As CEO and Executive Director of The Permanente Medical Group at Kaiser Permanente, I have been following with interest the exchange between Malcolm Gladwell and Steven Brill, prompted by Gladwell’s critique of Brill’s book (America’s Bitter Pill). Gladwell accurately points out that the solution to the problems of the American health care system that Brill puts forth in the book are very close to the structure of Kaiser Permanente. We provide world class hospital and ambulatory care to millions of Americans through our dedicated, physician-led Permanente medical groups, and pay for it through the not-for-profit Kaiser Foundation Health Plan.
Brill dismisses Gladwell’s criticism explaining that “Kaiser Permanente is not the same because it doesn’t have a monopoly, or oligopoly power, in any of its communities. It’s not a teaching hospital. It doesn’t have the network of high-quality doctors, or isn’t perceived to, like New York Presbyterian has in New York or the Cleveland Clinic has in Cleveland.”
Brill’s comments are not accurate. In our Northern California region, as an example, we sponsor 13 different residency programs, and train 500 residents a year. In addition, our teaching hospitals serve as training sites for all the major academic medical centers in the region for both medical students and residents. We have partnerships with several East Coast medical schools to provide medical school clerkship opportunities. And, on any given day, there are more medical students on our campuses than at the sponsoring medical schools.
Our quality and health outcomes have been pace-setting: a 30% lower risk-adjusted mortality rate from cardiovascular disease than the communities in which we operate; nation leading performance in stroke prevention and sepsis treatment, and a 50% reduction in death rate compared to the rest of the nation for patients with HIV/AIDS. And when the Centers for Disease Control chose California hospitals to care for the sickest patients with Ebola, two of the four destination sites were Kaiser Permanente hospitals.
Our Division of Research is the largest clinical and epidemiologic research facility in the U.S. outside of a university or federal institution with over a hundred million dollars a year in research grants.
And contrary to Brill’s assertion, over 1,000 of our physicians have academic appointments in university hospitals. We are the preferred practice option for many of the best trained physicians in the nation today, and have more than 10 highly qualified physician applicants for every new opening.
With nation leading quality, advanced information technology and our pick of the best physicians, it’s no surprise that over 40% of the insured population in Northern California choose us as their health care provider. It’s true that we do not exercise monopoly power – nor has that ever been our goal – and we think the fact that consumers and patients can choose to join us or select another provider, is a great catalyst of improvement and creative innovation, not a failure.
Rather than challenge Mr. Brill, or continue the debate, I invite him to visit us in Northern California, as experts like Malcolm Gladwell, Clay Christensen, and Atul Gawande have done. He can judge for himself whether this 70 year-long, continuously operating partnership between an integrated delivery system and a not-for-profit health plan isn’t in fact what he envisions as the model for health care in this country.
If he does, he will see that what he proposes is actually alive and well — a proven solution to the health care challenges the country faces.
Robert Pearl, MD is CEO and Executive Director of the Permanente Medical Group.