A Conversation with Dr. Richard Isaacs, CEO of The Permanente Medical Group and the Mid Atlantic Permanente Medical Group

By AJAY KOHLI, MD

Organizations aren’t built in crises. Their mettle, their history and their leadership define how organizations adapt and succeed, particularly in difficult times. Of the three, the most important quality is leadership. In this regard, Kaiser Permanente is leading the way in healthcare delivery.

I had the opportunity to speak with Dr. Richard Isaacs, CEO of The Permanente Medical Group and The MidAtlantic Permanente Medical Group, to discuss the strategic vision and granular details of Kaiser Permanente’s response to the global pandemic of COVID-19.

Kaiser Permanente has a strong foundation in the history of delivering care to the vulnerable. Founded in 1945 by a surgeon, Dr. Sidney Garfield, and an industrialist, Henry J. Kaiser, the organization grew from a single hospital in Oakland, California into one of the largest physician-led organizations in the world. Currently, it boasts more than 22,000 physicians responsible for the care of more than 12.5 million lives.

Many question how large healthcare organizations, like Kaiser Permanente, can adapt to a rapidly evolving problem, like the global pandemic of COVID-19, especially when cities and even countries are struggling under the burden.

While there are many reasons, three of the most important ones include:

Technology Infrastructure: Kaiser Permanente notably has one of the most advanced healthcare delivery technology platforms in the world: ‘KP HealthConnect.’ A Kaiser Permanente and Epic Medical Records collaboration, it was built on the premise of streamlining healthcare delivery in an accessible and meaningful way for both patients and healthcare providers. An important lesson of this endeavor was to ‘build not buy’ as Kaiser Permanente molded their HealthConnect platform to serve the needs of various patient populations and subspecialty physician groups. This ability to adapt their technological infrastructure has served Kaiser Permanente well in the global crisis of COVID-19. Through their existing technology platforms, they have been able to download the COVID-19 Mitigation, Suppression, and Recovery Playbooks to implement advanced triage protocols for patients suspected of having COVID-19 permitting rapid and effective containment. Additionally, their telemedicine technology has aided direct patient care for a variety of subspecialties including mental health and primary care, allowing providers to connect with patients and continue to provide needed care despite social distancing. Currently, KP has expanded its use of telemedicine video visits to 90 percent of total visits.

In the era of technology’s foray into healthcare, Kaiser Permanente has already become a leader in implementing this technology with the clinician-patient relationship at the forefront. Through several years of dedicated effort, Kaiser Permanente has implemented health technology in a manner that maintains patient care delivery as the primary goal. As most medical institutions now transition to an online telemedicine care delivery platform, Kaiser Permanente has already set the systems in place for sustained success. 

Streamline Healthcare Delivery: As many healthcare institutions across the nation have struggled to continue to provide care to their patients amidst the COVID-19 pandemic, Kaiser Permanente has remarkably transformed their healthcare delivery workflow to both effectively provide care to patients in need but also protect the population (and healthcare workers) from unnecessary exposure. Setting in place strategies to triage and test patients with suspected COVID-19 separately from essential healthcare service lines, such as labor & delivery and oncology, has allowed Kaiser Permanente to help maintain the health and well-being of their patients and healthcare staff. More importantly, having a system to separately address pandemic scares from the routine care of patients with chronic diseases ensures that the quality of healthcare delivered is not compromised during a pandemic.

Kaiser Permanente’s model is built around clinical centers of excellence. This allows for separation of care delivery: those with advanced clinical needs (e.g. oncology, cardiac care) have been able to continue to receive care at separate physical centers of excellence, limiting their exposure to patients under investigation for COVID-19 and healthcare providers who are serving those patients.

Disaster Preparedness: Since its establishment, the leaders at Kaiser Permanente have worked to address pandemics that have plagued the world over the past few decades. Tuberculosis, tetanus, poliomyelitis, HIV/AIDS, H1N1, measles and Ebola are amongst the diseases that Kaiser Permanente’s healthcare team has worked to eradicate. The best way to foresee the future is to prepare for it and that has been Kaiser Permanente’s underlying strategy for global pandemics, particularly COVID-19. To continue to stay prepared for the unknown, Kaiser Permanente built the Regional Emergency Management Program (profiled here by the Harvard Business Review) focused on addressing healthcare delivery during disasters.

Preparing for the disaster scenario has been ingrained within the Kaiser Permanente ethos – not if it will occur but when it will occur. In times when the largest countries are struggling in their response against COVID-19, Kaiser Permanente already has a blueprint for how to transform, and lead, as the crisis worsens.

These strategies — building an adaptable technologic infrastructure, streamlining healthcare delivery, and disaster preparedness —  have been the foundation for Kaiser Permanente’s success over the course of many decades. Not surprisingly, these strategies are once again proving their value in the face of the COVID-19 pandemic.

As COVID-19 continues to cripple healthcare capabilities across the country, there is an air of guarded optimism within California, particularly within the Bay Area and Northern California. The success of fast and decisive action by Dr. Richard Isaacs and his physician leaders has played a pivotal role in ensuring this. While the COVID wildfire may be contained for now, it is this legacy of Kaiser Permanente’s preparedness that will spot the embers that could light a second wave.

Ajay Kohli, MD is a radiology resident physician at the University of Pennsylvania Health System.