Podcast: Championing excellence in Permanente Medicine

Federation co-CEOs Maria Ansari, MD, FACC, and Ramin Davidoff, MD, share keys to high-quality, patient-centered care

The Permanente Medicine Podcast kicks off its 2024 season with a special extended episode featuring Maria Ansari, MD, FACC, and Ramin Davidoff, MD, co-CEOs of The Permanente Federation. Together, they share their leadership insights and vision for achieving excellence in Permanente Medicine.

As co-CEOs of the Federation, Dr. Ansari and Dr. Davidoff help guide a strategic vision that supports the work of more than 24,000 Permanente physicians and 90,000 staff who serve 12.5 million Kaiser Permanente members. The Federation serves as the national leadership and consulting organization for the Permanente Medical Groups, which, together with the Kaiser Foundation Health Plans and Kaiser Foundation Hospitals, comprise Kaiser Permanente.

In conversation with Chris Grant, podcast host and chief operating officer of the Federation, Dr. Ansari and Dr. Davidoff offer a behind-the-scenes glimpse into their co-CEO partnership and delve into some of the critical work taking place throughout the Permanente Medical Groups around improving patient outcomes, maintaining a human touch while adopting new technology, and supporting physician well-being.

“It’s really an honor,” says Dr. Ansari regarding her role co-leading the Federation and supporting the latest Permanente Medical Group efforts with Dr. Davidoff. “That physician voice and care delivery arm are critically important to Kaiser Permanente.”

In this episode, Drs. Ansari and Davidoff speak to some of the pressing issues facing health systems and how Kaiser Permanente is uniquely positioned to address these challenges. They also look back at pivotal moments in the evolution of patient-centered, integrated care and share their thoughts on what milestones might be on the horizon for the practice of medicine.

“I do know that the future is very bright for us,” says Dr. Davidoff in discussing what lies ahead for Kaiser Permanente. “We have the right people, we have the right value system, and we have the right ethos to practice the type and brand of medicine that our communities truly deserve.”

In addition to her Federation co-CEO role, Dr. Ansari serves as CEO and executive director of The Permanente Medical Group, and president and CEO of the Mid-Atlantic Permanente Medical Group. Dr. Davidoff is executive medical director and chair of the board for the Southern California Permanente Medical Group, as well as chair of the board and CEO for The Southeast Permanente Medical Group and Hawaii Permanente Medical Group on top of his Federation co-CEO position.

I want to honor and respect the commitment that our physicians have to this profession.

– Maria Ansari, MD, FACC

We don’t want to use technology that replaces the human touch, the human touch always needs to be in health care.

– Ramin Davidoff, MD

Related co-CEO story: Ramin Davidoff, MD, and Maria Ansari, MD, FACC Named Among Modern Healthcare’s “100 Most Influential People” for 2023

In this episode

2:28 Leading on behalf of the Permanente Medical Groups

7:04 How the Modern Healthcare “100 Most Influential People” recognition is a testament to the excellence of Permanente Medicine

11:35 Dr. Davidoff on the importance of patient input in advancing quality care

17:28 Dr. Ansari on using predictive analytics to improve patient outcomes

22:13 Dr. Davidoff on using e-visits and on-demand care to better serve patients

24:46 Dr. Ansari on supporting joy in medicine and preventing physician burnout

31:38 Pivotal moments for advancing integrated, patient-centered care

Connect with Chris Grant on X (formerly Twitter) at @cmgrant or LinkedIn.

Podcast guests for upcoming episodes that will be released later this spring include:

• Ainsley MacLean, MD, chief medical information officer and chief AI officer, Mid-Atlantic Permanente Medical Group
• Brian Hoberman, MD, executive vice president and chief information officer and national information technology leader, The Permanente Federation; chief information officer, The Permanente Medical Group
• Ted O’Connell, MD, director of medical education, Kaiser Permanente Northern California
• Lindia Willies-Jacobo, MD, senior associate dean for Admissions and Equity, Inclusion, and Diversity, and professor, Kaiser Permanente Bernard J. Tyson School of Medicine
• Sachin Jain, MD, CEO, SCAN Group and SCAN Health Plan

Program notes

• Learn more about The Permanente Federation and its mission.
• Find out additional details about the Permanente Medical Groups and their physician-led, multispecialty approach to medicine.
• Watch a video on the promise of Permanente Medicine.

Follow us: Subscribe to the Permanente Medicine Podcast on your favorite streaming platform.

Podcast transcript

Transcript is autogenerated. Although edited for clarity, it should not be considered an exact replication of the podcast and may also be updated as needed.

Maria Ansari, MD, FACC: The way that I think about promoting physician well-being is I want to honor and respect the commitment that our physicians have to this profession, but also help them with supporting the guardrails in an ethical and responsible way.

Ramin Davidoff, MD: At the end of the day, we don’t want to use technology that replaces the human touch. The human touch always needs to be in health care, but we are seeing opportunities to enhance efficiencies and sometimes the accuracy of the work that we provide in the health care that we provide for our patients through the use of digital transformation and technology and AI in general.

Chris Grant: Hello and welcome to the premiere of the Permanente Medicine Podcast’s 2024 season. I’m Chris Grant, your host and chief operating officer of The Permanente Federation. I’m excited to kick off the season by diving into our work and vision for excellence and the practice of Permanente Medicine and advancing integrated patient-centered care. Our guests today are leaders on this front, providing expert guidance and keen insight for the strategic direction of the Permanente Medical Groups and Kaiser Permanente. It’s my pleasure to welcome back to the show Dr. Ramin Davidoff, who serves as executive medical director and chair of the board of the Southern California Permanente Medical Group, as well as chair of the board and CEO of the Southeast Permanente Medical Group and Hawaii Permanente Medical Group. Also, another returning guest is Dr. Maria Ansari, CEO and executive director of The Permanente Medical Group and president and CEO of the Mid-Atlantic Permanente Medical Group. Both doctors Davidoff and Ansari also serve as the co-CEOs of The Permanente Federation, where I have the pleasure of seeing their inspiring work up close every day. Welcome back to the show, Ramin and Maria, it’s so great to have you both back and together this time to help kick off our 2024 season.

RD: Thank you, Chris.

MA: Thank you, Chris. Looking forward to it.

Leading on behalf of the Permanente Medical Groups

CG: As I mentioned earlier, I’ve had the great experience of working alongside both of you and seeing your exceptional leadership firsthand. Some of our listeners may not be familiar with The Permanente Federation and the roles of co-CEOs. Could you explain to our listeners how you work together on behalf of all the Permanente Medical Groups? Ramin, let’s start with you on this one.

RD: Thanks so much, Chris for this opportunity. It’s really been a pleasure to work with you, as well as our other Federation colleagues, in doing this incredibly important work on behalf of the Permanente Medical Groups and also being able to be a [Federation] co-CEO with Dr. Ansari has truly been a privilege and a highlight of the work that we do. We partner to provide leadership and strategic direction to the Permanente Medical Groups and also partner with our Kaiser Foundation Health Plan and Hospitals colleagues on Kaiser Permanente’s national strategy. This is critically important work that is conducted at the Federation level and being co-CEOs carries a tremendous responsibility. It is also an immense effort to help support the work of [more than] 24,000 Permanente physicians and 80,000 staff who serve [12.5] million Kaiser Permanente members.

We also develop priorities and strategic direction for The Permanente Federation, which is the national leadership and consulting organization for the Permanente Medical Groups. And I’ve already, in my three years in this role, have had multiple instances where I’ve noted the immense benefit that comes with the work that we do at the Federation level and working as a co-CEO together with Dr. Ansari on issues related to technology and government relations, as well as quality, growth, and certainly labor relations. [These] have been some of the issues that we’ve already dealt with that are incredibly important to the organization and I’m proud to be a part of this co-CEO tandem and to be working with our Federation colleagues.

CG: Ramin, just listening to you, the enormity of what you described, [more than] 24,000 physicians, [12.5] million patients and members that we care for every day. It’s quite an extraordinary role that you and Maria share. Maria, same question for you. Could you share with our listeners the work that you do together on behalf of the Permanente Medical Groups?

MA: Thanks, Chris. I think Dr. Davidoff did a really excellent job of describing the role that we play, and I am honored to work in partnership with Dr. Davidoff. Together we represent about 90% of the [Permanente Medical Group] program. When you think across this country, we represent at the Federation level all the independent Permanente Medical Groups speaking with one voice, I think that’s another part of it. We meet regularly with the executive medical directors of the other independent Permanente Medical Groups to make sure that we are all aligned and that includes supporting the practice, the technology, advocating at the national level for issues that are important to our physicians, everything from recruitment to Medicare funding. And with regards to partnership with [Kaiser Foundation Health Plan], [it’s] really working on that strategy and growth and joint decision making. So, it’s really an honor to work alongside Dr. Davidoff and to work with you, Chris, at the Federation and support the work that we do, which I think is critically important. It’s that physician voice and the care delivery arm of what makes Kaiser Permanente, Kaiser Permanente.

What making the most influential list says about Permanente Medicine

CG: Thank you both, Dr. Ansari and Davidoff. And you’re right, there’s such a mission orientation to the work we do, and I happen to have a backstage pass in working with both of you every day and seeing the two of you in action together. And one of my observations is that you share values, you share a very deep commitment to the practice of medicine and the mission of Kaiser Permanente, but I also see you sharing a friendship and a sense of humor and dealing with the enormity and the complexity of caring for [12.5] million individuals, but also understanding that this is human touch.

You were both named among Modern Healthcare’s 100 Most Influential People in health care toward the end of 2023. This is the first time that both Federation co-CEOs received this recognition concurrently. It’s quite an amazing accomplishment when you think of the literally millions of individuals that work in health care, to have both of you be among the 100 most influential. What does this achievement mean to each of you for the practice of Permanente Medicine and for you personally? Maria, why don’t we start with you on this one?

MA: Sure. Chris, you touched on it a little bit and it’s really recognizing that partnership that Ramin and I have on the Federation because we represent so many medical groups and physicians. We are collectively the largest physician-led [medical group] in the country. And it’s also a recognition, I think, of value-based care — something we’ve been doing for over seven decades — and the physician autonomy and having that voice is super important in today’s world where many practices are being bought up by venture capitalists, by retail, by insurance companies that don’t have an arm’s length that we have. We are an autonomous independent group; our doctors don’t know what pre-authorization is. When we think about recruitment and retention and how we want to practice medicine for the future, it’s really built on all the values that we have in our Permanente practice, and I think that people are looking for that. Something’s been lost in the way that care is being delivered in this country, and I think the recognition of us together, I don’t think the Permanente Medical Groups have ever been closer in alignment on strategy and a vision for the future than we are today.

CG: Ramin, I’d love to get your thoughts as well.

RD: Maria really beautifully mentioned all the things that were on my mind. As she said, this is truly an honor and a celebration of the practice of Permanente Medicine and Permanente physicians and its people. It has my name and Dr. Ansari’s name on it, but this is a celebration of Permanente Medicine, without question. Our physicians and other members of our teams have always shown the resilience and they’ve flexed their expertise during very difficult and challenging times that we’ve been facing in all of health care. And certainly, Kaiser Permanente has not been immune to the challenges that the entire industry has faced. And at the same time, the one stabilizing force in the entire organization has always been Permanente Medicine, its values, what it stands for, the way our physicians work collaboratively using state-of-the-art technology to provide nation-leading preventive care and world-class complex medical treatment. Medicine for me, and I know for Dr. Ansari as well, has always been about what’s best for the patient and that’s why we are both so incredibly passionate about Permanente Medicine and our model, our system of care. And also, on a personal note, although I am thrilled and honored to have this recognition, the honor is really exemplified more because it’s both of us on this. But also, my mom is really happy about this and she keeps telling her friends and everyone that she can talk to. That has been a really joyful thing for me to watch. But truly, this is all about the people of Permanente [Medicine] and our wonderful integrated model of care that we have.

How patient input helps improve care

CG: To your mom, Mrs. Davidoff, we congratulate her as well. Ruby, that’s wonderful. As you both know, a core area of excellence in the practice of Permanente Medicine centers on using research to promote better patient outcomes. Dr. Davidoff, you recently co-authored a study highlighting the important role patient advisory councils play in shaping health care quality. Can you speak to your observations from the study and how Permanente Medical Groups uniquely use patient input to provide the best care?

RD: This is another thing that I’m very passionate about, which is involvement of our patients, putting them at the center of everything that we do and truly shaping quality in health care. This is a study that was co-authored by Dr. Carrie Litman, who is an outstanding physician here in Southern California, Barbara Lewis, and [me]. I’m proud to say it was published in The Permanente Journal and it discusses how patients play a very important role, in fact a critical role, in shaping health care quality based on observations and experiences and everything that they’re feeling and seeing and experiencing in our health care environment. The patient advisory councils are a representative group of patients who meet regularly with physicians — I was on one when I was at the medical center in Baldwin Park — and the care team. These are patients, physicians, some administrators, and other members of the care teams getting together and sharing the perspectives on behalf of the patients and their feedback on the clinical operations that we’ve put into place.

This input always leads to more patient-centered care improvement. We have 23 patient advisory councils in Southern California, including nine specialty ones with specific topics around behavioral health and neonatal care as well as renal care. And they truly enable care improvements to levels which would otherwise not be possible if not for the help of our patients, for seeing things from a different lens, for seeing things in a different perspective.

Some of the examples that I can give you of things that we’ve worked on are redesigning our appointment reminder cards. This is something that might not seem very important, but for the patients it’s critically important. The messaging that we have on these cards for our patients help them prepare better for their upcoming appointments and overall improve the care that we provide. We’ve also modified our direct-to-patient texting programs in the surgical environment as well as in the emergency departments, and that really has improved the effectiveness of the outreach that we have. We were able to publish the results of some of this work and it allows us to fulfill our commitment to provide culturally responsible and equitable care.

CG: It’s really inspiring Ramin, just listening to so many applications from chronic disease management to an episode that could be the scariest moment in a patient’s life, and really turning to patient advisory councils to understand from their perspective what it’s like and what could Kaiser Permanente do to improve. And the fact that you’re sharing this more broadly beyond the organization and co-authored studies is terrific. Maria, I know you have important thoughts on how patient feedback can help influence quality of care.

MA: First, I have to say that Ramin is very serious about this topic because speaking of mothers, [he] met my mother just one time and immediately tried to recruit her into a patient advisory council. She’s full of ideas, so be careful what you ask for! Seriously though, I think when we listen to our patients and we give them agency over their health, it really just improves care. It improves trust. It allows us to see things that we wouldn’t otherwise pick up on. Everything from the parking situation to how forms are handled to the support a patient might need or what they might need to hear. At the end of the day, that’s what we’re here for. We’re here to meet the needs of our patients and if it’s not informed by our patients, how can we do our best work and build that trust? When we have the trust of our patients, they’re much more likely to comply with the treatment recommendation. They’re more likely to stick with us and develop that relationship. Like any relationship, it’s a two-way street and I really value our patient advisory councils, everything from subspecialty care to primary care, including the hospital side. It’s really essential to being able to deliver world-class care and I love hearing from them, and I hope my mom doesn’t drive you crazy.

RD: If I may jump in, Maria, your mom is absolutely wonderful, and we’d love to have her on the advisory council. I think she would be incredibly beneficial to our learning and she’s just delightful, so we’re looking forward to having her on board.

Using predictive analytics to improve patient outcomes

CG: Alright, we’re enlisting family members today, which is so exciting. Maria, I’m going to stay with you on this next question because I listened to you speak at the Becker’s [Hospital Review] round table about some of the most pressing issues for health systems in 2024. And one topic that came up was digital transformation, an area that is strongly influencing care delivery innovation at Kaiser Permanente. How do you see the evolution impacting the practice of Permanente Medicine and other health systems now and into the future?

MA: We are competing with medical groups and health systems that don’t even have a digital health record in some cases, so we’re far beyond that. But if we really want to leverage our electronic medical record, for instance, it’s to manage our population and being able to predict who’s going to need us most. It’s one thing to treat disease, it’s another to prevent disease at a population basis on a broad scale.

What if we could tell you using our predictive analytics, using our [electronic medical record], who’s going to have the next stroke, who’s going to have the next heart attack, who’s going to have the next cancer, who’s going to have the next fall, with a high degree of accuracy and being able to treat and prevent that? I think that’s where the next level is going to be. And we’re doing some of that already.

For instance, we have an advanced alert monitoring system in our hospitals. We’re not waiting for someone to call a code or for a patient to decompensate. We’re using hundreds of variables that are being used to predict who might have a decompensation in the middle of the night before any other alarm bells or triggers are released so that we can intervene and have a rapid response team at that patient’s bedside and helping support them to prevent that from happening. We use AI, for instance, to help look at mammograms and people who are due for a mammogram and trying to predict who’s going to most likely need a follow-up scan in short order. And that’s an example that comes out of the pandemic and the learning that we had.

So many patients during the pandemic didn’t come in for care. We didn’t close up shop, but patients just didn’t come in. They were afraid, they delayed their care. As the doors opened up and we went out of lockdown, we had about a two-year backlog of regular mammograms. How do you take care of that entire population all at once? We used AI to look at patients who had a normal mammogram who were due, and we were able to prioritize them using AI to look at the past mammograms to see who was most likely to have an abnormal mammogram, and we prioritize those patients. It actually was a better predictor of who might have cancer than traditional risk factors.

Using e-visits and on-demand care to meet patient needs

CG: Wow, that’s terrific. Ramin, I know this is an area that you as well have thought a lot about. I would be interested in your insights.

RD: Thank you, Chris. There’s not a whole lot I can add to Maria’s response, which was really outstanding. The whole society is rapidly adopting technology and it’s becoming a consumer-friendly society and it’s all about convenience, it’s all about ease. We also have to adopt and our patients are certainly adopting and they’re wanting us to be more transformative and use digital technologies and different forms of transformation to better meet their needs and convenience needs. And our physicians, frankly, are also adopting, and it’s not always within our comfort zone to adapt to this kind of change in health care. At the same time, we’re realizing more and through the really terrific examples that Dr. Ansari shared, we know that we could do things a lot more efficiently and better if we adopt the right technology, the new technology to improve our care delivery models. One thing that we constantly have to keep an eye on is to get feedback from our patients as well as our physicians to make sure that the innovations and the transformations that we’re putting into place are adding value.

We don’t want to adopt just for the sake of adoption new technology and digital gadgets. Our true north is always quality, and we want to provide it in an affordable manner. These types of transformations will have to add value to our care delivery model and one of the key areas that we have to focus on — this is an area of focus for both myself and I know for Dr. Ansari — is in adult primary care, where the number of messages that our physicians or [care] teams get far exceeds the number of visits that are received whether in person or by phone or by video. The messages are going through the roof and many of these are truly asynchronous clinical visits. This is a new demand that’s been put on the health care system. This type of request for health care needs is not replacing anything else.

It’s on top of everything that is being provided by our care teams already. And this requires our clinicians’ intervention a vast majority of the time. What we want to do is put into place technologies and transformations that will help support this increase in the volume and reduce the impact that our physicians are experiencing.

One of the things that we have put into place is electronic visits, something that I think is truly transformative. We’ve done close to 15.5 million e-visits since October 2019. We also launched Get Care Now in September 2021. This is essentially on-demand urgent care that’s available 24/7 virtually. We’ve conducted more than 1 million phone and video visits through Get Care Now since then.

At the end of the day, we don’t want to use technology that replaces the human touch. The human touch always needs to be in health care, but we are seeing opportunities to enhance efficiencies and sometimes the accuracy of the health care that we provide for our patients through the use of digital transformation and technology and AI in general.

Supporting joy in medicine and preventing physician burnout

CG: I love the enthusiasm that both of you share for innovation and digital technology and also this kind of focus on first and foremost meeting patient needs. I’m going to shift gears here to another topic that I know you both are incredibly passionate about. Last year, 4 Permanente Medical Groups were honored by the American Medical Association Joy in Medicine recognition program, including gold honors for the Southern California Permanente Medical Group and The Permanente Medical Group [The Southeast Permanente Medical Group and Washington Permanente Medical Group were also honored]. Congratulations to both of you on this significant achievement [which] recognizes the medical group’s efforts to support physician wellness.

I know you’re both strong advocates for promoting physician well-being and preventing burnout. How can health system leaders further support their physicians and medical teams so they can bring their best selves to work every day? Why don’t we start with you on this one, Dr. Ansari?

MA: Thank you, Chris. First of all, I am very honored about the recognition from the AMA and I do think it’s a good platform, or framework I should say, for how we can try to support our physician’s practice. The job of doctoring is hard, it’s hard work, and like Ramin was just describing, it’s changed. There are so many new lanes of care. Everyone goes into health care to serve, to provide the best that they can to their patients, and it’s hard to say no and to set limits to it and still have enough leftover at the end of the day for yourself, for your family, for your friends, for any sort of personal life. And it feels guilty sometimes to try to balance both of those and give the best of yourself to your patients. I think that the expectations of patients have changed, and the demands of the practice have changed.

The way that I think about promoting physician well-being is I want to honor and respect the commitment that our physicians have to this profession, but also help them with supporting the guardrails in an ethical and responsible way. And the way that I think about it is doctors love taking care of patients. They want to get back to doctoring. It’s all the other stuff that really gets in the way. So how do we take that off their plate?

Some of it is through team-based care so that we can have some of the clerical work taken off. Some of it is really providing [team-based social work support] because we do get involved in some of the social determinants of health, which affects [patients’] whole health, but we don’t have the resources to really connect them to the support that they might need around food insecurity or housing or finances. Having strong social work and partnerships with the community can help so that team is working at the top of their scope to allow the physician to get back to doctoring and doing physician work.

I think the other thing that’s really beautiful about Permanente Medicine that I think we can offer is that comradery that comes from a group practice, the learning environment, and the investment in your professional development to be the best leader or physician that you can be so that you can learn how to manage a difficult conversation, how you can lean into the space of community medicine, social medicine, digital health, education, research like Ramin has been doing, so that the breadth of your practice changes too. I think that happens in a large group practice where we invest in our physicians to be able to really be at the top of their game and feel supported to do that.

CG: It’s really exciting. And as a dad of a new physician coming out of residency and headed into fellowship, I’m excited to hear your commitment to the joy in medicine and creating capacity for doctors to practice and to not be bogged down with administrative tasks or burdens, but also, as you so nicely articulated Maria, to have the comradery in that friendship. Dr. Davidoff, I know this is an area of deep commitment because you and I have spent time talking about this, advancing the joy in medicine. I’m interested to hear your thoughts.

RD: I also want to congratulate the 4 Permanente Medical Groups that received the honor by the AMA, because I know going through that application process is very involved, very detailed. It involves active efforts in place by the medical groups to bring back the joy of practice to the physicians and colleagues. So, this is a huge honor and exemplifies the commitment of the Permanente Medical Groups to bring back the joy of practice of medicine to our physicians.

This is a particularly difficult time for all of society, but in particular physicians across the country are feeling burned out. There are many reasons that has caused this to happen — you and Dr. Ansari have talked about this — but the workload certainly is one huge factor. The volume and the lack of the hope in terms of the sustainability of being able to continue the practice for a long and healthy career without question is contributing to the fatigue and the burnout our physicians and our people are feeling.

There’s also a lack of connection with patients. The pandemic really threw us for a loop because we had to pivot to a virtual world. Whereas we would be able to see our patients on a regular basis, our colleagues, our nurses, there has been a loss in that connection, which is so important for the joy that we have in our practice. That community of clinicians to come together and work in an integrated fashion, something that we’ve been used to for decades, was suddenly disrupted. We are going to need to go back to that community of practice, that community of physicians working together, seeing our patients hopefully more and more in a face-to-face fashion, but certainly also including virtual capabilities in our armamentarium.

A lack of connection does lead to feelings of loss of hope and burnout, without question. One thing that both Dr. Ansari and I share is that our people are by far our most important assets, and through our belief in them, through our support and investment in our people, this does include use of technology to help improve their workload, their work burden, improving the safety and security of the workplace, as well as bringing back that respectful environment in our workplace with our patients, but also within ourselves as a physician community, are critical steps that we need to put into place to contribute to bringing that joy back into the practice of medicine.

Advancing integrated, patient-centered care

CG: Thank you Ramin. And I love how you both champion patient care and you carry the burden of ensuring a great environment for doctors. Every medical school application that I’ve ever read has this wonderful passion about improving lives, about caring for individuals at their darkest moments in their life. And listening to both of you, I know that you really try hard every day to create that environment that makes that medical school students’ vision possible in a lifelong career as a Permanente doctor.

I’ve asked both of you to look into your crystal balls and share your thoughts on the future of medicine multiple times. And it’s one of my favorite questions, but this time, before setting our eyes to the future, I’m asking you to turn back the clock to early in your medical careers. You both have risen to the top of the medical profession, but there were moments along that career that were game-changing for you in advancing the practice of integrated patient-centered care. I’d like to give you a moment to share your thoughts and given all that we’re facing today in the industry post-pandemic, such as unprecedented consolidation and emerging disruptors, I’d then like you to turn your sights to the future and your vision for the future of Kaiser Permanente. Maria, why don’t we start with you here.

MA: Chris, thank you for that opportunity to look back. And I do think that like you said, physicians come into this work with all their hopes and dreams to be able to focus and make a difference in the lives of patients. And when you go further along in your career, you start to think a little bit broader about how you can support patients and a practice that is ethical, that feels like it’s aligned with the best interest of the patient.

I think that’s what drew me to Kaiser Permanente, and it was really a pivotal moment for me professionally. I was at a nearby research institution and was doing all my research at Kaiser Permanente, and this was back in the 2000, 2002 timeframe. At that time, a study was released from the Division of Research here in Northern California showing that if you’re a Kaiser Permanente member and you live in Northern California, there was a 30% less likelihood of you dying of a heart attack or stroke. 30%! There’s no other intervention that could make such an impact. And just by being a Kaiser Permanente member, accounting for all other variables.

I’m a cardiologist, so I’m thinking I’m on the wrong ship. And I knew because I was doing a lot of research at Kaiser Permanente that it wasn’t because they had great cardiologists, which they do, but it’s really about the system of care. When you align the incentives, when the patient never has that heart attack, never has that stroke, that’s in the best interest of the patient. But it’s also surprise, surprise, in the best interest of the health organization. And that’s not generally the case; in most medical practices, the more disease burden you have, the more you get paid, the more reimbursement there is. And it just was like an a-ha moment: How did I not know about this? That you could have a practice where your incentives are aligned, where you’re focused on prevention and on outcomes and not procedures and volumes. And when the patient does well, you do well and the whole organization does well.

So for me, it really just changed the way I think about medicine. I feel like every American deserves to have Kaiser Permanente as their health care delivery system and insurance. My vision for the future, in answer to your question, is really speaking to a lot of what Dr. Davidoff was just talking about. Creating that environment, that sweet spot where you’re in an environment that honors and respects the patients that you care for, but also honors and respects the work that you do, so that you feel that the work you’re doing is work that you’re proud to deliver and work that is really physician-level work and that you’re making a difference in the lives of patients. You’re practicing ethically and you’re supported and valued and recognized. And that’s really the vision for the future.

I think that we are in the best position possible to do that. I know we’re not there yet, despite the AMA gold award there’s so much more work to do. This is not a Permanente Medicine problem, this is a national problem, but I’m confident that it’s going to be a Permanente Medicine solution because only physicians are going to be incentivized to fix this problem. There’s no insurance company or venture capitalists or outside consulting business firm that’s going to solve it for us. It’s going to be physician led, physician run, and I know with Ramin’s partnership and the rest of the Permanente Medical Groups, we are going to figure it out because we have to.

CG: I love it. Ramin, I’d love to close with your perspective.

RD: It was so beautifully said by Maria. I started practicing in 1998, and I can tell you in a million years I would’ve never thought to be in this position first and foremost, but also to work and lead through a pandemic of a generation, of a century, that we’ve had to deal with. And I just started out in 1998 as a urologist in our Baldwin Park facility here in Southern California, just trying to be the best physician that I could be. It was important for me that my patients felt comfortable with their care in my hands. So I wanted to be the best physician, the best surgeon, the best consultant, and the best colleague that I could be. I knew I couldn’t be the best at all of those. I just wanted to be the best that I could be.

And many of those principles truly helped me get through the difficult moments throughout the pandemic because I actually started this position right when the pandemic was starting, through wave after wave of surges that we were experiencing, the shutdowns in our society, and hospitals full of patients. [I] was really worried about our people, how we’re going to get through this. And many of those guiding principles really helped me figure out ways — along with members of my team and the rest of the Permanente Medical Groups — to get our patients, our members, our health care system through this massive crisis that we were facing.

I do know that the future is very bright for us. First of all, we have a tremendous collaborative model. Most importantly though, we have the right people, we have the right value system, we have the right ethos to practice the type and brand of medicine that our communities truly deserve, which brings value to the communities that we serve. And that’s super critically important.

I think that the experience 20 years from now is going to be completely different. It’s going to be a different patient experience. Disease and illness will never be eradicated completely, but health care will really, in the future, focus on prevention and management of chronic disease, population health, and coordinated care, things that we are exceptional at, and we still need to continue to get better at. We can’t stay complacent.

In our physician-led model, our people; use of science, data, technology; helping identify diseases earlier; intervening proactively; and better understanding progression of disease is what the future of health care would and will look like in the future. And so, helping our physicians reach and treat and engage patients so that they could receive the best possible quality care is the way to go in our roles, myself and Dr. Ansari’s role is to help create that environment.

I also believe that predictive analytics and precision medicine will be at the center of the discussion around everything that we do and the way we deliver effective health care in the coming months and years. Our future is incredibly bright. We cannot be complacent. We need to continue to improve and get better each and every day. And that’s why I’m very confident about our future as an organization.

CG: Wow, we covered a lot of ground in a both complex and exciting moment in the history of health care and listening to both of you, I have such extraordinary optimism about the future. We don’t have all the answers as you pointed out, but we have the leadership and the passion, and we’re well on our way. It’s always such a pleasure speaking with both of you. Every time we’re together, time flies and I feel energized every time we talk about the present and the future of medicine.

It’s such an honor to team with you, to work with you, and to focus on transforming care for all Kaiser Permanente members, but also for the nation as a whole. Thanks so much for coming back and for sharing your wisdom with our listeners. I so appreciate both of your leadership and look forward to the future. Thank you both.

And thank you once again to our listeners for tuning in. We have a lot more great guests this coming season, so please take a moment to subscribe to make sure you get every new episode when it drops. We’ll see you next time.

The opinions expressed on this podcast are those of the speakers and are not necessarily the views of Kaiser Permanente, the Permanente Medical Groups, or The Permanente Federation.