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Becker’s Healthcare Podcast
Addressing Workforce Shortages and Shaping the Future of Care at Kaiser Permanente
00:14:29
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- [00:00]
A
This is Scott Becker with the Becker Healthcare Podcast. We're thrilled today to be joined by Dr. Steve Parodi. Dr. Peroti is the executive vice president of the Permanente Medical Group. Brilliant leader, both generally an infectious disease as well. Dr. Paroti, can you take a moment and introduce yourself and tell us a little bit about your background?
- [00:24]
B
Sure, yeah. It's great to be with you, Scott. And I am, as you just referenced, an infectious disease physician. I've been with the Permanente Medical Group for 23 years. Years. And still practice and then have a role as the executive vice president for external affairs, communications, and brand for the Permanente Federation, which represents the 25,000 physicians that practice at Kaiser Permanente. And of course, Kaiser Permanente is an integrated care and coverage system that takes care of 12 and a half million patients in eight states and the District of Columbia.
- [00:55]
A
Thank you. And Kaiser Permanente, I think everybody probably recognizes this is the largest, not for. And just a magnificent system and amazing what they've done over the last few decades. Dr. Purdy, when you look at healthcare, what do you see as the most significant challenges facing the industry? And how is Kaiser Permanente trying to address it?
- [01:13]
B
It's a great question, Scott. There's so many pieces to this, but I'm going to pick one here, which is that we are facing an ongoing and looming physician workforce shortage in the United States. So you may be familiar with the fact that AAMC actually published a report back in 20 that showed that we are facing a shortage of up to 86,000 physicians by year 2036. And it's really due to a combination of demographics, aging patient population that needs more care, significant amount of the physician workforce is actually reaching retirement age. And then the fact that we've already got shortages in rural and some urban centers for underserved patients. And then the last part here is that physicians are voluntarily leaving the workforce due to burnout and other causes. So what are we doing about this? So the Permanente medical groups have been taking several approaches to addressing this issue. So first is that can we make the practices more sustainable? And we introduced about a year ago ambient AI scribes into our primary care clinics and actually have now expanded that into multiple different specialties. And anecdotally, our primary care practitioners are saying that they are saving up to one to two hours of documentation time per day that used to be done after hours. But even more importantly than that, the patients and physicians are finding that the exam room time is more meaningful, it's more impactful because we're spending more time with each other rather than interfacing with a computer. The second thing we've done is we're offering increased flexibility with clinical schedules. So whether that's start times, end times, but also how you structure your day. So more virtual opportunities here from a telephonic video or e visit perspective. And that's been a welcome addition came out of the pandemic. But we certainly have built upon that. And in fact, about half of our visits now are virtual as opposed to being in person. Third area that we're focused on here is actually we've created what we call virtualist positions. This is actually where physicians are opting to move to a virtual only practice and they're supporting the in person practices in a number of different ways. The other thing that we're doing is that, you know, there's no way that you can take care of the increasing number of patients that have clinical needs and chronic conditions without a team. And so we've seen a growth in team based care over the years. You referenced how Kaiser Permanente has been committed to quality outcomes. So we get those cardiovascular and diabetic case management teams involved because we get better outcomes at the end of the day and it also helps allow us to see more patients at scale. And then the last thing I'll just mention on this subject is that we are active participants in the AMA's Joy in Medicine recognition program where we've demonstrated a commitment to reducing physician burnout. And I'll give you one example of how we're going about that, is that we've created leadership programs that provide practicing physicians early or even mid or late career with training options for pursuing research, operational leadership and other passions that they might want to pursue so that hopefully they can continue also providing patient care.
- [04:45]
A
No. And that's fantastic. Particularly this concept of giving people additional pathways. When you speak about the physician shortages, and I hear the number for the AMC that the 86,000. I'm not sure if that was the AMA or the AMC aamc. It seems like that number is so understated, quite frankly. It seems like we're already short in so many specialists throughout the country and access is getting more and more challenging. Any thoughts there? Because it seems like we're already at that spot, even though it sounds so much worse going forward. But it seems challenging already in many places. Any thoughts there, Dr. Brody?
- [05:19]
B
I think, Scott, you're exactly right. We already have a problem, and it's one that's not surprising if you think about it from a policy perspective. Up until just a couple of years ago, the number of residency slots that we had, you know, funded in the United States have been frozen essentially for 20 plus years. And you know, we had a few residency slots finally approved by Congress just about two years ago. But it's a thousand slots. It's sort of a drop in the bucket, if you will. So I, I do think that this is a looming issue that actually a current issue that we've got to address now. And so there, there are policy questions that need to be addressed to some of the operational actions that we're taking as a health system.
- [06:12]
A
No, but I think you're very right. It's both policy decisions as to where do those residency spots go, what specialties, primary care or otherwise, and then how do they actually get funded and worked with. Couldn't agree with you more. And so many other issues as well. Talk for a second about pending health care policy changes and what's likely to have the biggest impact in 2026 and beyond and how is Permanente Medical Group looking in preparing for some of those changes?
- [06:41]
B
Yeah, so let me, let me give you item number one here, which is actually HR1, which represents, I think, a sea change in healthcare policy. The biggest that we've seen in a generation and the way I've been characterizing it for folks at Kaiser Permanente and others, is that this is the first major cut in government sponsored healthcare spending since World War II. And over the next 10 years, our patients are going to experience almost $1 trillion worth of cuts related primarily to Medicaid and the ACA program. And then on top of that, we've got the potential ending of the ACA tax credits that were instituted during the pandemic, which will, you know, likely leave additional patients without healthcare coverage. So how are we preparing for that? And really, I think the first step is to talk about how can we fully support people, patients, families who still qualify for coverage under the new rules that have been promulgated by HR1. And so we're working with our state departments of health to clarify how are we going to manage 6 month redeterminations? How are we going to support our patients either through knowledge or actually helping them fill out the forms or hopefully electronically do this using non licensed or licensed personnel? Can we partner with other community benefit organizations either from a funding perspective and or again to help with the paperwork when it comes to redeterminations. There's a second piece to this which is understanding that not everything is getting implemented at once. So this is actually phased in over the next 10 years. So there will be different funding steps and cliffs, to be quite honest with you, that we'll have to work through with our state partners to think about how can we minimize coverage loss. Because, Scott, you know, at the bottom line, if there's anything we've seen with healthcare policy over the last, I'd say 15, 20 years, is that when you do provide more coverage, you actually get better, better outcomes when it comes to preventive services, cardiovascular disease outcomes, cancer screening outcomes. And that's what's really on the line here. And so the messaging that we've been sharing with the physicians, with the staff, is that we remain committed to high quality care. We're committed to providing the services and help that our patients need to get through the redetermination processes.
- [09:20]
A
Thank you. And I think your point is so well taken. You could be all over the board on the spectrum of how health should be funded, but I think most people have come to the conclusion that having coverage for everybody is a good thing. Then we've got to figure out how to make sure there's enough supply, take care of everybody, and so there's actual real access to go with it. But I think your point on coverage is so well taken and thank you for that. Dr. Purdy, let me ask you the next question. If you were to look at sort of what risks or investments are worth making now in a complicated changing healthcare environment, where's important to keep on taking risks or making investments?
- [09:57]
B
That's a great question, Scott, and I'm going to give you sort of the, the answer that, you know, doubling down on using AI effectively within healthcare is going to be critically important. And we've made some investments in generative AI systems that are helping us with, you know, advanced predictive analytics, both on the hospital side and ambulatory side, to understand which patients are at risk for clinical deterioration, which patients are at risk for being in need of services, whether those are medical, social or mental health and behavioral in nature. And we've seen early results where we have a system in place looking at and predicting clinical deterioration in the hospitalized population and been able to demonstrate that we can save up to 500 lives a year if we've got a team that's reviewing those results that are being served up by an AI and then actually prompting teams to respond to those results. And you know, what's really been gratifying about that particular program that I'm citing is that there's been an iterative process so that the humans are always in the loop when it comes to the clinical decision making, but they're also in the loop when it comes to the design of what this AI is prompting. And if something's not working right, the clinicians on the ground, as well as the IT developers are connected to each other so that we can make improvements. So I think we're going to need to do more of those types of investments. And the reason I cite that is I think it's relevant to what we were talking about earlier. How are you going to scale the existing workforce? And even if we are able to expand the workforce through some policy decisions, we're going to have a very large aged population. I mean, it's just the reality from a demographics perspective. And so if you want to be able to expand the reach of our existing workforce, or whatever the new workforce of tomorrow is, it's going to need to be supported by AI.
- [12:06]
A
Thank you. And I think your point on both technology, AI and people, and trying to make this work together is so important. Both the physician, the nurses, the technology together to make it work. Dr. Purdy, when you look at the best opportunities for growth going forward, how do you think about opportunities for growth?
- [12:27]
B
So when I think about this, I think there's a tremendous opportunity to think about where we provide the health care of the future. And of course, the traditional model has been a person comes to see us, they're seeing us in a clinic, they're seeing us in the office, or seeing us in a hospital or emergency room. I think there's going to be more integration of healthcare into the home setting. And, you know, we actually have examples of what that looks like born out of the necessity of providing more hospital capacity during the pandemic, where we implemented an advanced care at home program, which is essentially providing hospitalized care in the home and using a combination of on the ground teams, remote teams, as well as technology and remote patient monitoring. We now have an average daily census of 30 to 40 patients per day that are getting hospital care in the home. And that's provided us with some insights into, you know, not only being able to provide that kind of care, but also saying, okay, well, what other applications would this look like? Either from a home health perspective, a condition continuum of care perspective, or, you know, basic levels of care that don't require in person, in home care, but could be done remotely with a clinician connecting to their patient into the home virtually. So I think that's the tremendous opportunity of the future. And to be honest with you, that's actually what patients want. They want to be able to get care where they are and when they want it. And this is an example of the healthcare system becoming responsive to that desire and need.
- [14:05]
A
Steve Dr. Perotti, I want to thank you so much for joining us today. It's such a pleasure to visit with you and hear your perspective. Obviously, we have huge regard for the Kaiser Permanente System, the Permanente Medical Group, and great theater leadership like you speaking about the challenges going forward and how we try and make this work. Thank you so much for joining us today on the Beckers Healthcare Podcast.
- [14:26]
B
Thank you for having me. Scott.