Latest / Becker’s Healthcare Podcast / Maria Ansari, MD, Co-Chief Executive Officer of The Permanente Federation and Chief Executive Officer and Executive Director of The Permanente Medical Group at Kaiser Permanente

Transcript

Maria Ansari, MD, Co-Chief Executive Officer of The Permanente Federation and Chief Executive Officer and Executive Director of The Permanente Medical Group at Kaiser Permanente · Becker’s Healthcare Podcast

• 0:00
  Welcome to this episode of Leadership Unscripted, a
• 0:02
  Becker's healthcare podcast. I'm Chris Sosa, your host,
• 0:05
  and I am thrilled today to be joined
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  by doctor Maria Ansari. She, of course, is
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  co chief executive officer of the Permanente Federation,
• 0:12
  executive director and chief executive officer of the
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  Permanente Medical Group, CEO of Northwest Permanente,
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  and president and CEO of the Mid Atlantic
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  Permanente Medical Group. Maria, thank you for joining
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  us today. It's wonderful to be here, Chris.
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  Thanks for having me. Awesome. So looking forward
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  to this discussion. But before we get into
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  that, could you please give our audience just
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  a little bit of background on yourself and
• 0:33
  your organization?
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  Sure. The Permanente Medical Groups that you mentioned
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  are three of the largest physician led, physician
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  run medical groups in the country, and they're
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  part of an integrated health care system with
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  Kaiser Permanente.
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  And one of the things that's really unique
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  about that is one physician leadership and ownership
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  of the medical group where we have autonomy
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  over our practice.
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  And the biggest part is the integration
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  with a hospital and health plan system so
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  that all our incentives are aligned for the
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  best interest of the patient. So that's
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  the basis of value based care. And in
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  that model,
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  basically, when the patient does better, the entire
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  system does better.
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  Got it. Thank you, Maria, for sharing that.
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  So this conversation is a little bit different
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  maybe from some other podcast that we do
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  at Becker's that we're really delving into your
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  journey as a health care leader. And so
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  the first question I have for you is,
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  what do you consider your most memorable day
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  or period from your career?
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  You know, I consider myself an academic refugee.
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  I had planned to spend my whole life
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  in academics doing research, training folks,
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  and practicing medicine.
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  And some of my research
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  was at Kaiser Permanente because that is where
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  a lot of in medical informatics is and
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  a lot of patients are. And so
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  when I was doing that, I had a
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  light bulb moment. I
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  learned while I was doing my research there
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  that if you're a Kaiser Permanente member and
• 2:00
  you live in Northern California, you're thirty percent
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  less likely to
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  die of a heart attack or stroke.
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  And it just really spoke to me, and
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  I
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  as a cardiologist,
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  I just couldn't understand why what was different
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  at Kaiser Permanente
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  because in my practice, if my patients never
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  have a heart attack or never have a
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  stroke
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  or have a reduction in those things, we
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  actually lose money.
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  And I saw in the Kaiser Permanente model
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  that the way they were practicing
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  in an integrated care model, they did so
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  much work on prevention
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  that they were able to reduce heart attacks
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  and strokes. And I realized that I wanted
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  to be a part of that program, and
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  I just jumped ship at that time. It
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  was a pivotal moment in my career. I
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  left academic medicine,
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  and I joined Kaiser Permanente
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  over twenty years ago, and I haven't looked
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  back. Well, no doubt you're not alone in
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  in having that pivot, that light bulb moment
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  to taking
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  better care of patients before they even need
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  a cardiologist.
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  Right? And such a worthwhile goal.
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  You mentioned when you
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  arrived at Kaiser and and all the research
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  wonderful research you've done, not that anyone is
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  pushing you out the door far from it,
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  but I do have another question for you
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  and that simply is,
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  what would you tell your successor? You know,
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  anyone who takes over for you in in
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  this capacity or even another capacity?
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  The job is is really
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  has a lot of demands on it, and
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  you have to really have a north star
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  in your mind about where you're trying to
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  go and what you're in service of.
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  And when you realize who your true boss
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  is,
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  I I think that you will do the
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  right things, and I think you have to
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  free yourself
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  from being married to a title,
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  and really think about
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  servant leadership.
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  Are you serving the needs of our patients?
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  Are you serving the needs of the organization
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  and your colleagues
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  and doing your best work in that way?
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  I think sometimes people work they don't maybe
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  they don't take risks. They're afraid of the
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  board. They're afraid of what people might say,
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  and they hold on to,
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  kinda just keeping the status quo. And the
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  more you do that, the less
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  you're gonna succeed. And I think it's really
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  releasing yourself
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  from trying to hold on to your title
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  or your position and really just make those
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  calculated risks,
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  and free yourself from those
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  kind of that mindset and and do the
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  right thing for your North Star.
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  Maria, I love that you mentioned taking risks
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  because as other leaders have said on this
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  podcast and any other number of forums, it
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  is such an important part of leadership.
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  So in that light, what would you say
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  is the accomplishment that you're most proud of
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  and why?
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  One of the things that I'm really committed
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  to is trying to
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  highlight the importance of physician leadership. And oftentimes,
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  we see health systems bring on technology
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  and it becomes
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  really a burden for our physicians. It's created
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  a huge amount
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  of burnout and clerical burden for our physicians.
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  And so I was really proud,
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  to be able to roll out the largest
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  deployment of Ambient AI Scribe technology,
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  in the country. And we started with a
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  pilot. We rolled it out quite boldly,
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  with 10,000
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  physicians almost overnight. We did a two week
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  pilot, and then we just pushed it out
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  to all the physicians' phones
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  over a two week period, and the uptake
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  was
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  huge.
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  And then we took it and rolled it
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  across all of Kaiser Permanente,
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  the entire enterprise,
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  22,000
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  physicians after that, and then eventually now to
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  35,000
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  physicians and staff.
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  And it's been such a game changer.
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  You know, this was a few years ago
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  when AI was still new. We were worried
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  about hallucinations,
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  quality,
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  patient acceptance, all of that. So it was
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  maybe a risky move, but we did our
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  pilot. We got patient feedback.
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  Patients, by the way, loved it because the
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  physician is now looking at them and not
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  the computer.
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  We, got
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  we've worked through some kinks with the software.
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  And then what we saw with our physicians
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  is very quickly a reduction in their pajama
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  time as we call it. That's the time
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  that people spend after hours charting about one
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  to two hours a day.
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  And our physician engagement
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  and their joy and meaning in medicine went
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  up. We actually reduced our attrition rate in
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  primary care,
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  from voluntary attrition from six percent down to
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  two percent.
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  And so it's really been a bold move
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  that has paid off in spades, and now
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  we're using it more and more, the same
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  AI technology
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  to help us answer,
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  emails from our patients, to help with chart
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  summaries, discharge summaries.
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  We still have physician oversight. We still have
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  physicians review everything more as an editor, but
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  not as the initial author for everything.
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  That's probably the thing that, was a first
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  out of the gate type use of AI
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  in our system, and I've seen other health
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  systems,
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  really follow suit since we rolled that out.
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  Yeah. It's certainly something to be very proud
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  of, Maria. And as a patient, I can
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  certainly
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  I always appreciate when my physician is focused
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  on me and not just trying and to
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  enter notes into a computer, which I know
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  is important because everything has to be written
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  down. But, yes, to have AI,
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  reduce that burden is just huge. And the
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  way you guys did it,
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  just those numbers that you gave me, I
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  mean, 10,000 over two weeks and then 22,000,
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  35,000, the numbers are just staggering that you're
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  able to accomplish that in such a short,
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  amount of time. So congratulations on that. I'm
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  sure there are more things to come as
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  far as, rollouts and other projects you have
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  are concerned.
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  Take a little bit of a turn here.
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  As far as our next question is concerned,
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  that is. So there are any number of
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  issues that I think
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  deserve
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  a bright brighter spotlights in health care.
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  But you think you'd take one and say,
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  okay. This is one that I would spotlight
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  and why?
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  Right now, I think everyone's looking at the
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  rising cost of health care,
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  particularly, obviously, in this country where we are
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  not actually seeing the returns in terms
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  of longevity
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  or overall chronic disease burden in this country.
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  We're seeing an aging demographic
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  where
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  even
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  within the older population, we're seeing most patients
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  65
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  with two to three chronic conditions at least,
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  maybe one per decade
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  of age. And then even in our young
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  healthy population, we're we're seeing that the young
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  and healthy are not so healthy. And so
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  the disease burden is up, costs are up,
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  utilization is up,
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  and it's it doesn't seem like there's an
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  end in sight. And there is a solution
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  out there, but nobody seems to want to
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  look at that, and that is really value
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  based care. And what value based care is
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  is it takes
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  the old system, which is the way most
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  of this country operates, in a fee for
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  service, siloed,
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  fragmented, transactional way. So
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  you have a condition, you go see the
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  doctor,
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  the physician receives payment for the caring for
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  your chronic condition,
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  the hospitals
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  get payment when you're sick and you're hospitalized,
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  so they all feed off of disease.
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  Everything is profiting off of disease, and so
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  we're wondering why is the disease burden going
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  up. Well, the system is incentivized
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  to have high disease burden. I don't think
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  any physician or any hospital wants people to
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  be sick, But what if you designed a
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  system that profited off of wellness
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  so that when you do it's not that
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  we make money by doing more. We make
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  money by doing better, and that's value based
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  care. So that if our hospital is completely
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  empty,
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  that's in the best interest of the patient
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  because they're not sick enough to be in
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  the hospital,
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  and the system actually makes money because they
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  are not staffing those beds. And so
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  as a if we never have if you
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  never have that heart attack, you never have
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  that stroke, you never have that cancer,
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  that's in the best interest of the patient.
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  And so,
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  we want to be able to focus on
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  prevention. Everything every doctor wants to be able
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  to have the time to focus on preventing
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  that disease in the first place.
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  And so a model of care that allows
• 10:27
  you to do that, we actually have the
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  most affordable health care with the best outcomes,
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  and our patients live on average about five
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  years longer.
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  Thirty percent less heart attacks, twenty five percent
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  less cancer.
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  So these are things that happen when you
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  design the system.
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  The system has to be aligned with the
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  right incentives, and I think
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  converting people to value based care from a
• 10:53
  fee for service
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  takes a lot of
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  kind of a mindset shift,
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  because
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  we're not really reimbursed for prevention,
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  and we don't have systems designed
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  to really focus on that. So in our
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  system, because all our colleagues work together, if
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  you come into the dermatologist
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  for
• 11:14
  a rash or psoriasis, the
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  the team there is gonna ask you, have
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  you had your colon cancer screening? Have you
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  had your flu shot?
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  You know, all the things that you're due
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  for from a prevention standpoint. We're all working
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  together in a collaborative way.
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  That's well said, Maria. And yeah. I I
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  am curious though. So when you consider value
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  based care and your
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  organization's
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  movement toward it,
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  What do you think is the next step
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  for
• 11:46
  Kaiser to say, okay. We're really
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  embracing what it means to
• 11:52
  provide value based care?
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  The next I think the next step is
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  really trying to
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  improve the health care in our communities outside
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  our walls and outside just the Kaiser Permanente
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  membership.
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  And so we do take a lot of
• 12:06
  our protocols and our evidence based approaches
• 12:09
  to FQHCs,
• 12:12
  to other,
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  county hospitals, for instance,
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  to really try to share best practices
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  and spread
• 12:21
  value based care.
• 12:23
  That makes a lot of sense, Maria.
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  So the last question I have for you,
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  and you can relate this to a person
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  or group of people, whatever you feel is
• 12:32
  appropriate, and that simply is, what is an
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  underrated leadership trait
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  and whom have you seen embody that trait?
• 12:40
  This goes back a little bit to what
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  I was talking about earlier, and I think
• 12:44
  it is a little bit around
• 12:47
  risk taking, but it's also about
• 12:50
  other people's opinions. And there's a quote from,
• 12:53
  Melissa Radke that does something like this.
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  What an interesting little prison we build from
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  the invisible bricks of other people's opinions.
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  And I think that kind of holds us
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  back from
• 13:06
  really
• 13:07
  being our true selves, being our authentic selves,
• 13:10
  bringing joy into our work, and and kind
• 13:13
  of releasing yourselves about what will people think
• 13:16
  and and going for gold. So I'm thinking
• 13:18
  of Alyssa Lou. You know, she's not out
• 13:21
  there saying, you know, okay. Well,
• 13:24
  I have to do this, this, and this,
• 13:25
  and I have to win. She's there, just
• 13:28
  being her true self,
• 13:30
  enjoying that joyful moment and bringing it,
• 13:33
  to the stage for the world to see.
• 13:36
  And I think,
• 13:37
  our jobs are really hard. We have to
• 13:39
  have fun in it. We have to, see
• 13:41
  the bright lights. We have to it's like
• 13:43
  bringing your art, to the world, and I
• 13:45
  think from a leadership perspective,
• 13:49
  that's part of it. I believe in joy
• 13:51
  in medicine. I believe in joy in leadership,
• 13:53
  leadership sustainability,
• 13:55
  and so that would be my,
• 13:58
  the trait that I would say is just
• 14:00
  be bringing authenticity to your to the stage.
• 14:05
  I love that, Maria, especially of where you
• 14:07
  said that
• 14:08
  we can
• 14:09
  do better at bringing our authentic selves and
• 14:12
  bringing our own art into the world. I
• 14:14
  mean, because yeah. You know, you might not
• 14:16
  be in a, quote, unquote, artistic field, but
• 14:18
  that doesn't mean what you do doesn't have
• 14:20
  some artistic element to it, whether you're a
• 14:23
  figure skater, as you mentioned, Alyssa Lou, or
• 14:25
  a cardiologist, or a journalist, whatever it may
• 14:27
  be. Wonderful.
• 14:29
  If I could just add, something to that.
• 14:32
  When we think about,
• 14:34
  you know, leaders and CEOs, for instance, I
• 14:37
  think a lot of times people have something
• 14:39
  in their mind about what a CEO looks
• 14:41
  like, what how a CEO should behave,
• 14:43
  And I wanna free people from that because
• 14:46
  I'm the first female CEO at my medical
• 14:49
  group, in eight and we've been around eighty
• 14:52
  years.
• 14:53
  And or they think they have to speak
• 14:55
  like Obama or, you know, act a certain
• 14:58
  way, dress a certain way, and just bringing
• 15:01
  your true self and releasing yourself from what
• 15:03
  everyone else thinks. You're gonna be at your
• 15:05
  best when you're yourself, and I think that
• 15:08
  Alyssa Lou kinda energy, bring it to the
• 15:10
  workplace.
• 15:12
  Maria, I think that is the perfect place
• 15:13
  to end this podcast. Thank you so much
• 15:15
  for being on, the show today, so to
• 15:18
  speak.
• 15:19
  We can't wait to see you. You know,
• 15:20
  you're gonna be at our conference before too
• 15:22
  long, and I'm sure our paths will cross
• 15:24
  again, and I can't wait until that happens.
• 15:26
  Thank you so much. It was nice to
• 15:28
  see you, and, looking forward to Becker.