Recently, we had the pleasure of introducing Dr. Robert M. Pearl, M.D. to our headquarters for a special fireside chat with CEO Aaron Levie. Declared one of the most powerful physician-leaders in the nation by Modern Healthcare, Dr. Pearl is Executive Director and CEO of the Kaiser Permanente Medical Group and also serves as President and CEO of the Kaiser Permanente Mid-Atlantic Medical Group.
As CEO of the largest medical group in the nation, Dr. Pearl is responsible for the healthcare of 3.4 million Kaiser Permanente members and oversees 8,000 physicians and 33,000 staff members across 21 medical centers in Northern California. He also oversees, as President and CEO of the Mid-Atlantic Permanente Medical Group, the health care provided to more than 600,000 Kaiser Permanente members in Maryland, Virginia and the District of Columbia. Dr. Pearl is a board-certified physician in plastic and reconstructive surgery specializing in correcting birth defects, such as cleft lip and cleft palate in children. He also is on the faculty at Stanford University Graduate School of Business where he teaches a course on strategy that I had the pleasure to guest lecture in last year.
During his talk, Dr. Pearl discussed how Kaiser has leveraged health IT to become a global high quality leader in care delivery. By combining an integrated delivery system with digital tools, Kaiser has uniquely positioned itself to redefine the practice of medicine. Dr. Pearl explained, “We’re both a health care and a technology company, providing the highest quality and most convenient service using advanced IT solutions. Our goal is to provide nation leading health care that is both high-tech and high-touch.”
Their integrated system enabled Kaiser to invest in technology early, increasing access to patient care
When asked how Kaiser Permanente became such a strong health IT leader, Dr. Pearl explained that it is a combination of their highly integrated and physician-led system as well as how they leverage IT solutions for rapid access to patient care. In his February 2014 Health Affairs article titled, “Internet, Mobile and Video: Lessons from Kaiser Permanente,” he focused on the power these 21st century tools can have in patient care. He explained that historically “the underuse of internet, mobile, and video technologies across the U.S. healthcare system was driven by two factors: the predominant fee-for-service payment model, which reimburses providers only for face-to-face visits, and the barriers posed by the financial and other resources necessary to implement these technologies and integrate them into care delivery workflows.”
Even today, Medicare does not pay providers for virtual care (except in rural areas) and commercial insurers are reimbursing telemedicine on a state-by-state basis. Because of its integrated model, Kaiser has avoided many of these limitations, and has embraced both computer and mobile-based applications and tools. At no charge, patients can access a suite of patient-friendly internet, mobile and video tools including online appointment scheduling, prescription refills, preventive and disease management apps, remote physician video-visits and secure emailing with doctors. Today Kaiser Permanente provides more than 100 internet, mobile, and video applications that give patients the ability to review disease and procedure-specific information; access their personal health information; and manage their healthcare online.
This investment has paid off. According to Dr. Pearl, Kaiser Permanente in Northern California provided 15 million in-person patient visits and 11 million virtual visits last year through video, secure email messaging, and digital imagery. He expects that number to increase to 18 million virtual visits from 2016 to 2017, ultimately overtaking in-person care office visits. Part of Kaiser Permanente’s success is the younger age of their physicians compared to the general community, and their ability to be very selective in choosing physicians, with 10 applicants for every opening daily.
The transition from regional to digital care offers patients more flexibility and choice
The transition from care having to be in the doctor’s office Monday through Friday to the patient being able to obtain care “wherever, whenever and however they want” has provided patients with more flexibility and choice. Dr. Pearl emphasized the importance of understanding “choice” in a 21st century context. In the past, choice meant being given a thick directory of doctors each January 1st by your insurance company, but with limited control over the actual health care experience itself. In the future, he believes patients will have increased control over their care experience and how they choose to interact with their physicians. His goal is to eliminate distance and time for the patient, so that through a variety of computer, mobile and video applications, people can obtain information about their medical problems, receive medical treatment and have their questions answered immediately, wherever they may be. He pointed out that in the particularly busy Silicon Valley, this is what people have come to expect from other major industries like retail, travel and financial institutions— and healthcare should be no different.
Kaiser Permanente has successfully shown that video visits using encrypted web-based video built into Kaiser’s physician web pages (My Doctor Online) do in fact provide convenient and high quality care. Pregnancy care, dermatology and after hours urgent care have been quite successful. Secure messaging and mini-phone appointments with doctors have also proven popular in primary care. When surveyed, 90% of the Kaiser career physicians said that the availability of online tools allowed them to provide higher quality care for their patients and accounts for the high physician retention rate at The Permanente Medical Group
In the future, the patient will own their own medical record
Dr. Pearl also commented on the nature of access to patient medical records for both patients and doctors. He says that physicians value being able to access patient information outside of the normal office hours from their home or mobile device. Since Kaiser Permanente has had its Electronic Health Record (EHR) system in place for over 7 years, it is rare for a physician to need information that is not immediately available to them online.
When asked about the future, Dr. Pearl believes that patients will carry their full medical record on their smart phone, and increasingly will be able to serve as their own “first-line-of-triage.” The availability of information has allowed patients to take more control of their lives and decide for themselves when to consult the “expert.” Building the technology and assembling the medical knowledge in an easy-to-access format for patients is the next step, and these apps are already under way. While Kaiser Permanente members have access to their complete medical record 24X7 regardless of which of the Kaiser facility they choose, this is not the reality for the rest of the healthcare delivery system.
In the future, Dr. Pearl hopes that doctors will be able to store patient records in a cloud-based platform that can be accessed any time and anywhere, becoming a “life-saving tool” during health-related emergencies or before procedures at an out-of-plan doctor’s office. This medical record platform will need to integrate records instantly for patients with multiple doctors and securely store and view all of the information in one efficient application. Dr. Pearls believes this type of cloud-based platform is a major opportunity for Box. He thinks the Affordable Care Act will serve as an accelerator, since this legislation will force changes in healthcare payment models, technology adoption, and approaches to medical care.
Without question, in the future, IT will be even more pivotal in supporting value-based, high quality, personalized healthcare delivery. And as pressure from the government and commercial insurance carriers forces doctors to become more efficient in their operations, we can expect the EHR market to mature and support more cloud and mobile-based workflows. Kaiser is way ahead of the curve because of its unique integrated nature between its doctors, hospitals and health plan. The rest of the country is not only looking at Kaiser as a model of high quality, integrated care delivery and superior patient outcomes, but also as an innovative health IT pioneer. Dr. Pearl closed by saying that the future of healthcare is bright and that advanced IT applications and tools will become increasingly powerful and important over the next decade.
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