Podcast: Navigating change and challenges facing health care

Maria Ansari, MD, shares her journey, what she’s learned about leadership, and her vision for integrated, value-based care

Through her first 100 days as co-CEO of The Permanente Federation and executive leader of 2 Permanente Medical Groups, Maria Ansari, MD, FACC, has been at the center of critical discussions focused on the present and future of health care. This includes navigating challenges around staffing shortages, financial industry challenges, as well as physician and clinician burnout.

As CEO and executive director of The Permanente Medical Group (TPMG) and president and CEO of the Mid-Atlantic Permanente Medical Group (MAPMG), Dr. Ansari leads 2 of the largest and most accomplished medical groups in the nation. Through this lens, she offers a glimpse into her areas of focus while supporting the work of nearly 24,000 Permanente physicians and 80,000 staff who serve 12.6 million Kaiser Permanente members.

“I think we can be at the leading edge of transformation in care,” Dr. Ansari says in her conversation with podcast host Chris Grant, chief operating officer and executive vice president of the Federation. “It’s in our DNA to be innovative and think outside the box.”

Dr. Ansari also shares some of her keys to navigating this transformational period in medicine while championing Kaiser Permanente’s model for value-based integrated care. In doing so, she also underscores how this model is key for providing high-quality care to individuals amid an evolving health care landscape.

The world around us is finally seeing that this integrated model is actually improving the lives of patients, having them live longer and healthier lives.

– Maria Ansari, MD, FACC

Dr. Ansari is the first woman leader in the 75-year history of TPMG and first female CEO for MAPMG. Using her personal learnings, she shares insights on the podcast on the path being paved for emerging women leaders in medicine and offers advice for young physicians starting out on their career journey.

“My advice to women and physicians who are interested in leadership is to get rid of that notion of what you think a leader should look like and look in the mirror,” she says.

Related story: “Permanente Federation co-CEOs talk health care innovation, quality, and physician leadership”

In this episode

2:00 Dr. Ansari’s reflections on her first 100 days

3:24 Passion for cooking and other interests outside of medicine

7:44 Dr. Ansari’s 5 priorities for the current health care environment

10:02 Inspiring female doctors and the changing face of leadership in medicine

13:33 Touting value-based care through a period of tremendous innovation

17:49 Investing in the future and building a strong physician pipeline

18:35 Advice for people starting out on their career path in medicine

Connect with Chris Grant on X (formerly Twitter) at @cmgrant and Dr. Ansari at @MariaAnsariMD.

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: When you’re part of something bigger than yourself, when you start to change and impact care on a broader level and really elevate the health of a community, because the lane of a physician is not just in the office or in the hospital, it’s really within the social fabric of our communities. 

Chris Grant: Hello, I’m Chris Grant, chief operating officer at Kaiser Permanente, The Permanente Federation, and I’m pleased to share with you a special bonus episode of the Permanente Medicine Podcast. As we navigate a period of great change and accelerated innovation in health care, physician leadership is more important than ever. But what does an ideal future for medicine look like and how do we get there? 

Earlier this year, my guest, Dr. Maria Ansari, assumed the leadership role of CEO and executive director of The Permanente Medical Group and president and CEO of the Mid-Atlantic Permanente Medical Group, which combined have more than 11,000 physicians and almost 45,000 staff delivering high-quality health care to more than 5.4 million Kaiser Permanente members in northern California, Maryland, Virginia, and Washington D.C. She’s also co-CEO of The Permanente Federation, which serves the national interests of the Permanente Medical Groups. Maria recently marked her first 100 days in these roles, and I’ve asked her to reflect upon what she’s learned and her vision for looking forward. Maria, I want to thank you for joining us on the show today. I’ve had the pleasure of seeing your exceptional leadership up close in our work within the Federation, as well as at [Kaiser Permanente] San Francisco, and I’m so excited for our audience to get to know you a little better today. 

MA: Well, thank you. I just marked 100 days and it’s been quite an experience, just tremendous talent, commitment from our people, and I’m really proud to lead during this time. It’s definitely a challenging time to lead, but I also think that leading when change is hard is also exciting. I think we often think about change being hard, but I think it’s the resistance to change that exhausts us and we’re going to fail if we stay in our comfort zone. And so I always say success is not a comfortable procedure and we’re in a zone of discomfort, but we’re going to be successful and we have to work through that. And that’s been kind of some of my realization during the first 100 days is creating some changes that don’t always feel frictionless. 

CG: Yeah, it’s such great insight and I often use the salient analogy where you can have the strongest, most enormous headwinds, but if you’re a thoughtful sailor and skilled, you can turn the sails and navigate through headwinds and actually get momentum. So I love your focus on leading through hard times. It certainly is really quite rewarding. 

MA: I was just about to say I think that it’s more rewarding when you work through that. It’s not smooth sailing, but it just makes the reward that much greater. 

CG: Yeah, it’s so true. Alright, we’re going to get to hard hitting questions in a moment, but I’d like to start out on a personal note. We’ve been friends reaching back about 12 years, and I’d really like to give our audience a glimpse into Dr. Ansari, the person. Could you share something about yourself outside of work that perhaps our audience might not know about you? 

MA: Sure. Well, you might be surprised to know that I’m a good cook. I know it seems like it might be hard to find time to cook, but my family are immigrants. We traveled a lot when I was growing up and I think there’s just so much connection through food and food from all over the world. So I have a little bit of wanderlust where I’ve traveled a lot since I was little and I’ve enjoyed food from all parts of the world. So during the pandemic, I joined a virtual cooking club and we met every Sunday and cooked our way through the pandemic. And now I think I’m a much better cook because of it. And of course, my favorite food is Persian food. 

CG: I’ve actually heard that you’re quite a gourmet. 

MA: Yeah, I’m a foodie at heart. And then to balance it all out, I’m a Peloton fiend. I love the Peloton. It’s good for my mental health, but also helps with the foodie part of me. 

CG: So an hour of cooking and an hour on the Peloton to follow it. It makes sense. 

MA: Half-an-hour on the Peloton, that’s all. 

CG: Alright. How do you go about prioritizing all of the important work at hand and are there certain areas of focus that you feel particularly passionate about in the coming months and years? 

MA: It’s a good question. I think when you’re at the 30,000-foot view, there’s so much that you could get involved with and so much that, especially in this time of disruptive change in the external environment, and the world’s changed. People want different things. The expectations are different. There’s a backlog in care, so the world is really changing. And so what I really try to do is focus on the highest priority areas. I have five priority areas that I’m working on right now, but I would say the one that I focus on the most is really around innovation and transformation of care. I think that we can be at the leading edge of that. It’s in our DNA to be innovative, to think outside the box. We’re not beholden to the typical payer regulations because we work in a value-based system, a capitated model where we can really manage an entire population in a vertically integrated program. 

And I think Cecil Cutting said it best. He was one of our founding partners in Permanente Medicine and he said, this may well have been the most extraordinary experiment in the delivery of health care the world has ever seen. And I think we’re still experimenting, we’re still innovating as we go. And the future is more consumerism. Patients want the same experience that they have outside of health care within health care, where they are care, when they want it, how they want it, where they want it, and then there’s more likely to be more care at home. And so how do we use digital support tools to allow us to care for patients at home. And thinking about just one other thing I’d like to say about that is for Kaiser Permanente going into people’s home, we have a trusted relationship. And so I think that that’s different than Amazon going into your home, for instance, or other retail giants going into your home, that we’re building on 75 years of trust. 

CG: Yeah, absolutely. Certainly in the last three, four years, we’ve seen the greatest transformation of both consumer-centric care, where we serve patients, where they are, when they need us most, at the moment they need us. So Maria, you mentioned your five priorities. I know what they are, but I know that some of our listeners are going, I can’t wait to hear. So maybe you could shed a little bit of light onto your five. 

MA: Sure. Well, I think it starts with recruitment and retention. This is because the workforce has been burned out post pandemic and really having a talented staff and committed staff is super important to our success as an organization. The other is desktop medicine, otherwise known as the physician in basket. And that has become a big challenge for our physicians to keep up with, but it’s also been a great source of communication with our patients. Third is really a virtual urgent care model to be able to provide convenient care. I would like to be able to do it 24/7 eventually. Fourth is innovation, and fifth is financial stewardship to help health care become more affordable so that patients can have better access to health care. 

CG: It’s a great list of priorities and it’s kind of succinct and clear. And when you can create that level of clarity from a strategy standpoint, everybody can align in a thoughtful way to address a key set, and a finite set, of really, really important priorities. 

MA: And I think that the priorities have both a patient-facing component and the provider side, our clinicians, our doctors, our nurses, our physician’s assistants, our nurse practitioners. It’s really looking from both lenses; how can we enhance care for our patients and also have a viable workforce and organization to serve those needs. 

CG: On that note, as the first woman to lead both The Permanente Medical Group in Northern California and the Mid-Atlantic Permanente Medical Group, you’re a great role model for young female physicians, and quite frankly, for all of us who aspire to be future health care leaders. What does being the first woman to lead in these medical groups mean to you? And what advice do you have for women in medicine who are contemplating the role as a physician leader? 

MA: Well, I’m super proud to be the first woman leader in our 75-year history for TPMG and first female CEO for MAPMG. I think the face of medicine is changing. So in primary care, 60% of the physician workforce are now women. So we’re starting to see more women. And I think it’s just a message that our leaders look like our physicians and anyone can be a leader. I think one of the things that I always kind of pictured that the leader was the person who was the endowed chair with the gray hair and the mustache, and you just put them up on a pedestal. But if you just look around you, we’re surrounded by people who exhibit leadership qualities, who are leading teams, who are creating change, who are inspiring people. And so I think there’s leaders among us, and I would say that I’m just like everyone else and somebody had to do it, but I am proud to do it. 

But I also just want to say that suspend your disbelief and my advice to women and physicians who are interested in leadership is to get rid of that notion of what you think a leader should look like and look in the mirror. Take on small projects. It’s your track record that should count. And I think the world is appreciating that more and more that lean into the work, demonstrate good work, contribute to the organizational good. And I think that’s the pathway to leadership, and that’s what motivates me is really to do the work. I view myself honestly as a vessel for all the other physicians to accomplish the greatness that they want to see in this organization. 

CG: I love your picture of suspending the picture of what makes a leader. I do think that for decades there’s textbooks and stereotypes of what a leader looks like. And this goes beyond the first woman, right? It doesn’t matter what age, shape, size, ethnicity, color, religion, gender orientation, you may be anything and everything’s possible. And in fact, we need that broadness of society to be the future. 

MA: I totally agree with that. And I think I always thought, well, if you’re going to be the CEO, then you have to talk like Obama, have the charisma of Ronald Reagan, or whatever. And it’s no, just be yourself. Just be yourself. And I think that there’s all sorts of, as you said, shapes and sizes and looks and voices, quiet people, introverts, extroverts, it doesn’t matter. I think it’s really about being your authentic self, doing good work, and leading change. 

CG: I love it. And for all of our listeners, that means you, every person that’s listening has a role to play in leading the future of health care. And there’s leadership within Kaiser Permanente and many health care organizations, quite frankly, that are calling upon you to step up and welcoming you to lead alongside. 

MA: That sounds like an invitation, Chris. Nice work. 

CG: It’s an invitation, it’s encouragement. We have a lot of medical school students and residents and fellows that tune into our podcast and they are the future. These past few years have represented some of the fastest innovation and greatest transformation we’ve ever witnessed in health care. This period has also put a spotlight on the importance of value-based care. So, Dr. Ansari, what do you see as some of the keys to navigating this transformational period in medicine and championing value-based care? 

MA: Yeah, I definitely feel that Kaiser Permanente is way ahead of the game in value-based care. We have a 75-year track record providing care in a vertically integrated model. And the world around us is finally seeing that this is actually improving the lives of patients, having them live longer and healthier lives. And what we need to do is stay ahead of that. There’s a lot of other groups that are out there touting value-based care, and I just want to caution that not all value-based care is alike. Receiving extra payment for a good quality outcome is not the same as value-based care, at least not in terms of a population health-based care, equitable health care. And I think what we need to do is really think differently as we go forward as to what that’s going to look like in the future. And what I think is going to be an asset-light system where we’re going to provide more and more care outside the walls of a hospital and clinic setting. 

And that usually means going back to the patient’s home. I always think about the more things change, the more they look the same. And so going back to the early days of medicine when we provided care in people’s homes, I do think that that’s part of the future. I think using technology and AI for population-based health and for individual prediction of disease and disease management. So I think value-based care will take population health, which some might say is somewhat of a crude approach, and really use technology to make it more precise and have predictive analytics to take care of a large group of a community and lift up their health collectively, but have it tailored to the individual patient. And we’ve been doing that. You can go in to see your dermatologist or get your eye examined and we will remind you to get your mammogram. 

And it’s more than that now. Now we’re using AI to look at women who are due for their mammogram. And we’re using that AI to say beyond just the age and the general prediction of whether you’re going to have breast cancer by usual means, we’re using thousands of data points looking at your prior normal mammogram to see what biomarkers are present on the imaging radiograph that’s going to predict that you’re actually more likely than other women, also with normal mammograms, to get breast cancer. And so augmenting our traditional risk factor assessment using technology, this is value-based care. We are caring for the entire population, and the most desired outcome for the patient and the most desired outcome in our system is to never get cancer. And that’s why our cancer rates are 30% lower than the rest of the population. 

CG: Yeah, it’s just beautiful. So the future of value-based care is personalized care, it’s using data analytics and predictive analytics, and it’s delivering care where people are in the most convenient way to meet their needs. I’ve seen you as a fervent advocate for making those investments; to have the technology and the data analytic capabilities takes upfront investment, both investment of physician know-how and analytic expertise, as well as software and hardware investments. And you’ve just been an advocate and a champion for those investments in order to help realize what that futur’ may hold. 

MA: The company that recruits the best, top talent is the one that’s going to succeed because it really does come from caring for patients and having that curiosity and the ability to innovate. And so having a physician-led and physician-run organization is a big part of that. And to feed that, you need the best clinicians. 

CG: So at the core of the Dr. Ansari strategy is recruiting the best and brightest to help create the future. And I think that’s a great segueway into this next question. You’re truly an inspiring leader with a constant eye on what’s next in health care, and we’ve talked a bit about that today. Let’s think about the future here. What guidance would you give to those who are just starting out on their journey into this field? Maybe they’re premed in undergraduate, or maybe they just got accepted into medical school. What advice would you give them and what’s your hope for the future of medicine? 

MA: I love that question. There’s no other profession that I would’ve gone into than medicine. One of my colleagues once said that the most intimate thing a person will do is seek health care. Seeking health care, it’s a very intimate act where they’re trusting you with something very personal, their health, and they tell you things that they might not tell other family members or somebody from their clergy or whatever. You have the privilege to provide that care to be in that space and to change the trajectory of someone’s life. There’s science behind it, so there’s discovery. And so you get to use your intellect. There’s a personal component, an emotional connection component with that patient, and then changing the face of their future, not just at an individual level, which I think is where you get the good feels, but also when you’re part of something bigger than yourself, when you start to change and impact care on a broader level and really elevate the health of a community, because the lane of a physician is not just in the office or in the hospital. It’s really within the social fabric of our communities impacting everything from health equity, access to care, food insecurity, violence in our communities, public health issues that threaten the health of our community from climate change on. And so, the opportunities are endless, and your ability to impact, you actually have a voice, and you actually have the skills and tools to change the health of the community. So I would just say there’s no better profession. It’s very rewarding, and there’s many lanes to participate in. 

CG: Yeah, I couldn’t agree with you more. It’s really interesting listening to you, Maria, as you oversee 11,000 doctors and 45,000 employees, it’s kind of a monumental role and task, almost overwhelming just thinking about it. But when you talk about the profession, you talk about it at the most intimate level. And I often say that we meet people side by side with them at either the happiest moments of their life, maybe they’re having a baby, but often at the scariest moments of their life. It could be a heart attack or a cancer diagnosis, and we help them through that journey, both with physical medicine and emotionally. And your point about impacting communities is so true. I’ve read a lot of studies, and there’s no greater indicator of an individual’s future health, or quite frankly, their life expectancy, than the ZIP code that they live in. 

MA: Yeah. It’s our mission, right? To really improve the lives of the people who live in our community, where we live and where we work. 

CG: Right. Well, I hope that there are hundreds and thousands of Dr. Ansaris coming up through elementary school, middle school, high school, and into the medical schools that share your passion, your sense of accountability, and your sense of responsibility. The other thing that I’ve seen in you, and Maria, you talked about the future of care being innovation and data analytics supported, but also disproportionately, in the home. I remember being back at Harvard with you and walking back, and you had told me a story about you making house calls. And so to some extent, this journey of your time in health care of starting out making house calls in San Francisco to homebound and disadvantaged populations, and then now helping to develop technology and workflow and capabilities to deliver care to folks in the comfort of their home virtually, or video, or remote monitoring is just really a wonderful full circle. 

MA: Yeah. It’s hard to have predicted that a decade or so ago. 

CG: So true. Well, we could continue this conversation for hours, and I love every time I speak with Dr. Ansari, and it’s been a pleasure speaking with you today. Thank you for taking the time to be on our podcast and for sharing your insights. I think you’ve motivated an upcoming generation and also all those that are leading the charge today The future of Permanente Medicines in great hands with you helping to lead the way. I can’t wait to see what we accomplish together in the months and years ahead. 

MA: Chris, I want to thank you for your partnership and your leadership at the Federation and for your friendship. Thanks for having me. 

CG: Thank you, Maria. It’s such a privilege for all the same reasons that you so eloquently outlined. And thanks again to our listeners for tuning in this season. I’ve enjoyed sharing this special episode of the Permanente Medicine podcast and look forward to our new season coming in early 2024. Be sure to catch up with past episodes by searching for the podcast on your favorite streaming service, and I hope you take a moment to subscribe or share a review. We’ll see you next time.