Being a head and neck surgeon has positioned me for every opportunity I’ve had at Kaiser Permanente. —Richard Isaacs, MD
Explore This IssueApril 2020
I believe we do prevention better than anybody in the country because our physicians and staff have an almost relentless focus on it. We consider every interaction we have with our patients—in person, on the phone, via secure email, etc.—to be an opportunity to practice preventive medicine.
This focus on prevention has significantly improved individual and population health, created better patient care experiences, and controlled costs. As an example, Kaiser Permanente Northern California members are 52 percent less likely to die from colorectal cancer—and our total number of colorectal cancer cases has decreased by 26 percent—since TPMG successfully launched an integrated and comprehensive screening program.
At the same time, we have centers of excellence that rival the best in the world because our surgeons get really good at what they do, given the volume of patients we have. One great example is the work we’re doing with thoracic surgery. In Northern California, we shifted thoracic surgery cases from 16 hospitals to five designated specialty-care centers. And a study showed that by shifting lung cancer surgery to designated centers, we reduced the number of days patients spent in the hospital, decreased intensive care use, and reduced post-operative complications.
We also saw an increase in the use of minimally invasive, video-assisted thoracoscopic surgery, and the average operating time for these types of surgeries decreased. This is a model for the country.
Dr. Chiu: It’s also almost like the Shouldice Hernia Hospital model, where you get so good at what you’re doing that you’re going to do it cost-effectively as well as more safely for the patient, with better outcomes.
Dr. Isaacs: Exactly. We developed a center of excellence for cancer care, and every Thursday we have Sloan-Kettering-like grand rounds, where every surgical oncologist, every radiation oncologist, reviews every patient. And we do it within telemedicine: There’s a hub in Santa Clara, there’s a hub in Oakland, and there’s a hub in greater Sacramento. But when it comes time to make the clinical decisions and have a tumor board, patients have the benefit of a large group of experts evaluating their cases and making comprehensive and coordinated treatment plans.
Dr. Chiu: You clearly are a physician-run health system. What do you think the advantages are of that versus the non-physician-run health systems that seem to populate the country?
Dr. Isaacs: I believe it’s important to have physician leadership in healthcare organizations, because the focus will be on care delivery. At TPMG, for example, we don’t answer to a health plan; we work in conjunction with a health plan. The benefit of this arrangement is that the incentives are very much aligned. Our program is largely pre-paid, like it was in the Mojave Desert more than 80 years ago, so the focus is on population health and doing the right thing for patient care. If you lead with quality, you are creating a model that helps ensure patients are getting the care they need, as opposed to the fee-for-service model that provides incentives for providing more care, but not necessarily better care.
Dr. Chiu: How do you address burnout within your physician group?
Dr. Isaacs: When I assumed the role of CEO nearly three years ago, I created a strategy with The Permanente Medical Group’s board of directors that is focused on what I call total performance. There are three components to total performance: joy and meaning in medicine, exceptional care experience, and operational excellence.
Our Joy and Meaning in Medicine program, or JAMM as we call it, is about more than striving for the absence of clinician burnout. It’s about helping our physicians and staff reconnect to their purpose by optimizing workflows and tools that enable them to focus more of their time on work that is meaningful and makes a positive impact on the lives of others.
Our operational leaders have been closely engaged in the development and execution of JAMM, and they are gathering data directly from our physicians to better understand the factors that affect JAMM in their day-to-day work.