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At the Intersection of Technology, Equity and Community
Episode

Janet Liang, Group President & COO and Jodie Lesh, Chief Transformation Officer, Kaiser Permanente

At the Intersection of Technology, Equity and Community

Find out what Kaiser Permanente is doing to improve access to care and close the gaps in delivering innovative and effective care to a large part of our country. 

In this episode, we are privileged to host two outstanding leaders, Janet Liang and Jodie Lesh. Janet is the Executive Vice President, Group President, and Chief Operating Officer of Care Delivery for Kaiser Foundation Health Plan and Hospitals and Jodie is the Chief Transformation Officer. 

Janet and Jodie share what Kaiser has been doing to improve health disparities and health equity. They share the company’s vision for care delivery at home and provided phenomenal examples of what Kaiser had done to reach out and support individuals and communities during the pandemic. They also cover the topic of acceleration of technology, digital equity, and Kaiser’s integrated model that allowed them to care for patients in a holistic way and spend dollars on projects that have the greatest impacts on people’s lives. They also delved into the importance of understanding the belief systems of people and behavior change and mention a few other innovations coming in through digital health. 

There’s plenty of exceptional examples, insights, and callouts in this wonderful conversation, so don’t miss it!

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At the Intersection of Technology, Equity and Community

About Jodie Liang

Jodie is the Chief Transformation Officer at Kaiser Permanente. She leads the Office of Transformation, which focuses on driving transformative innovation system-wide to create meaningful, sustainable, and structural growth and change. Jodi operates as a cross-functional orchestrator of complex, disruptive initiatives and support of the organization’s shared agenda with the goal of creating more healthy years for members. Prior to this role, Jodie headed the organization’s delivery systems strategy and innovation efforts, including the development and implementation of capital projects in excess of three billion dollars per year.

 

About Janet Liang

Janet Liang is the Executive Vice President, Group President, and Chief Operating Officer of Care Delivery for Kaiser Foundation Health Plan and Hospitals. In her role, she’s accountable for Kaiser Permanente California Market, serving over nine point two million members. In addition, she directs strategy and innovation, and care delivery operations, including Continuum of care services, Medicare, and their more than five hundred store pharmacy organization and thirty-six hospitals. Janet reports directly to Kaiser Permanente’s Chair and Chief Executive Officer, and she’s a member of the National Executive Team. She’s a native San Franciscan and she joined Kaiser Permanente in 2007. Prior to her role, she was the President of Kaiser Foundation Health Plan and Hospitals of Hawaii for seven years and also held executive roles over a 15-year career at Group Health Cooperative now Kaiser Foundation Health Plan of Washington.

At the Intersection of Technology, Equity and Community with Kaiser Permanente’s Janet Liang, Group President & COO and Jodie Lesh, Chief Transformation Officer: Audio automatically transcribed by Sonix

At the Intersection of Technology, Equity and Community with Kaiser Permanente’s Janet Liang, Group President & COO and Jodie Lesh, Chief Transformation Officer: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Saul Marquez:
Hey everybody, Saul Marquez with the Outcomes Rocket. I have the privilege of hosting two unbelievable, outstanding leaders. First, I want to introduce you to Jodie Lesh. She is the Chief Transformation Officer at Kaiser Permanente. Jodie leads the Office of Transformation, which focuses on driving transformative innovation system-wide to create meaningful, sustainable, and structural growth and change. Jodi operates as a cross-functional orchestrator of complex, disruptive initiatives and support of the organization’s shared agenda with the goal of creating more healthy years for members. Prior to this role, Jodie headed the organization’s delivery systems strategy and innovation efforts, including the development and implementation of capital projects in excess of three billion dollars per year. We also have Janet Liang with us today. She is the Executive Vice President, Group President, and Chief Operating Officer of Care Delivery for Kaiser Foundation Health Plan and Hospitals. In her role, she’s accountable for Kaiser Permanente California Market, serving over nine point two million members. In addition, she directs strategy and innovation, and care delivery operations, including Continuum of care services, Medicare, and their more than five hundred store pharmacy organization and thirty-six hospitals. Janet reports directly to Kaiser Permanente’s Chair and Chief Executive Officer, and she’s a member of the National Executive Team. She’s a native San Franciscan and she joined Kaiser Permanente in 2007. Prior to her role, she was the President of Kaiser Foundation Health Plan and Hospitals of Hawaii for seven years and also held executive roles over a 15-year career at Group Health Cooperative now Kaiser Foundation Health Plan of Washington. Just an amazing opportunity to connect with both of you and learn more about what you guys are doing to improve access to care and to really close the gaps in delivering innovative and effective care to really a large part of our country. So I am so excited to be here with Jodie and Janet. I just want to welcome both of you to the podcast.

Janet Liang:
Thanks, Saul.

Jodie Lesh:
Thank you.

Saul Marquez:
Absolutely. Now, the work that you all are doing at Kaiser has really been so inspiring and set the tone really for health care overall for the country. I’m excited to dig in. Before we dive into some of the specifics, though, I’d love to learn more about what inspires your work in health care.

Janet Liang:
Yeah, so Saul I’m so glad you asked that question because it’s so important that we all get to work in fields and careers and health care that really inspires a deeper passion for ourselves and for me. I am Chinese American and grew up in an immigrant family in the Bay Area around San Francisco. And when I was growing up, we had hardship and health care was one of those burdens around health care costs in our family. And so I sort of always in the back of my mind, I thought about how there are economic barriers to access to health care. And I had decided that I was going to go to college and pursue becoming an attorney to seek legal justice as a form of social justice. And then during that time, the Clinton administration really began conversations the first or second round of conversations around health care reform. And I was just so inspired by the dialogue around health care as a right, you know, that it shouldn’t be based on your employment status and that just like the basic right to education, people should have basic rights to access to healthcare. And I threw myself into that in terms of my career. And I feel so fortunate that I’m able to work in a field that can address what I consider to be a fundamental right for people in this country. And I will say too that, I’m inspired not just to work in health care, but I’m specifically inspired to work at Kaiser Permanente because we’re an organization that has a seventy-five-year mission that is grounded not just in care for our members and our patients, but for our communities. And I think that’s the important link on understanding how we bring about equity and opportunity for people in their lives through health care.

Saul Marquez:
Now, that’s wonderful. Janet, thank you so much for sharing that. And the experience you had is certainly formative. And I think it’s fantastic that you bring that forth in how you guys are doing your work on inclusion at Kaiser. Thank you for sharing that. Jodie, how about you tell us about you? What inspires your work in health care?

Jodie Lesh:
Oh, it’s so interesting always to hear Janet’s story, and it’s funny how there are some real similarities and also some interesting differences. I, too, actually had not really planned on going into health care immediately. I had an interest in getting a law degree as well. I find that interesting. But I had an experience. I grew up in a fairly privileged family, but I had an experience very early on that shaped a lot of how I felt about what my career ambitions would be. And so I was about 13 years old and I had met a girl, I think, at summer camp who was participating in a new nonprofit that was starting called Teen Line. It was a teen-to-teen outreach hotline that was sponsored by a local hospital here. And I had asked my parents if I could do it. And they had some trepidations. They weren’t quite sure what this was about and what kind of calls we’d receive and whether or not I was really emotionally prepared for that. I was pretty young. I was the youngest. I was both the first and the youngest listener on this line. And one of the things I remember about those calls we went through, first of all, very extensive training, hours of training. I think it was about six weeks and multiple times a week training. And one of the very first calls that I received on that was a call from a young woman about my age who was from a very disadvantaged family economically, had lived in very, very tough conditions and her family. And it actually turned to teen prostitution in order to help her family make ends meet. And I’ll be honest, I had never heard a story like that. I didn’t grow up knowing people who were in those situations. And as the years went on, I actually participated on that line for three years, I learned about countless stories and really learned about people’s lives in a way that I just think was incredibly unique. So I went on to college, still expecting that I would go in to get a degree in law. And somehow I actually ended up right out of undergraduate working for Kaiser Permanente. And I’ve had a long gap in between, and I haven’t been at Kaiser since I was twenty-two. But I did spend a couple of years. And I agree with Janet that what I saw both in health care and Kaiser Permanente in particular, was this commitment not only to our members, but this commitment to improving the conditions in our community, not just the health conditions, but also the social and environmental conditions. And what I realized at that point was that by joining an organization like Kaiser Permanente and I eventually did return and I’ve been Kaiser it almost 20 years, was that we really could make a profound impact on our communities and that the mission of this organization supported that in a very, very personal level. I realize that your passion could actually become your profession, something I’ve really instilled in my children now. So it was an interesting road to get there, very different from Janet’s, but very similar in terms of just this really understanding about health care as a basic human right. And the ability to participate in that mission at Kaiser Permanente was very, very special and unique and continues to be.

Saul Marquez:
Thank you, Jodie. And what an amazing experience as a young person with this call. Then you just get surprised and you’re like, wow, all the stuff that’s out there. I’ll share with you, so I grew up in a poor Mexican family, you know, and growing up in that environment also taught me a lot about the importance of having social equity and access to proper care. So I’m moved by what Kaiser does and by what both of you are helping lead the organization with. So, number one, thank you for the work that you do and the heart that you do it with. You know, I remember being at a meeting a couple of years ago and hearing the late Bernard Tyson talking about just some of the amazing work with the food programs that you guys do, et cetera. You do so much for the community. And so definitely excited to hear more about that. So talk to us a little bit about how you and the business are adding value to the health care ecosystem.

Janet Liang:
You know Saul, it’s you know, we happen to be doing this podcast at the knock on wood, hopefully, the tail end of a very trying 15 months for the world through the pandemic. And there were a lot of things that I believe that because of our foundation as integrated care and coverage organization, it really enabled us to bring the best of who we are to assist our counties and cities and the public health institutions to really do the identification, to do the treatment and to now joyfully be in this vaccination stage. But I think these themes around equity and inclusion, digital divide, acceleration of technology, all kind of fast-forwarded because of the pandemic. It required all health care organizations to really take a look at what we could do differently, to be able to do virtual health and to be able to function in a pandemic. And so I thought we could talk a little bit about Jodie and I could talk about those three themes today with you and I did invite Jodi to kind of kick us off.

Jodie Lesh:
You know, it’s one of the things that pandemic, Janet to your point, highlighted was something that I think that we certainly knew and understood and had been working on for many years at Kaiser Permanente around health disparities and the need to strive for health equity. But the pandemic highlighted that. And it’s just an extraordinary once in a lifetime, hopefully, way. One of the areas that we’ve been looking at as most health care organizations are doing, we are increasingly leveraging technology to improve care delivery, improve quality, improve the care experience and to improve access. But one of the things that we realize as we move to this world where we’re using technology in a much more significant way through digital technology and telehealth, we do realize that there is a gap, this digital divide, or what we really refer to as digital equity issue that needs to be addressed. And we know that technology has the potential to significantly improve care delivery in a myriad of ways, increasing efficiency and affordability or increasing access and doing things like extending resources from this one-to-one model to this one-to-many model. But there are a lot of perils associated with greater use of technology and health care. And that’s something that we’re really getting into in the digital equity space. And one of those is, is this issue of the potential for inherent bias, both in the sort of source data, in an interpretation, and then even in our action. And that’s something that we’re looking at. And the other area is this digital divide issue. And so we’re actually delving very, very deep into this issue and really looking at this issue of uneven and unequal access and the ability to use technology for care delivery. And some of the areas that we’re looking at are areas that I think traditionally people have looked at, things like access to broadband, access to devices. We know that in terms of devices, for example, like access to a laptop for somebody making under thirty thousand dollars a year, that access is somewhere around 50 percent. And people who make over one hundred thousand dollars a year, it’s not ninety-five percent. So we know that. And also looking at the issue of digital literacy, but we’re also really looking at some of the kind of less traditional viewpoints of digital equity, like really pushing against these generalizations that we make about the barriers that people have to use, really looking at how we do hybrid solutions. So there really is an element of patient choice. So we don’t force the digital solution on people or we let people toggle or to choose between the two really understanding the issue of cultural competency and underlying bias. And then ultimately in the recommendations, looking at things like how can Kaiser Permanente use its influence around to influence policy around broadband access? Looking at even our own facilities, we’re looking at now about how we might use our own facilities to increase broadband access and 5G access, looking at technical assistance models, looking at models around consumer engagement, and helping people learn how to use technology. So really being expansive and how we’re addressing that issue with this umbrella of equity and inclusion. So we’re very excited about this work and we think it’s critically important not only for our own business but the overall access to technology and society.

Saul Marquez:
Jodie, I’m glad you spent some time diving into the digital divide because a lot of people just assume, yeah, you know, with the pandemic we scaled digital and now access is easy, but truly there’s gaps and figuring out how to solve those gaps is critical to success. So appreciate you diving into that. And even the thought, like, can we make some of these devices prescribable? Is there a pathway where CMS could say, yeah, we’re going to start covering these?

Jodie Lesh:
Exactly. And that’s where some of the policy influence could really come into play. And that’s the beauty of working for Kaiser Permanente, is just this incredible assets and influence and voice that we have. And then looking at how we use that.

Janet Liang:
Yeah. And during the pandemic, we had waivers, right? They were broad waivers from Medicare that allowed us to do all kinds of different things that we normally couldn’t. And so we are advocating and working really hard on making some of the waivers permanent. For example, we had over, I want to say, nineteen hundred patients at one time that we were essentially monitoring them from home and they would have normally been in the hospital, so mostly medical patients and some of our post-surgical patients. Because of the shelter in place and the shutdown, we still needed to be able to take care of our patients. And so we deployed technology, monitoring equipment, put physicians and nurses both with the ability to visit people at home as well as being able to monitor in a sort of like a centralized command center monitoring all of our patients in these beds, so it was pretty amazing. And it just out of, I think, crisis, you’re able to innovate. But also those waivers allowed us to do things that we otherwise couldn’t have done. So I appreciate that you mentioning that. Right now I think the hospital associations, medical groups, all of us are working really hard to be able to have more flexibility because really this is a time where I think that there’s a big movement to move care at home where people can have privacy, dignity, support of family as long as we’re able to monitor for clinical conditions and handle escalations.

Saul Marquez:
Yeah, and this care delivery at home is really a hot topic. I mean, I would love to kind of hear the perspective that you all are taking on that and maybe what your vision is for this area.

Jodie Lesh:
I think, Janet, maybe I can start. I think we have a vision. First of all, I do want to say that Kaiser Permanente has a very significant program of care in the home today and always has. Now, the question is, can we start looking at different types of populations, one of which is hospital-at-home? You may have seen that Kaiser Permanente recently invested in the medical home, which is a hospital and home company, along with Mayo Clinic, to really build that model, to be able to scale that model and to be able to take care of sicker patients in their home, which has significant potential to improve quality, service, access, and safety. There are a lot of challenges associated with that and a lot of infrastructure that needs to be built, including supply chain capabilities, being able to get things into people’s home quickly, workforce considerations. Janet talked about sort of command center concept. How do you quickly resolve issues and get either people or technology or things into people’s homes so they can care for themselves? So we’re embarking on an effort now to do a number of things. One is to look at the whole continuum of potential patients that can be treated in the home. We have people who have multiple chronic and complex conditions, frail elderly, people who have trouble getting to us that could benefit from here in the home. And also looking at the infrastructure, again, supply chain technology, including remote patient monitoring, documentation in the home, being able to have interoperability with our electronic medical record. There’s quite a bit of infrastructure that needs to be built. But this is an area of significant focus for Kaiser Permanente, both operationally and in the innovation space and in our investment space. So there’s a lot of potential here. There’s a lot of potential to leverage A.I. in this space to do predictive analytics, to look at rising risk, and to deploy resources towards that. So I care at home has always been a very significant part. As Janet said, the regulatory environment does need to catch up a bit, but I think the pandemic helped shed light on what was possible and what was safe and effective. So we’re optimistic that this will be a growing part of our business and then we’ll sort of blend and merge into our extensive telehealth and digital engagement models as well and sort of kind of bring that together. So this is an area ripe for continued innovation and capability building.

Saul Marquez:
Fantastic.

Janet Liang:
And the one thing I would add to is both that, you know, it’s not just hospital care, but it’s also managing chronic conditions, symptoms that might arise from patients that you normally would see your primary care physician. So it’s that full so full-spectrum is your primary care office. It’s your specialty. It’s your pharmacist who’s helping you, medication management, your nurse that’s helping you manage your diabetes. It’s the full continuum that we can do as one organization. It’s like bringing the entire health care system to your living room.

Jodie Lesh:
So I think that’s and sort of and building those capabilities that allow that to be cost-effective. It’s not the kind of Marcus Welby. It’s more like the Amazon Uber thing. It’s around how do you build automation and predictive analytics and things like that to make this an effective and cost-effective and safe and efficient operation? But I think we all believe that that is very possible.

Saul Marquez:
Yeah. And the thing that I really love about the approach, especially from an organization like Kaiser Permanente, is that vertical integration that seeks to optimize both cost and care. And I think it’s just the perfect setup.

Janet Liang:
You know, I’d also want to say that the health care consumer changed through the pandemic. I think there before the pandemic, I don’t think there was really low adoption of video visits for care. The idea that you would do care from home, I think felt less personal. And now or a somehow second to coming into an office. And now the health care consumer doesn’t want to have to come in unless they really really have to. They want to text their doctor, they want to be like, do I really have to pick up the phone and call? Do I really have to schedule? Do I need to drive in? Can I can you just video with me and I can go pick up my script or have it mailed to me. So there’s a new consumer health care consumer that I think matches up nicely with our interest to move care outside of the walls of medical offices and hospitals.

Saul Marquez:
That is a great point, Janet. Yeah, the world is changing. We’ve been conditioned and I think it’s going to help with some of those access issues, but it certainly doesn’t take care of all of them. And having bright minds like both of yours and these types of problems are key. You know, what would you say makes what you do different and maybe better than what’s available today for communities and patients?

Janet Liang:
Yeah, because there are also individuals where some of this technology is not going to be a solution, where you live in multigenerational households, where you may not have the privacy or you live in neighborhoods where you don’t have Internet connections. It’s an affordability issue as well as an infrastructure issue in your community. So, you know, our tenet around community health and social health really is our platform for reaching out beyond our walls to engage individuals in their communities. And so if you look at what we did during the pandemic, for example, when in the state of California, when we were hiring contact tracers in the beginning, at the very beginning of the pandemic, we recognize that there are vulnerable communities that fundamentally have mistrust in the medical community and individuals they don’t know or can’t speak their language or come from their community. And so we provided one hundred million dollar grant to the Public Health Institute to recruit and train contact tracers from the communities. So it was we ended up having, I think 70 percent of the contact tracers they hire spoke a second language and were diverse. They were Latino and black and various combinations of Asian Americans that all spoke the language came from their communities and did the contact tracing. And there’s trust and then you could have the transparency. But that’s just one example. We also have a long history of working with and promoting black-owned businesses and minority-owned businesses. And we know that you have to have jobs in communities for people to have that combination of. You need your health, but you also need an income, a stable income and you need to have good school systems. You have to have a safe neighborhood. You have to have all these things together to really have community health and a sense of security. And so we’ve done a ton of things to support local jobs in the cultivation of jobs. We’ve done supporting minority businesses through our buying and our purchasing. We belong to an organization called the Billion Dollar Roundtable because we spend over a billion dollars a year in businesses that are owned by diverse individuals, diversity-owned businesses, and that it was a conscious effort to move away from, you know, sometimes the lowest cost commodity. It may cost us more to support the local business or that minority-owned business, but it speaks to our values to support those organizations.

Jodie Lesh:
Just one thing, and I think you mentioned this and sold it to me. There’s the model itself. Kaiser Permanente is model, the integrated model. And the care and coverage model combined really allows us to look upstream at these social and environmental and economic issues that would be different in a business that was for-profit, publicly-traded kind of fee-for-service type of model. So the model itself allows us to participate in things that might be difficult for other businesses. And I think so there’s this issue of social factors. And the impact that they have on people’s health is something that is widely known. But not every organization is in a position to do what we can do because we ultimately have a mission, first of all, to improve the health of our communities. And also the even the sort of this care and coverage model allows us to care for the whole patient in this very holistic way. So we get into things that other people might have. Other businesses might have a challenge. And just one example. I know Janet and I talk a lot about this. You know Janet mentioned and I think you did too this need for employment. Very, very important. We know that people’s economic condition has a material impact on their health. But one of the things that we’re able to do is we’re able to really galvanize all of the assets of Kaiser Permanente, all of our influence, our hard assets, our soft assets, our people to be able to bring to bear on problems. And one example of that I just wanted to highlight was we have a very extensive building program. You could imagine we have a very large footprint of hospitals and clinics and administrative buildings and other types of capital assets. And one of the things that we did a few years ago is we started looking at that building program and developed a program called Building for Impact. And what we did is we looked at how can we find shared value. How could we look at building these buildings in a way that not only provided benefit to our business but also benefited the community? And we had built a building a few years ago in a part of South Los Angeles, Baldwin Hills, where we looked at how we were going to build that building. First of all, the siting of that building was on a piece of land that had been really underdeveloped, had really fallen by the wayside, had once been a thriving economic center of the community, and had fallen into disrepair. Lots of failed development promises. And then when we went to build the building, we really engaged the community and asked them what they needed. And many of those things were incorporated, like walking paths and exercise and community rooms. But one of the things people said to us was we needed jobs. And so we used our construction program to bring people who had been previously incarcerated into the building trades as apprentices and then allowed them to get their apprenticeship training on that job and eventually become full-fledged electricians, carpenters, and then go on and build careers in the construction field, which is very lucrative. So these are the type of things, you know, we’re able to do as an organization that’s different than what other organizations are able to do. So it’s a very special place to work as a result.

Janet Liang:
Yeah. So I want to say it’s all healthcare. Anyone in healthcare wants to be able to do this. And the ideas that we’re talking about, they would love to do it. But everyone’s trapped outside of Kaiser and a fee-for-service health care system where you’re a little bit tied to your revenue comes in from production. Doing procedures, doing visits and this no one pays you to do this other work. And so in a prepaid model like ours, where we essentially finance our own care by selling our insurance directly, we get this monthly premium and we can make decisions on where do we want to spend our dollars to have the greatest impact on people’s lives, right, fom preventing illness to saving lives. So it’s there’s a freedom in that. And that, I think, is the envy that people have, because I’m sure if other health care systems had that freedom, they would be out there doing the same. That’s why I say, you know, Kaiser Permanente is a really unique ecosystem and our members really benefit from our ability to think about them as members So that’s the other thing I always say, is that it’s not just about the patient in front of me and I take care of you and you’re well and you’re gone. It’s we’re responsible for you for the rest of your life. So we are completely motivated to keep you healthy, to figure out what’s wrong, to want you to get your screening and prevention done because we are going to be your health care provider for your whole life and hopefully the next generation. We have like three or four-generation families that stay with us that we’re incredibly proud of, to say that we’ve been a part of their lives.

Saul Marquez:
Truly, truly different. I mean, that’s the touch that differentiates. And Jodi, Janet, both of you provided some phenomenal examples of how Kaiser is doing this. Let’s hone in on outcomes. So talk to us about, you know, maybe one or two things that you guys are really, really proud about as far as outcomes.

Janet Liang:
Well, I’ll tell you that no matter what survey regulatory body, CMS, Medicare, Five Star, NCQA, Office of the Patient Advocate, Health care organizations, Diversity Inc. We’re always like number one, number two, top ten, top decile. And so over and over again, you’ll see it’s in quality, it’s in affordability, it’s in value at various satisfaction and interaction with us. So our model really produces meaningful outcomes for our members and our patients. And lately what’s been super exciting is that we have been more transparent with ourselves about outcomes for patients, clinical outcomes for patients by race and ethnicity. We’ve always looked at it by disease or by age and even gender, but sitting down and saying, OK, we’re going to look at our, say, hospital infection rates and we’re going to look and see if there’s any variation between infection rates, between our white patients, our black patients or Latino patients. And if there’s variation, we need to ask ourselves what’s going on here so we’re systematically looking at all of our measures. And I will tell you that there’s some unexplainable variation. Hmm. And we’re beginning this journey of asking ourselves what is the systemic bias, unconscious bias that’s going on that we don’t understand that’s happening or there’s something in our rules and policies that are affecting how we end up treating, caring, placing, diagnosing patients, and this is a very it takes courage to do this work and we’re up for it and we’re really proud to be able to do this. Our goal is to be able to not only learn from ourselves and take a look at what’s happening in our system but be able to publish some of our findings to share with the broader health care community. So it’s been really very interesting to see it. Now during the pandemic, this whole conversation became very transparent on social media and everywhere around what we were seeing with who is getting vaccinated, who’s not getting vaccinated, who is contracting COVID and dying from COVID, who who is not. You saw more people of color, people in disenfranchised communities being affected and disproportionately by covid. That was really the highlight of what happens every day in health care. And so we want to continue to build on this conversation and sort of leverage this new interest by society and the public in general around what we need to do in healthcare so that it’s more than just a provider side. It’s everybody. It’s all around public health and private health care.

Saul Marquez:
Totally. Yeah, Janet. And I think that’s a phenomenal example. And even if you think about some of the work that’s being done around pharma and the clinical trials, having those be a little bit more diverse in focus, I think you guys doing this, having this type of focus will have those downstream impacts that I think many communities will benefit from. So huge kudos to you and the organization for having that focus. I feel and believe that one of the biggest ways that we learn is through setbacks. If you had to point to any setbacks, the biggest setbacks you’ve had, which one would you want to chat about? And a key learning that came out of it.

Jodie Lesh:
I’m not sure I would call it a setback for us, but maybe kind of a setback for the country is this issue of vaccine confidence and the fact that the vaccine rate is slowing down? And one of the things that we recently did in my group was a national study on really understanding what people’s perceptions were about the vaccine and what was standing in the way of people getting vaccinated and what we call the movable middle. What would it take to move people from trepidation to actually getting the vaccine? And we set out to look at that not just by very traditional race and age and ethnicity and things in that line, but to really understand the belief systems that underlie these decisions that people had. Issues of trust, issues of how people perceive risk, how people make choices for themselves and their family, how people collect information from who, how, and where. And really what we came from that was these or the series of archetypes that we’re using to develop a whole series of interventions, whether they be how we change service design, those mask vacc sites worked for a lot of people and not for others, people who had access, transportation challenges, people who were, you know, kind of intimidated by that. Also messengers, you know, there was a lot of kind of one-size-fits messaging. And now we’re realizing that there are trusted messengers and we have to tap into that. And to me, I mean, this is certainly a challenge and potentially a setback if we can’t catch up with this variant and get people vaccinated. But also this tremendous learning about how we look at our patients and how we look at members of our community, not just through these traditional ways in which we categorize people, but really looking at how people make decisions. And to me, one of the greatest hopes, sort of the next frontier of health care is really understanding how to impact positive behavior change, you know, things like smoking and eating and obesity. And I think in order to do that, we’re going to have to understand people in very new and much, much deeper ways and really understanding the sort of the science of influence and how behavior change is affected and not. And there’s a lot to learn, I think, as an organization, as a society in the vaccine, as a challenge. There’s no doubt about it. But like so many other things in COVID, also represents a great opportunity for us to learn and to try new things and to incorporate those learnings, not just for the pandemic and COVID, but also into our business as we move forward. And I think this whole issue of behavior change and perceptions and decision making is really a very, very important next frontier for us.

Janet Liang:
Yeah, And I would add I would, yes. And I would also add to this as I was thinking about your question, not a setback, but I don’t think it is a setback. But I do think of it as something that we’re all grappling with and that’s this demand for mental health services right now is overwhelming. Everyone. I started saying that there was a lot of suffering and hardship during this 15-month pandemic and with schools closing, children at home trying to learn at home, families trying to juggle it all, job loss, fear, associated isolation, so there is much more anxiety. And I think people are feeling the weight of all of the social ramifications of COVID and the kind of what happened with all the practices. And so you’re seeing a huge, huge need, growth, and demand for support services, coaching, crisis intervention. And there just isn’t across the country enough mental health providers in the United States to meet all the needs. And so we’ve got a lot of work to do as an industry to promote people going into the profession. We’ve got to think creatively about the different roles of maybe paraprofessionals in the field because it takes seven years of graduate college education, plus a clinical rotation to produce a licensed therapist. And we need really faster than that. So there’s a lot of innovation coming from various organizations, digital tools through telehealth. And but I think we’re still in the early stages of really transforming what’s possible in mental health care. So I look forward to it, but it’s we’re all in it. We want to be able to meet the needs and we’re all struggling to be able to do that right now.

Saul Marquez:
For sure. Some great call outs, Jodi and Janet. I agree. And then there’s there’s a community and there’s also the caregivers that have gone through so much, the nurses, the doctors, the respiratory therapist, go down the line where everybody is struggling. So great, call out, and a lot of work’s happening to bridge the gaps, but still more to be done. You know, how about the other side of the question? What are you most excited about today?

Jodie Lesh:
For me, I’m really excited about the different ways in which technology can extend our care model. We’ve talked a little bit about this using digital tools in mental health as an example. And we’ve been exploring things like digital twin technology that might allow us to do more predictive work around people who are at risk of getting illness or helping people understand the impacts of the decisions they might make around their own health. I think that technology, even with the digital divide issues, has the ability to extend care out into the community, into people’s homes in ways that would significantly improve access. So I’m very excited about that and I’m very bullish about moving care into the home. And, you know, even things like smart technologies that allow people to age in place, you know, we’re starting to see a lot of that. And that is something, you know, we saw a lot, quite candidly, during COVID in our skilled nursing facilities that shed light on some of the risk of receiving care or living in those settings. So letting people age in place is an exciting new frontier for us as well. So there’s just for me in the job that I’m in, this tremendous innovation potential in this field. And I’m just really excited. And we’re at a place in time when we not only need to we can do it, but we also need to do it. And so there’s a lot of, I think, support even on the on some of the more traditional barriers like regulatory barriers. And even though some of the some of the types of companies coming up are potentially competitors to us, I welcome all these startups and innovation around hospital at home and technology companies and virtual care and things like that, because I think that’s making us all better and pushing the entire industry towards really improving access and quality and the affordability of care, which continues to be a significant challenge.

Saul Marquez:
Yeah, I totally agree, Jody, but very exciting.

Janet Liang:
You know, I want to close by just saying that sort of why I got into health care and what we see today. And unfortunately, it took a pandemic for, I think, the country, the federal government to really understand the importance of universal access to health care and the importance of our public health infrastructure. So I am very excited to see all of the various bills that were passed for funding to support public health, access to health care coverage, and all of these health care organizations coming together to really accelerate the health care consumers needs around access and convenience. And so we’re moving in the right direction. And for me, if health care can be seen as a right and we make it easy to access and good quality, health care is available for people and no matter where they live and no matter what their race or background or circumstance, that is a very good thing. So I think we’re moving in the right direction.

Saul Marquez:
Totally agree. What a phenomenal discussion with both of you. Just want to say thank you, Janet and Jodie, on the intersection of inclusion and innovation. Certainly a very exciting things that both of you have shared, the work that your teams at Kaiser Permanente are doing. I just want to say thank you. And I know that the listeners are stimulated, so certainly want to say thank you for joining us today and sharing your thoughts.

Janet Liang:
Thank you, Saul.

Jodie Lesh:
Thank you for having us.

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Things You’ll Learn

  • It is important to work in fields and careers that inspire deeper passion. 
  • Just like the basic rights to education, people should have basic rights to access to healthcare.
  • Your passion could become your profession.
  • There is a gap, a digital divide, a digital equity issue that needs to be addressed.
  • Technology has the potential to significantly improve care delivery and in a myriad of ways.
  • Don’t force digital solutions on people.
  • Understand the issue of cultural competency and underlying bias. 
  • We are working really hard to be able to have more flexibility because there’s a big movement to move care at home where people can have privacy, dignity, support of family as long as we’re able to monitor for clinical conditions and handle escalations. 
  • The health care consumer changed through the pandemic.
  • People’s economic condition has a material impact on their health.
  • We’re responsible for you for the rest of your life. So we are completely motivated to keep you healthy. 
  • One of the greatest hopes, the next frontier of healthcare is really understanding how to impact positive behavior change. 
  • It took a pandemic for the country, the federal government to really understand the importance of universal access to healthcare and the importance of our public health infrastructure. 

 

Resources