member outcomes? 37 00:01:23,414 --> 00:01:25,194 I actually think the framing of, 38 00:01:25,575 --> 00:01:26,554 tension between 39 00:01:27,420 --> 00:01:29,920 quality and affordability is a symptom of, 40 00:01:31,500 --> 00:01:33,900 the relate when the relationship between payers and 41 00:01:33,900 --> 00:01:35,520 the delivery system is 42 00:01:36,219 --> 00:01:37,600 contractual and transactional, 43 00:01:38,060 --> 00:01:39,900 it tends to reduce very quickly to, 44 00:01:40,855 --> 00:01:42,534 we want you to do more in this 45 00:01:42,534 --> 00:01:43,995 area that will improve quality, 46 00:01:44,534 --> 00:01:46,454 and the delivery system says this is what 47 00:01:46,454 --> 00:01:47,974 it will cost, and you get into this 48 00:01:47,974 --> 00:01:50,474 spiral of who's gonna pay for what. 49 00:01:51,655 --> 00:01:54,215 I think a much more advantageous way to 50 00:01:54,454 --> 00:01:57,189 is to seek alignment between payers and the 51 00:01:57,189 --> 00:01:59,850 delivery system so that together, you're 52 00:02:00,549 --> 00:02:02,390 all focused on how do we provide the 53 00:02:02,390 --> 00:02:03,609 best quality, 54 00:02:04,390 --> 00:02:04,890 equity, 55 00:02:05,189 --> 00:02:05,689 access, 56 00:02:06,230 --> 00:02:07,049 care experience, 57 00:02:07,510 --> 00:02:09,370 and provider and clinician 58 00:02:10,205 --> 00:02:10,705 satisfaction 59 00:02:11,084 --> 00:02:13,324 at the lowest possible cost for the communities 60 00:02:13,324 --> 00:02:14,224 that we serve. 61 00:02:14,764 --> 00:02:16,044 When you frame it that way and you've 62 00:02:16,044 --> 00:02:16,784 got genuine 63 00:02:17,164 --> 00:02:20,204 alignment and you've got hospital systems and medical 64 00:02:20,204 --> 00:02:21,344 groups that are 65 00:02:22,044 --> 00:02:24,064 see success as population health, 66 00:02:24,685 --> 00:02:25,860 then the trade off 67 00:02:26,340 --> 00:02:28,900 reframes dramatically where we know that when you 68 00:02:28,900 --> 00:02:31,080 provide great preventive care, that's 69 00:02:31,460 --> 00:02:33,699 best for the patients, and it also avoids 70 00:02:33,699 --> 00:02:35,400 downstream costs of more hospitalizations. 71 00:02:36,580 --> 00:02:38,180 When you avoid a patient having to say 72 00:02:38,180 --> 00:02:40,259 to the emergency room because of care that 73 00:02:40,259 --> 00:02:41,080 you've done upstream, 74 00:02:41,965 --> 00:02:43,824 better for the patients and avoids, 75 00:02:44,604 --> 00:02:46,625 the most costly parts of the health system. 76 00:02:47,085 --> 00:02:48,865 So when we've got genuine alignment, 77 00:02:49,165 --> 00:02:49,985 we're aligning, 78 00:02:50,525 --> 00:02:51,585 quality and affordability 79 00:02:52,044 --> 00:02:54,365 much more often than they're at a trade 80 00:02:54,365 --> 00:02:55,585 off of one another. 81 00:02:56,229 --> 00:02:59,129 Absolutely. And now kinda switching gears a bit, 82 00:02:59,349 --> 00:03:01,750 addressing health equity has become a critical focus 83 00:03:01,750 --> 00:03:03,909 for many health plans. Can you share an 84 00:03:03,909 --> 00:03:06,409 overview of a key initiative here 85 00:03:06,870 --> 00:03:08,810 that you're involved in or particularly 86 00:03:09,270 --> 00:03:11,125 excited about? And what are you hoping to 87 00:03:11,125 --> 00:03:12,025 achieve with that? 88 00:03:12,644 --> 00:03:13,465 Yeah. So 89 00:03:13,844 --> 00:03:16,724 I'm really proud that our members have a 90 00:03:16,724 --> 00:03:19,844 20% less chance of dying from cancer and 91 00:03:19,844 --> 00:03:21,764 thirty three percent less chance of dying from 92 00:03:21,764 --> 00:03:23,144 cardiac related diseases. 93 00:03:24,069 --> 00:03:26,629 Our sister organization, Mid Atlantic, did research showing 94 00:03:26,629 --> 00:03:27,770 that our members, 95 00:03:28,150 --> 00:03:31,110 on average, live six years longer, and African 96 00:03:31,110 --> 00:03:33,669 Americans live nine years longer than people who 97 00:03:33,669 --> 00:03:35,370 don't benefit from our health system. 98 00:03:36,389 --> 00:03:38,710 In certain areas, we've managed to close and 99 00:03:38,710 --> 00:03:39,210 eliminate 100 00:03:40,175 --> 00:03:43,294 racial health care gap, particularly around colorectal cancer 101 00:03:43,294 --> 00:03:43,794 screening, 102 00:03:44,254 --> 00:03:46,275 some of the diabetic prevention measures, 103 00:03:46,814 --> 00:03:48,335 and we know that we've got a ton 104 00:03:48,335 --> 00:03:49,314 more work to do. 105 00:03:49,615 --> 00:03:50,814 If you ask me what what am I 106 00:03:50,814 --> 00:03:52,735 most proud of in addition to closing some 107 00:03:52,735 --> 00:03:53,460 of those gaps, 108 00:03:53,860 --> 00:03:56,020 I'll just a couple of areas. One is 109 00:03:56,020 --> 00:03:56,760 our board 110 00:03:57,460 --> 00:03:58,760 follows just five KPIs, 111 00:03:59,700 --> 00:04:00,840 relates to quality, 112 00:04:01,379 --> 00:04:02,360 to care experience, 113 00:04:03,379 --> 00:04:03,879 to 114 00:04:04,659 --> 00:04:06,520 physician satisfaction and engagement, 115 00:04:07,004 --> 00:04:09,645 making our care affordable, and then the one 116 00:04:09,645 --> 00:04:10,944 is around health equity. 117 00:04:11,245 --> 00:04:13,884 So that commitment from board level throughout the 118 00:04:13,884 --> 00:04:14,384 organization, 119 00:04:14,685 --> 00:04:16,225 I think, is really important. 120 00:04:16,845 --> 00:04:17,745 And then secondly, 121 00:04:18,045 --> 00:04:20,685 often our health equity efforts have been very 122 00:04:20,685 --> 00:04:22,680 focused on on prevention 123 00:04:23,300 --> 00:04:25,540 in primary care, which is the core of 124 00:04:25,540 --> 00:04:26,199 our organization. 125 00:04:26,740 --> 00:04:29,139 But we've actually challenged all of our service 126 00:04:29,139 --> 00:04:29,639 lines 127 00:04:30,419 --> 00:04:32,519 to look at health equity gaps. 128 00:04:33,139 --> 00:04:34,419 I was really proud the other day. I 129 00:04:34,419 --> 00:04:35,939 was in one of our medical centers in 130 00:04:35,939 --> 00:04:36,680 San Francisco, 131 00:04:37,204 --> 00:04:39,464 and they'd, taken our TAVR program. 132 00:04:40,084 --> 00:04:42,824 That's a program that I think very seldom 133 00:04:43,285 --> 00:04:45,845 gets viewed through an equity lens, and they 134 00:04:45,845 --> 00:04:48,185 looked at the national data and found that 135 00:04:48,805 --> 00:04:49,305 that, 136 00:04:49,685 --> 00:04:52,139 different racial groups just don't get access to 137 00:04:52,139 --> 00:04:54,779 TAVR at all for a myriad of reasons 138 00:04:54,779 --> 00:04:56,560 around health system design, 139 00:04:57,339 --> 00:04:59,279 around care that doesn't connect 140 00:04:59,580 --> 00:05:01,600 culturally with with different groups. 141 00:05:02,139 --> 00:05:03,660 And so now that we've got that data 142 00:05:03,660 --> 00:05:05,259 and then we've managed we've looked at our 143 00:05:05,259 --> 00:05:07,264 own data, which isn't as 144 00:05:07,564 --> 00:05:09,264 exaggerated as the national data, 145 00:05:09,964 --> 00:05:12,204 but it's given us absolute clarity about a 146 00:05:12,204 --> 00:05:14,204 gap that we need to close. So doing 147 00:05:14,204 --> 00:05:16,685 that, we've got about a 120 service lines. 148 00:05:16,685 --> 00:05:19,164 Doing that in every service line, means that 149 00:05:19,164 --> 00:05:21,199 we'll get completely clear about the gaps that 150 00:05:21,199 --> 00:05:23,360 we need to close and then work through 151 00:05:23,360 --> 00:05:24,720 what we need to do to close that 152 00:05:24,720 --> 00:05:25,220 gap. 153 00:05:26,000 --> 00:05:27,379 Got it. Got it. Now 154 00:05:27,839 --> 00:05:28,819 moving forward, 155 00:05:29,199 --> 00:05:31,839 member satisfaction is essential to thrive in today's 156 00:05:31,839 --> 00:05:34,975 competitive health care market. What experience or engagement 157 00:05:35,115 --> 00:05:38,314 strategies have proven effective for organization, and how 158 00:05:38,314 --> 00:05:39,535 are you measuring success? 159 00:05:40,154 --> 00:05:41,675 Yeah. This is an area where we've changed 160 00:05:41,675 --> 00:05:42,954 dramatically in the last, 161 00:05:43,355 --> 00:05:44,254 eighteen months. 162 00:05:45,355 --> 00:05:47,514 Previously, we'd had a paper based survey that 163 00:05:47,514 --> 00:05:48,975 were mailed to people's homes, 164 00:05:49,660 --> 00:05:51,899 and so we are only able to sample 165 00:05:51,899 --> 00:05:53,660 a small proportion of patients, and we got 166 00:05:53,660 --> 00:05:55,199 an even smaller response rate. 167 00:05:55,819 --> 00:05:57,099 In the last year and a half, we 168 00:05:57,099 --> 00:05:58,479 moved to a digital platform, 169 00:05:59,259 --> 00:06:00,479 where we can survey 170 00:06:01,019 --> 00:06:03,419 everybody that comes in with care for care. 171 00:06:03,419 --> 00:06:06,044 We still get a low response rate, although 172 00:06:06,044 --> 00:06:07,824 compared to many other surveys, 173 00:06:08,285 --> 00:06:10,524 it's about two to three times the response 174 00:06:10,524 --> 00:06:11,024 rate. 175 00:06:11,724 --> 00:06:14,865 But instead of having survey feedback patient feedback 176 00:06:15,084 --> 00:06:15,805 in the, 177 00:06:16,444 --> 00:06:18,444 tens of thousands, we're now getting it in 178 00:06:18,444 --> 00:06:20,224 the in the tune of millions. 179 00:06:21,060 --> 00:06:22,740 And the volume of data has enabled us 180 00:06:22,740 --> 00:06:24,199 to get much, much more 181 00:06:24,899 --> 00:06:25,959 precise around, 182 00:06:26,819 --> 00:06:28,979 seeing where we have gaps. So we know 183 00:06:28,979 --> 00:06:31,800 that our overall net promoter score is 87. 184 00:06:32,660 --> 00:06:34,845 But when we break down by age, there's 185 00:06:34,845 --> 00:06:37,964 almost a 30 gap between different groups, just 186 00:06:37,964 --> 00:06:38,865 as one example. 187 00:06:39,404 --> 00:06:41,884 So that's enabling us to get much more 188 00:06:41,884 --> 00:06:42,865 focused and targeted 189 00:06:43,324 --> 00:06:43,824 on 190 00:06:44,204 --> 00:06:45,504 where is our service, 191 00:06:46,204 --> 00:06:47,805 not landing in the way that we'd like 192 00:06:47,805 --> 00:06:48,384 it to. 193 00:06:48,730 --> 00:06:50,410 Now the area is what we call closed 194 00:06:50,410 --> 00:06:51,149 loop resolution, 195 00:06:51,610 --> 00:06:52,910 where when we get 196 00:06:53,930 --> 00:06:55,790 feedback where we could have done better, 197 00:06:56,170 --> 00:07:00,730 that immediately routes to the operational leaders, physicians 198 00:07:00,730 --> 00:07:03,310 and administrative leaders in those areas 199 00:07:03,995 --> 00:07:04,895 so that we're able 200 00:07:05,595 --> 00:07:07,694 to, wherever we can, immediately respond. 201 00:07:08,235 --> 00:07:10,475 And we've got some great examples of being 202 00:07:10,475 --> 00:07:11,535 able to, 203 00:07:12,074 --> 00:07:14,495 catch patients before they've reached their car 204 00:07:15,035 --> 00:07:17,194 and call them back to rectify the problem 205 00:07:17,194 --> 00:07:20,050 they had or or examples where patients have 206 00:07:20,050 --> 00:07:20,550 been 207 00:07:20,850 --> 00:07:22,149 initially very unhappy. 208 00:07:22,529 --> 00:07:24,930 And then as they've seen us take action 209 00:07:24,930 --> 00:07:25,589 to respond, 210 00:07:26,129 --> 00:07:28,289 they've then taken upon themselves to sort of 211 00:07:28,289 --> 00:07:30,470 re regrade their response to us. 212 00:07:30,794 --> 00:07:33,354 So like every health system, we've got plenty 213 00:07:33,354 --> 00:07:35,435 of opportunity to get better in our daily 214 00:07:35,435 --> 00:07:35,935 interactions. 215 00:07:36,634 --> 00:07:39,035 And this the closed loop feedback's giving us 216 00:07:39,035 --> 00:07:41,194 some enabling us to be much more agile 217 00:07:41,194 --> 00:07:42,495 in responding to patients', 218 00:07:42,875 --> 00:07:43,774 patients' needs. 219 00:07:44,500 --> 00:07:46,180 Absolutely. Well, Lawrence, I wanna thank you for 220 00:07:46,180 --> 00:07:47,860 your time today. But before I let you 221 00:07:47,860 --> 00:07:50,259 go, I have one more question. Looking ahead, 222 00:07:50,259 --> 00:07:51,959 what do you see as the biggest opportunity 223 00:07:52,020 --> 00:07:54,199 for payers to lead the change in transforming 224 00:07:54,259 --> 00:07:56,819 care delivery and driving better outcomes for all 225 00:07:56,819 --> 00:07:57,319 stakeholders? 226 00:07:57,644 --> 00:07:59,164 And how can leaders take a step in 227 00:07:59,164 --> 00:08:00,305 this direction now? 228 00:08:01,245 --> 00:08:02,524 Yeah. It really goes back to what I 229 00:08:02,524 --> 00:08:03,904 said at the beginning that 230 00:08:04,604 --> 00:08:06,865 so often our provider, 231 00:08:07,964 --> 00:08:10,444 the delivery system, and payer is stuck in 232 00:08:10,444 --> 00:08:11,104 a cycle 233 00:08:11,404 --> 00:08:11,904 of, 234 00:08:12,979 --> 00:08:14,360 who's gonna get paid for what. 235 00:08:14,819 --> 00:08:16,819 And, of of course, the the flow of 236 00:08:16,819 --> 00:08:18,120 resources is important, 237 00:08:18,819 --> 00:08:20,519 but the real breakthrough comes 238 00:08:20,899 --> 00:08:23,479 when we've got, the delivery system, 239 00:08:23,779 --> 00:08:27,379 medical groups, hospital systems, all aligned around using 240 00:08:27,379 --> 00:08:30,014 limited resources as we know affordability for our 241 00:08:30,014 --> 00:08:32,254 patients is probably the biggest challenge that we 242 00:08:32,254 --> 00:08:33,315 face in The US, 243 00:08:33,934 --> 00:08:36,274 and trying to use those limited resources, 244 00:08:36,894 --> 00:08:38,115 make care more affordable, 245 00:08:38,654 --> 00:08:42,915 and provide great quality equity experience access. And 246 00:08:43,580 --> 00:08:44,639 we know with shortages 247 00:08:45,100 --> 00:08:47,820 in in health professions, it's also gotta work 248 00:08:47,820 --> 00:08:48,879 for health professionals. 249 00:08:49,659 --> 00:08:51,500 When we get that alignment, I think we 250 00:08:51,500 --> 00:08:54,539 can do extraordinarily better. We know that The 251 00:08:54,539 --> 00:08:57,019 US health system was spending $5,000,000,000,000, 252 00:08:57,019 --> 00:08:58,879 18% of the entire economy, 253 00:08:59,315 --> 00:09:01,075 and we're getting the worst outcomes of any 254 00:09:01,075 --> 00:09:01,575 developed, 255 00:09:02,034 --> 00:09:03,735 developed economy on the globe. 256 00:09:04,195 --> 00:09:06,595 So it's not through lack of resources, but 257 00:09:06,595 --> 00:09:08,754 the way that we're using resources just isn't 258 00:09:08,754 --> 00:09:11,794 delivering population health. So where we get that 259 00:09:11,794 --> 00:09:13,735 alignment and where we really 260 00:09:14,370 --> 00:09:14,870 enable 261 00:09:15,570 --> 00:09:16,870 medical groups and hospitals, 262 00:09:18,049 --> 00:09:19,190 to be successful 263 00:09:19,570 --> 00:09:21,429 by delivering population health, 264 00:09:21,730 --> 00:09:23,730 that I think is the brightest hope for 265 00:09:23,730 --> 00:09:25,410 how we can improve the care of our 266 00:09:25,410 --> 00:09:25,910 nation. 267 00:09:26,431 --> 00:09:28,591 Absolutely. Well, that's a great spot. And, Lawrence, 268 00:09:28,591 --> 00:09:30,031 I wanna thank you once again for your 269 00:09:30,031 --> 00:09:31,231 time today and for joining me on the 270 00:09:31,231 --> 00:09:33,971 Becker's Healthcare podcast. Thanks. It's been a privilege.