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Hello, and welcome to the Becker's Healthcare podcast.
My name is Chanel Banger recording live at
the Becker's
and sitting down with Lawrence Hamilton,
the executive vice president at the Permanente Medical
Group. Lawrence, thank you so much for joining
me today. It's my pleasure. Good good to
be with you. Perfect. Well, to get us
started out, can you please introduce yourself and
share a bit about your organization?
Sure. So the Permanente Medical Group is part
of Kaiser Permanente.
We care for in
the Permanente Medical Group, we care for 4,600,000
members in Northern California,
and we do that through 55,000
colleagues, including 10,000 physicians
across 21 hospitals.
Perfect. And moving forward into the meat of
the podcast a bit,
balancing affordability and quality is a constant challenge
for health plans. How is your organization innovating
to manage the cost of care while maintaining
or improving member outcomes?
I actually think the framing of,
tension between
quality and affordability is a symptom of,
the relate when the relationship between payers and
the delivery system is
contractual and transactional,
it tends to reduce very quickly to,
we want you to do more in this
area that will improve quality,
and the delivery system says this is what
it will cost, and you get into this
spiral of who's gonna pay for what.
I think a much more advantageous way to
is to seek alignment between payers and the
delivery system so that together, you're
all focused on how do we provide the
best quality,
equity,
access,
care experience,
and provider and clinician
satisfaction
at the lowest possible cost for the communities
that we serve.
When you frame it that way and you've
got genuine
alignment and you've got hospital systems and medical
groups that are
see success as population health,
then the trade off
reframes dramatically where we know that when you
provide great preventive care, that's
best for the patients, and it also avoids
downstream costs of more hospitalizations.
When you avoid a patient having to say
to the emergency room because of care that
you've done upstream,
better for the patients and avoids,
the most costly parts of the health system.
So when we've got genuine alignment,
we're aligning,
quality and affordability
much more often than they're at a trade
off of one another.
Absolutely. And now kinda switching gears a bit,
addressing health equity has become a critical focus
for many health plans. Can you share an
overview of a key initiative here
that you're involved in or particularly
excited about? And what are you hoping to
achieve with that?
Yeah. So
I'm really proud that our members have a
20% less chance of dying from cancer and
thirty three percent less chance of dying from
cardiac related diseases.
Our sister organization, Mid Atlantic, did research showing
that our members,
on average, live six years longer, and African
Americans live nine years longer than people who
don't benefit from our health system.
In certain areas, we've managed to close and
eliminate
racial health care gap, particularly around colorectal cancer
screening,
some of the diabetic prevention measures,
and we know that we've got a ton
more work to do.
If you ask me what what am I
most proud of in addition to closing some
of those gaps,
I'll just a couple of areas. One is
our board
follows just five KPIs,
relates to quality,
to care experience,
to
physician satisfaction and engagement,
making our care affordable, and then the one
is around health equity.
So that commitment from board level throughout the
organization,
I think, is really important.
And then secondly,
often our health equity efforts have been very
focused on on prevention
in primary care, which is the core of
our organization.
But we've actually challenged all of our service
lines
to look at health equity gaps.
I was really proud the other day. I
was in one of our medical centers in
San Francisco,
and they'd, taken our TAVR program.
That's a program that I think very seldom
gets viewed through an equity lens, and they
looked at the national data and found that
that,
different racial groups just don't get access to
TAVR at all for a myriad of reasons
around health system design,
around care that doesn't connect
culturally with with different groups.
And so now that we've got that data
and then we've managed we've looked at our
own data, which isn't as
exaggerated as the national data,
but it's given us absolute clarity about a
gap that we need to close. So doing
that, we've got about a 120 service lines.
Doing that in every service line, means that
we'll get completely clear about the gaps that
we need to close and then work through
what we need to do to close that
gap.
Got it. Got it. Now
moving forward,
member satisfaction is essential to thrive in today's
competitive health care market. What experience or engagement
strategies have proven effective for organization, and how
are you measuring success?
Yeah. This is an area where we've changed
dramatically in the last,
eighteen months.
Previously, we'd had a paper based survey that
were mailed to people's homes,
and so we are only able to sample
a small proportion of patients, and we got
an even smaller response rate.
In the last year and a half, we
moved to a digital platform,
where we can survey
everybody that comes in with care for care.
We still get a low response rate, although
compared to many other surveys,
it's about two to three times the response
rate.
But instead of having survey feedback patient feedback
in the,
tens of thousands, we're now getting it in
the in the tune of millions.
And the volume of data has enabled us
to get much, much more
precise around,
seeing where we have gaps. So we know
that our overall net promoter score is 87.
But when we break down by age, there's
almost a 30 gap between different groups, just
as one example.
So that's enabling us to get much more
focused and targeted
on
where is our service,
not landing in the way that we'd like
it to.
Now the area is what we call closed
loop resolution,
where when we get
feedback where we could have done better,
that immediately routes to the operational leaders, physicians
and administrative leaders in those areas
so that we're able
to, wherever we can, immediately respond.
And we've got some great examples of being
able to,
catch patients before they've reached their car
and call them back to rectify the problem
they had or or examples where patients have
been
initially very unhappy.
And then as they've seen us take action
to respond,
they've then taken upon themselves to sort of
re regrade their response to us.
So like every health system, we've got plenty
of opportunity to get better in our daily
interactions.
And this the closed loop feedback's giving us
some enabling us to be much more agile
in responding to patients',
patients' needs.
Absolutely. Well, Lawrence, I wanna thank you for
your time today. But before I let you
go, I have one more question. Looking ahead,
what do you see as the biggest opportunity
for payers to lead the change in transforming
care delivery and driving better outcomes for all
stakeholders?
And how can leaders take a step in
this direction now?
Yeah. It really goes back to what I
said at the beginning that
so often our provider,
the delivery system, and payer is stuck in
a cycle
of,
who's gonna get paid for what.
And, of of course, the the flow of
resources is important,
but the real breakthrough comes
when we've got, the delivery system,
medical groups, hospital systems, all aligned around using
limited resources as we know affordability for our
patients is probably the biggest challenge that we
face in The US,
and trying to use those limited resources,
make care more affordable,
and provide great quality equity experience access. And
we know with shortages
in in health professions, it's also gotta work
for health professionals.
When we get that alignment, I think we
can do extraordinarily better. We know that The
US health system was spending $5,000,000,000,000,
18% of the entire economy,
and we're getting the worst outcomes of any
developed,
developed economy on the globe.
So it's not through lack of resources, but
the way that we're using resources just isn't
delivering population health. So where we get that
alignment and where we really
enable
medical groups and hospitals,
to be successful
by delivering population health,
that I think is the brightest hope for
how we can improve the care of our
nation.
Absolutely. Well, that's a great spot. And, Lawrence,
I wanna thank you once again for your
time today and for joining me on the
Becker's Healthcare podcast. Thanks. It's been a privilege.