Name: A New Metric For Healthy Living
Uploaded: 2019-04-02
Duration: 16 min 22 s
Description: Bernard Tyson sits down with Fortune editor-in-chief Clifton Leaf.

So what is this bolder metric of health that we should be looking at? [ BLANK_AUDIO ] I think it's an evolution of where we ultimately need to get to in the industry. And we're certainly working on it within Kaiser Permeanente. If you stop and look at historically how we've measured quality and the assumptions of quality, a lot of it has been based on process measurements, right, so you make an assumption that if you do certain things, certain things will happen. Right. So I think we're all starting to evolve much more to outcome measurements that is more relevant To the functionality of the person if you will as opposed to just the center please be in on the the care provided itself and I think the second part is you know really thinking through the Uber messages of measurements if you will which. For us is starting to really get better defined around the healthy life years of individuals. Mm- hm. So how do we start to quantify health over the lifespan of a person? And what are the things that we need to be working on and doing with the people to assist and to partner and better health for the long term. That lends itself to a question about As I call it, which lanes should we be in. And, it starts to force the rethinking of the ecosystem of health that would suggest that we should think broader Than just be in the medical care length because there are other determinants and factors and behaviors that in fact will impact the healthy life years of individuals much more than the intervention of medical care. I talked about the inputs and outputs of health, and that we weren't fully cognizant of what those would be But in the case of paying for health, in health care those inputs and outputs are also some what misguided too. As you point out, I mean most of where we spend our money in the last couple of years of life. Basically prolonging people who's life in many cases with very difficult interventions is phenomenally expensive, and that's where our investment is. But we're not investing In the systems that would help create those healthy life years earlier. So how are you changing that model. Well, I mean it goes back to I don't think that all of that fits into the lane of just medical care. So if you stop and think about it and I think Arianna kinda touched on this earlier bought lifestyle behavior changes those types of things. You think about the whole ecosystem around a individual that impacts your health. Where you live, do you live in areas with a infrastructure that lends itself to healthy lifestyles, healthy behaviors, how well you sleep. Those kinds of things that comes into context in a very Different way. I also think that as we continue to work on this together, the question is, how do we invest all the dollars in a longitudinal way that allows you to early on get to early detection, early diagnosis, early treatment, and to move away, at least in our experience, from episodic care being the solution, waiting until something happens. And I think now with the data that's available to us and as we're learning more with the use of data, as well as technology, allowing us to begin to think very differently There are different ways that you can monitor and oversee and some of the great things that our Permanente physicians are doing lends itself to that kind of practice changes that are going on. And you talk a lot about high touch, high tech, tell me, tell us rather, some of the technology that's sort of coming into play now that you think is game changing. Well, I mean I think you stop and think about the ways in which we can monitor and assist our patients and members at home, so the home environment things that will not require you to physically come in that's the salary for an appointment. I had something on my leg that was bothering me. And I wanted my dermatologist to take a look at it [ CROSSTALK ]. Yeah, you want to work on it? It's still, I got a little band- aid on it now, see? And was able to take a picture of it, and bring it to the doctor and take a look at it. And Then set up a virtual visit, and get all of that done without me having to come in. And you wanna move people out of the hospital setting, you wanna move them into their homes. Where they are, at their offices? Right, and then you have where we can have opportunities for our members To decide with the physician, should I come in for a physical visit, or can I do it virtually with telehealth and telehealth capabilities? Being able to make an appointment online, to be given those Choices and then in agreement with the physician, to decide what's the best approach to look after you. You got some blowback recently for a telemedicine visit in which somebody was told they had a Yeah, terminal disease in that and you said that it was unfair in terms of the criticism that you'd gotten on there. But talk a little bit about how you sort of make sure that those technologies are also being used sensitively. Yeah, I wouldn't say unfair. It wasn't factually all Correct, right? So the idea that we would have, as they call it, a robot to go in the room to tell a patient you're gonna die. I mean, we would never do anything like that. So what was missing was the whole team approach that happened with the doctors going in earlier and this is an extension of that And the idea that a robot is going in by itself and gonna provide it, that's not the scenario itself. Right. And having a professional in the room, a nurse or a physician, etc. But it is a lesson On and what we did talk about within Kaiser Permanente is to make sure that the high touch. If there's anything else we need to learn with the high touch, is what else do we need to do to make sure that at any point. Our members, or the family are not feeling that the tech Has taken over the church and is a reminder that the personal interaction and healthcare is still about touch, must be present at all times. You know, I mean, you obviously invest as a healthcare CEO and as a hospital CEO in technology, in buildings, in You know all of the resources that you need to run these massive hospitals. But you also have put huge investments in things that, you know, some might say we're sort of outside of the main highway for healthcare, the social determinants of health. You've invested in homelessness in. All sorts of mental health interventions that are outside of the traditional healthcare lane. Talk a little bit about that and why social determinants are more important than ever Well, in our model [ UNKNOWN ]. And by the way, we use the term, our line of sight is 1366 right now, it's approximately 13 13 Million members that we almost have. That you almost have. So we're at 12. 4 million tech- [ CROSSTALK ]. When I talk to you next month about, we'll- Yeah. Okay. And they live and exist in communities of 66 million people. Right, right. And so we are as engaged and involved in the infastructure of those communities that 13 million people are living in And / or $ 66 million residing, yeah. And so it is in that vein that we look at, what are the determinants of health that we should get actively engaged in? Whether it's directly, through initiatives like our $ 200 million initiative on the homeless and affordable housing. To advocacy around things like gun prevention and how to deal with gun violence or gun injuries without getting into the political debate of whether or not people should own guns. And so it is because we don't view ourselves as just a medical care program, we're a health system. These items become critically important as part of helping our members and helping our community maximize their health. I would love to get some comments, questions from the audience. So if you wanna have a question, or say something, please make yourself known and we'll get a paddle over to you, one of our runners. So while we're waiting for that, I, you know, it is so unusual for someone, if you think about who your customers are, you're saying that you're not just thinking about your 12. 4 million customers, you're thinking about the 66 million people who live Who are neighbors of your customers, who live and work with your customers. It's a completely different change of thinking and mindset. How do you make sure that you are providing You know, benefits for them that are really serving your customers most of all, I mean how do you. As a CEO you have to pick and choose what you do. Yeah right, I mean don't we don't ever miss the main thing our members, our purchaser. Customers Pay us to provide high quality care and services to our members, their employees, their family members, etc. So we don't miss that at all. But we also have an obligation to the communities in which we exist as a not for profit 501C3 corporation. Don't forget that line of sight as well. Right. I think where we have complete alignment. The issues that we're working on. What our members are also a benefit to the community and vice- versa. Mm- hm. So it's not like we're doing something unique for our members and then we have to think of something else for the communities- These issues covers the entire community, and so the homelessness issue is one example of that. We've got one right there please. Just let us know who you are too. Sure, I'm Megan Jones Bell. I'm Headspace's Chief Science Officer. I know that you are really forward thinking around mental health, and particularly the integration of Digital mental health solutions with in- person case. I'd just love if you could share any learnings about what's actually learning around that integration of technology. And that high touch service. Well and I'm glad you asked that, First of all, we believe strongly as I describe it, that the mental metaphor if you will is how to reconnect the head to the body when we think holistically about a total health agenda That has led us to really rethink everything from how do we design now, mental health services that is attached to the body. And that has led to in some of our, for example primary care facilities, in areas we've added now, mental health services. Where the handoff is seamless, like it is in any other part of the practice within Permanente medical groups. And so we have been very comfortable, for example, if you went in with a pain in your knee, and you went to see your primary care physician, and then all of a sudden That primary care physician wants you to see an orthopedic specialist, or someone. That's a smooth handoff. Well, that's the same concept we're using in some of our facilities that we're looking at driving that kind of approach, as well. And then, in addition to that is how to use technology in which it works for the patient, and it works for our specialist. To provide mental health services, where you might be dealing with an acuity level of mental health services, that it lends itself very well to the use of access through telephonic, and other methods. I think also, we're looking at what other types of technology we went to introduce. That serves as early warning signs for our members and for our deliveries. That will allow us to be more proactive in the prevention of episodic things happening as we go along as well. And that lines up very well with our model and with how we Always design the practice of care by our physicians and others in the Permanente Medical Group of Kaiser Permanente. We have another question. Could I also ask you about the cost of care? Because all these interventions are expensive, and you have such an ambitious agenda for change Talk about how you can control some of the cost of this. If we don't hear anything, one of the things we should all hear is the cry that healthcare is unaffordable, period, right? So I don't start with affordability equals let's manage our call structure. Affordability starts with really understanding what that means for what's coming out of people's pocket for us to do what we need to do. In that vein, I think that as we're talking about the opportunities to continue to transform How we deliver both care and coverage and everything that makes up healthcare. We have to rethink how we're gonna rebase our cost structure from our investments that we make that produces different results for our members, and for the American people in this case. I also think that we have to deal with how we A rest the escalation, the trend of the cost that goes up every year. That is the challenge that we have in front of us. And so, if we are for example, investing a lot in the technology. To create new access point through technology, that is a very different course structure than building a medical office, having staff everywhere all those kinds of the things. Overtime you gotta reconcile those two financial models if you will. In which the results are different. At least, in our case, we are still working through there because as we create more convenience, people are using it even more and we need to figure out how much of that fits into the lifetime cause as supposed to the episodic here. Alright, well thank you very much for not [ CROSS TALK ] Thank you. CEO, [ APPLAUSE ] That was a good meeting, thank you. Thank you CEO. It's so good to see you. [ BLANK_AUDIO ]

A New Metric For Healthy Living 

Health

Bernard Tyson sits down with Fortune editor-in-chief Clifton Leaf. 