← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Nolan Chang, MD, EVP of Corporate Development, Strategy, and Finance at The Permanente Federation LLC
00:19:41
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- [00:02]
Athenahealth Representative
@ Athenahealth, we know your ambulatory practice wants healthier a healthier business, healthier care teams, and healthier patients. But the complexities of modern healthcare tech make it hard for you and your care teams to focus on what matters most. That's where athenahealth can help our AI native all in one solutions reduce administrative burdens, streamline billing and payments, and deliver critical insights when clinicians need it most. That means fewer clicks, more time for patients, and stronger bottom Practicing medicine is complex, but running a practice can be that much simpler. With Athenahealth, see how simpler is healthier at athenahealth.com.
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Scott King
Hello everyone. This is Scott King with the Becker's Healthcare Podcast. I'm thrilled today to be joined by a very Special guest in Dr. Nolan Chang, Executive Vice President, Corporate Development Strategy and Finance with the Permanente Federation. Dr. Chang, how are you doing today?
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Dr. Nolan Chang
I'm great. How are you today, Scott?
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Scott King
I'm good. You know, it's actually kind of a nice sunny day in Chicago. We've had some good luck with weather the last few weeks here, but yeah, excited. It's Friday as we record to get to the weekend.
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Dr. Nolan Chang
And that's interesting that it's sunny in Chicago, but it's overcast and a little bit drizzly out here in Southern California.
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Scott King
It's quite the opposite of what you would think on any given day. I definitely agree with that.
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Dr. Nolan Chang
Exactly.
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Scott King
Maybe it'll switch up soon, but as we wait for the weather to get good for everyone, there is a lot going on in healthcare, Dr. Chang, so we have a lot to get to. I really want to get your opinion on some of the kind of the big topics and trends in healthcare. But before we get started, can you please just tell us a little about yourself and your work in healthcare?
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Dr. Nolan Chang
Yeah. Thank you, Scott. And thank you for having me. So, by training, I'm a family medicine physician, but like Scott said, I get to serve as the executive vice president in the Permanente Federation. It's the national arm of all the Permanente medical groups in Kaiser Permanente. And in that role, I have a broad set of responsibilities, including strategy, corporate development, finance, a lot of the business functions. And I really pursued this role because I think affordability is going to be, if not the biggest, one of the biggest challenges of our generation of healthcare professionals. And so it's something that I wanted to be able to jump into to make a difference and really improve the care that we deliver across the country for our patients.
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Scott King
That's fantastic. And Dr. Ching, I think we were talking before And I think you said you came into this role during the pandemic, is that correct?
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Dr. Nolan Chang
Yeah, maybe a few months in this specific role, a few months before the pandemic hit, and geez, it became a storm pretty quickly. I remember asking my colleagues that were in their roles longer, I was like, this, is this normal? And they said, absolutely not. And since that day of five years before, I'm just wondering when it's going to get back to normal.
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Scott King
Right, right. And you know, you can argue that it didn't, it didn't get back to normal. And the things are much different now. How, how interesting was that time for you to kind of take on way more than you probably bargained for. And do you, do you think that's kind of set you up to deal, kind of troubleshoot things and come up with solutions maybe quicker than you would have?
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Dr. Nolan Chang
Yeah, for sure. Definitely. The role is different, especially early on, than when I expected it to be. For me, the focus in coming to this role was how do I translate finances into ways that are meaningful for physicians? Because for physicians, we go, we spend many, many years, decades, if not training how to be the best clinicians. But if we're trying to solve for affordability, how do we see that not as a negative, but as a positive? Because we've taken this oath as physicians to be able to take care of our patients. And if one of their big pain points is affordability, how do we recognize that as a barrier to the care that we can deliver? But taking a step back then, when the pandemic hit, it was more thrust into how do we mobilize around a patient, keeping the patient and the needs at the center in a very resource limited environment as we know, whether it be protective equipment, ventilators, all these devices. And if all of a sudden the hospital census, inpatient census went up dramatically, were we going to have the beds, the technological platforms to be able to take care of them? It was a scramble in a limited resource kind of world. But in many ways, I think that it really helped prepare me for where we are today. We still have to provide those business functions, but how do we translate what we're seeing into financial performance? Because it really isn't the finances that drive the strategy of the organization. It should be the other way around. What's your strategy? What's the current environment? And how do the financial outcomes determine whether or not we're being successful in the midst of the pandemic? It was a raging fire. I think most people in health care right now say that the fire hasn't died down, maybe a little bit more smoldering. But there is a lot of uncertainty now and it continues to be resource limited. So how are we solving for these things? How are we adapting our systems as an organization to be able to empower our clinicians, our physicians, our healthcare teams to be able to take care of our patients who are in their own experiences and in their own world in a very tumultuous period of time.
- [04:57]
Scott King
Absolutely. And Dr. Chang, I think, you know, something that had really kind of hit its stride, or started to at least, and now it's kind of in full force for now, is AI. And you know, health systems use AI. They have so many uses for it. We're seeing, you know, other industries obviously use AI, but you know, it's reported that nearly half of medical practices reported using AI in some capacity in the last year. It remains a key topic for health IT leaders. From your perspective, what are the use cases that are now making a difference and how are you leveraging them in your organization?
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Dr. Nolan Chang
It's a fantastic question, and it's one, I think that's oftentimes pivotal for organizations because when we talk about artificial intelligence, it's technology which should be a part of your solution. It shouldn't replace your strategy. Technology, in my mind is not the strategy, it's how do you apply technology to your strategy? And we started this conversation talking about the pandemic. And it was great in Kaiser Perimeter that we already had a significant amount of investment in the infrastructure. So during the pandemic we went from maybe 90% in person and 10% virtual to flipping that to almost 98% virtual and 2% inpatient. And luckily we had a lot of the technologies in place and so the ability to text patients to let them know that we're ready. Because during that period of time, remember, people weren't willing to come in the building. And so we'd have people wait in the parking lots in their cars and be able to predict wait times and text them to let them know now it's safe to come in and be seen. Having the technological platforms to be able to do video visits, to be able to make sure that we're able to connect with patients. Because our organization, we're not just value based care, I like to say we're longitudinal value based care. To see me as a pre physician, you have to have KP insurance. And so our patients stay in the system for a lot longer. So that way we're able to deliver on outcomes and drive quality and affordability through that. And so what I oftentimes mean by that, if a patient's switching health plans every two to three years, it leads to more fragmented care. But if you stay in the system for 17 years or more, then you really can understand the return on things like investing in treating hypertension or a vaccine or preventative screening. And so that really aligns my interest with those of the patients. And why I say that is because that really highlights how we apply technology. So during the pandemic, being able to see somebody through a video visit was really powerful. To see the fears that they have in their eyes and the frustrations that they're experiencing allowed me to address their clinical need, but also the needs that they may not be aware of. But then you fast forward to what we're doing today. So I say we're longitudinal value based care, but we are a relationship based organization, primarily that relationship between a physician and the care team and a patient. But even between us and our regulators, us and our payers, we've applied technology over the past couple of years to be able to augment that. One of the big things that we've really highlighted out there is our ambient AI technology. We know that there's pain points, there are problems that our physicians are asking us to solve in regards to burnout and not having that connection with the patients. But we also hear that from our patients. We ask them about the experience. How was your time with your physician? It was frustrating for me to hear that sometimes my patients would say, doc, you're spending more time on the computer than you are with me. And that's heartbreaking because everything I'm putting into that computer really is to take care of a patient. But using ambient AI dictation systems allow me to sit, need an a face to face with my patient and have a really connected conversation where I'm not worried about the time of the day. Am I going to be able to capture everything by keystrokes? Allowing the technology to do that for me, not only improve the documentation but also improve the experience with our patients so that they have more confidence, more understanding what we're trying to do on the front end of a lot of these things. Something that we're really excited about is we were able to come up with something called the KP Intelligent Navigator, the Kaiser Permanent Intelligent Navigator. When I first started practicing over 20 years ago, the predominant interaction was face to face visit. But through some of the technology that I just mentioned, there's so many different tools that we have available now to be able to meet our patients needs, whether it be face to face, visits, visits, telephone, email, chat, you name it. This can be overwhelming for our patients because most of them are not medically trained. So when they interact with us, whether it be through our portal or one of our call center agents, they just tell us what's going on with them. But how do we connect them with the right resource? Because they don't know if this is something they need to go to the ER for or if this is something they can just do an E visit for. Right. But using large language models, we were able to leverage the experience of our physicians in getting our patients to the right resource. And so we've been excited because for our 4.9 million members in Southern California, we've deployed this technology and it's able to get the patient to the right place at the right time with almost a 98% accuracy and also, also almost a 9% increase in patient satisfaction. When we look at these things and it's caused some pretty scary things for patients that are really interacting the portal virtually and just typing things in. We've been able to catch things mining the patient's chart and saying, this patient's at high risk for a cardiac event. We need to get them to the er. And so there's been really some wonderful things that have come out and how we're applying artificial intelligence really to augment the relationship, let our patients know that we know them, even at the point of booking, leveraging all their past data, what the words that they're using, to be able to make sure that they're able to navigate the system in a seamless fashion. Because we don't want patients spending their discretionary energy trying to figure out where do I need to go? We want to connect them, make sure that we're able to address the concerns that they have.
- [10:45]
Scott King
Yeah, I think that's great. A lot of times when we talk with system leaders, you know, their focus in utilizing AI is kind of just system wide for efficiency. So it's, I think it's wonderful to hear how patient focused yours has been. And as virtual care expands from AI enabled tools and remote monitoring to the broader digital health platforms, introducing new technology brings challenges. So what advice do you have for leaders trying to navigate everything from governance to patient engagement? And can you share an example of how your organization has balanced innovation with operational constraints?
- [11:22]
Dr. Nolan Chang
Yes, Scott, that's a wonderful question because I think you articulated a lot of the challenges. Right. So as you bring on all these different technologies to be able to address Pain points. One of the things uniquely for us is, you know, Kaiser Permanente, we're an integrated system. So we have the health plan, we have the hospital system and delivery system and the physician groups. We're able to look at that and say, how do we integrate this into a unique patient experience? Because it's not the technology and the people and the facilities and the experience that are separate. Right. All these elements have to come together, if done well, to create a cohesive experience. Because in as you bring in different technologies, as we adopt change, everybody knows the hype curve. There's a point where it gets more complicated as you add more on and before it becomes seamless and the patients can get lost in that. For us as an organization, we always try to take a step back and say, what's the problem that we're trying to solve? And then go from there. Then what's the role of each of the elements of the solution? The facilities, the people, the space staff, the stuff, the technology. And then we try to bring it together cohesively. The governance is critically important because we have the technology arms in the organization, clinical arms, the health plan. And you called out like, if it's focusing on efficiency or revenue or outcomes, it really does dictate a different solution. But we try to balance that. So the seven principles that we really focus on are transparency, accountability, safety, equity, quality, privacy and clinician oversight. And we try to balance that. So even right before this, I was on our AI Council. We're looking at some different technologies and saying, how do we apply this? And everybody got have to give their perspective, be able to find what's the right solution. So I talked about the ambient dictation. There's a quality element to that. And so how long do you hold. Hold these things? How do we check things? Because as you introduce new technologies, it oftentimes ends in a replacement. Hopefully it's an augmentation. But if you're not thoughtful about how this impacts cost, affordability, quality, experience, then it can go sideways pretty quickly. We also leverage our patient advisory councils, where we ask our patients to give us input really early on and say, help us understand what you think about this. How would this be received well or not? And also our care teams as a whole, and so those are some governance and operational principles. But it oftentimes will come down to change management technology. And we oftentimes, when we talk about artificial intelligence, we like to say that it's augmented intelligence, because if you don't frame it right, it can be something that's Quite fearful. You and I were talking earlier about what's the healthcare environment like? And I said, when are things going to get back to normal? The people that are taking care of our patients on the front line are feeling that same angst. We still hear about burnout and a lot of fear and anxiety. You introduce more change. Does it heighten the fear and anxiety or does it leave it? If applied? Right. If they know that we're trying to solve their pain points, then hopefully you should alleviate but also allow them to be engaged. That's why we shift oftentimes from saying artificial intelligence, which can sound scary, to augmented intelligence, because we want to be able to augment our people. But then we have to be able to connect with them and understand how much discretionary energy if they're solving for some other clinical implementation, a quality program that we're trying to put in place, do they have the discretionary energy to implement something around technology? Do they understand the long game? Because in that hype curve, there's a period where it's going to be inefficient before it gets efficient. And we have to bring them along in that journey, help paint that picture so they understand the impact to them, so them. So while it's about technology, there's also a lot of elements about basic management at the individual team and also at the organizational level.
- [15:08]
Scott King
Yeah, you know, you just had basically a lot of great thoughts and advice on dealing with emerging tech just there. But if you had to kind of zero in on your number one piece of advice for healthcare leaders as they prepare for further advancements in technology and rising demands for care, what would that be?
- [15:26]
Dr. Nolan Chang
Yeah, I mean, I think there's so many different things, but one of the things that's being trained as clinician, one of the things that we would learn in our training is when you're running to a code, the first pulse you check is your own. Right. So I think it's important to know where we're at individually, as leaders, as an organization. If we don't acknowledge the fear or anxiety or the overwhelming challenges that we're facing, I think we can be dazzled by the shining new piece of technology and just go down that road and lose sight of what we're really trying to accomplish. So are we using technology to solve for the fears and anxieties that we have and an increasing volatile marketplace, or is it really aligned around the pain points of applying our organizational strategies and solving for that? Because the marketplace is looking for value. Right. We hear about the struggles, increasing rates People want a better experience. They don't understand why the cost is going up and why they can't get in to see somebody or get a medication or just get an issue met. So I think the big piece is really understanding where we're at and the problems that we're trying to solve and then applying the technology because you don't want the technology leading. Because as you go out there and meet with all these great companies, they oftentimes will have solutions looking for problems versus understanding the problem and applying a solution. So definitely understanding what we're trying to solve and, and how it moves the organization forward is probably the key thing that I try to keep central as we look at these different solutions.
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Scott King
I think it's a great number one piece of advice for dealing with, for further advancements in technology. And Dr. Chang, the last thing I want to ask you that we ask a lot of leaders on the podcast, is how are you evolving as a leader?
- [17:07]
Dr. Nolan Chang
Yeah, that's a fantastic question. Different times require different leadership skill sets. And we talked about before the pandemic, a lot of it was, you know, the solution hadn't really changed over many years. If we grew 100,000 members, we knew how many hospitals or exam rooms we need. A lot of it was around efficiency. There weren't a whole lot of disruptions that came about. But the pandemic, if anything, was an absolutely great accelerator. Today is very, very different than it was five years ago. So for me, evolving as a leader is really not focusing or balancing. We always are going to need efficiencies, but understanding how we focus on transformation. And so it's really more about connecting with the hearts and minds of people and storytelling and bringing them along on the journey, because we will go, we will go much further together. I think during these periods of uncertainty, it's easy to splinter or divide as an organization, divide as a team. And that's not going to really help us accomplish our mission. In permanente medicine, we are a large group practice with a social mission. I mean, people join us for that mission. And so if we stay true to that, I'm confident we will be able to really augment the value, because I think during this period of time, people need that, that belief in that mission and trust in that vision. So for me, as a leader really is, how are we engaging, how are we telling stories, how are we listening is probably the most important element. So how I'm applying my time is critically important. Having conversations like this and getting the message out there and highlighting the opportunities is one of the ways I look to do that and so it's necessarily solving as many as problems is broadening the conversation for me.
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Scott King
Well Dr. Shane, thanks so much for joining us on the podcast. I thought this was a great conversation, very informative and looking forward to working with you again soon.
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Dr. Nolan Chang
Likewise Scott. Thank you so much for having me. I look forward to our future discussions.
- [18:56]
Scott King
Absolutely.
- [18:59]
Athenahealth Representative
At athenahealth, we know your ambulatory practice wants healthier a healthier business, healthier care teams and healthier patients. But the complexities of modern healthcare tech make it hard for you and your care teams to focus on what matters most. That's where athenahealth can help our AI native all in one solutions reduce administrative burdens, streamline billing and payments, and deliver critical insights when clinicians need it most. That means fewer clicks, more time for patients and stronger bottom lines. Practicing medicine is complex, but rest running a practice can be that much simpler with Athenahealth. See how simpler is healthier@athenahealth.com.