Journalist Reed Abelson begins his New York Times article today with “When people talk about the future of health care, Kaiser Permanente is often the model they have in mind.” Let’s examine the ‘why’ and the ‘how’.
We believe better-coordinated patient care leads to more rapid diagnosis, more rapid and effective treatment, through a more humanistic and holistic approach, individually tailored to the person before us. We achieve those superior outcomes first and foremost through (1) a culture of collaboration (highly-reliable team-care, Patient-Centered-Medical-Homes [PCMH]), (2) a culture of safety (best care, best time, best place, no errors), (3) a culture of continuous improvement, powered by (a) sophisticated technology (our exceptional electronic medical record – embedded with the latest best practices; analytics; and performance management systems), as well as (b) physicians and staff who confidently place the interests of the patient before all else.
We believe that physician pay should compensate for long hours of very intense work, devoted to the patient and family, simultaneously devoid of financial incentives of self-enrichment. That’s why our physicians are salaried, rewarded for individual or collective quality achievement, patient satisfaction, and keeping members optimally healthy. Traditional models of healthcare, particularly “fee-for-service” (FFS) models, lead to self-enrichment by maximizing testing, treatment, surgeries and hospitals, often without benefit to the patient (see Atul Gawande’s 2009 New Yorker article, or Steven Brill’s 2013 Time article, among many others).
We believe that physician leadership is a critical component of “re-engineering care” to make it more affordable, more highly satisfying, and more effective, as Mr. Halvorson states in the interview. To do so requires the sensibilities, experience and expertise of physicians. We provide the care in the exam-room, at the bedside, in the OR, after all. Our medical groups are self-governed, making ALL medical decisions with patient and family through a shared-decision-making process. What the Permanente physician establishes as medically necessary for that particular patient gets done, without ANY interference from the insurance end of the business. See my recent editorial in the Atlanta Business Chronicle for more information about the role of physician leadership in redesigning medical care in our country.
We are indeed the face of future health care, AND we have even more re-engineering work to do before we sleep.