Latest / Becker’s Healthcare Digital Health + Health IT / Nolan Chang, MD, EVP of Corporate Development, Strategy, and Finance at The Permanente Federation LLC

Transcript

Nolan Chang, MD, EVP of Corporate Development, Strategy, and Finance at The Permanente Federation LLC · Becker’s Healthcare Digital Health + Health IT

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  Hello, everyone. This is Scott King with the
• 0:45
  Becker's Healthcare podcast.
• 0:47
  I'm thrilled today to be joined by a
• 0:48
  very special guest in doctor Nolan Cheng, executive
• 0:52
  vice president corporate development strategy and finance with
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  the Permanente Federation. Doctor Cheng, how are you
• 0:57
  doing today? I'm great. How are you today,
• 0:59
  Scott? I'm good. You know, it's actually kind
• 1:01
  of a nice sunny day in Chicago. We've
• 1:03
  had some good luck with, weather the last
• 1:05
  few weeks here. But, yeah, excited it's Friday
• 1:08
  as we record to get to the weekend.
• 1:10
  And that's interesting that it's sunny in Chicago,
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  but it it's overcast and a little bit
• 1:14
  drizzly out here in Southern California.
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  It's quite the opposite of what you would
• 1:18
  think on any given day. I definitely agree
• 1:20
  with that. Exactly.
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  Maybe it'll switch up soon. But as we
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  wait for the weather to get good for
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  everyone, there is a lot going on in
• 1:27
  health care, doctor Cheng. So we have a
• 1:29
  lot to get to. I I really wanna
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  get your opinion on some of the kind
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  of the big topics and trends in health
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  care. But before we get started, can you
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  please just tell us a little about yourself
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  and your work in health care? Yeah. Thank
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  you, Scott, and thank you for having me.
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  So by training, I'm a family medicine physician.
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  But like Scott said, I get to serve
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  as the executive vice president in the Permanente
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  Federation. It's the national arm of all the
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  Permanente medical groups in Kaiser Permanente.
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  And in that role, I have a broad
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  set of responsibilities, including strategy, corporate development,
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  finance, a lot of the business functions.
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  And I really pursued this role because I
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  think affordability
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  is going to be, if not the biggest,
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  one of the biggest challenges of our generation
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  of health care
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  professionals. And so it's something that I wanted
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  to be able to jump into to make
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  a difference and really improve care that we
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  deliver across the country for our patients.
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  That's fantastic. And doctor Chiang, I think we
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  were talking before, and I think you said
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  you came into this role during the pandemic.
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  Is that correct? Yeah. Maybe a few months,
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  in this specific role, few months before the
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  pandemic hit. And and jeez, it became a
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  storm pretty quickly. I remember asking my colleagues
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  that were in their roles longer. It's like,
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  this is this normal? And they said, absolutely
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  not. And since that day of five years
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  before,
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  I'm just wondering when it's gonna get back
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  to normal.
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  Right. Right. And and, you know, you can
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  argue that it didn't. It didn't get back
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  to normal, and the things are are much
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  different now. How
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  how interesting was that time for you to
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  kinda take on way more than you probably
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  bargained for? And do you do you think
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  that's kinda set you up to to deal,
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  kinda troubleshoot things and come up with solutions
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  maybe quicker than you would have?
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  Yeah. For sure. It it definitely, the role
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  is different, especially early on than when I
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  expected it to be. For me, the focus
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  in coming to this role was how do
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  I translate finances
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  into ways that are meaningful for physicians? Because
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  for physicians, we go we spend many, many
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  years, decades, if not, training how to be
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  the best clinicians.
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  But if we're trying to solve affordability, how
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  do we see that not as a negative,
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  but as a positive? Because we've taken this
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  oath as physicians to be able to take
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  care of our patients. And if one of
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  their big pain points is affordability, how do
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  we recognize that as a barrier to the
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  care that we can deliver?
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  So but taking a step back then
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  when the pandemic hit, it was more thrust
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  into how do we mobilize around a patient,
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  keeping the patient and the needs at the
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  center in a very resource limited environment as
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  we know whether it be protective equipment,
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  ventilators, all these devices.
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  If all of a sudden this hospital census,
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  inpatient census went up dramatically, were we gonna
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  have the beds,
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  the the technological platforms to be able to
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  take care of them? It was a scramble
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  in a limited resource kind of world. But
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  in many ways, I think that
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  it really helped prepare me for where we
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  are today.
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  We still have to provide those business functions,
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  but how do we translate what we're seeing
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  into financial performance? Because it really isn't the
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  finances that drive the strategy of the organization.
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  It should be the other way around. What's
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  your strategy? What's the current environment? And how
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  do the financial outcomes determine whether or not
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  we're being successful? In the midst of the
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  pandemic, it was a raging fire. I think
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  most people in health care right now say
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  that the fire hasn't died down and maybe
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  a little bit more smoldering.
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  But there is a lot of uncertainty now,
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  and it continues to be resource limited.
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  So how are we solving for these things?
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  How are we adapting our systems as an
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  organization
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  to be able to empower
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  our clinicians, our physicians, our health care teams
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  to be able to take care of our
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  patients who are in their
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  own experiences and in their own world in
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  a very tumultuous period of time.
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  Absolutely. And and, doctor Chang, I think, you
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  know, something that that had really kinda hit
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  hit its stride
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  or started to at least, and now it's
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  kinda in full force
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  for now is is AI. And, you know,
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  health systems use
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  AI. They have so many uses for it.
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  We we're seeing, you know, under other industries
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  obviously use AI. But, you know, it's reported
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  that nearly half of medical practices reported using
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  AI in some capacity in the last year.
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  It remains a key topic for health IT
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  leaders. From your perspective, what are the use
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  cases that are now making a difference, and
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  how are you leveraging them in your organization?
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  It's a it's a fantastic question, and it's
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  one I think that's oftentimes pivotal for organizations.
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  Because when we talk about artificial intelligence,
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  it's technology which should be part of your
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  solution. It shouldn't replace your strategy. Technology, in
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  my mind, is not the strategy. It's how
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  do you apply technology to your strategy. And
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  we started this conversation talking about the pandemic,
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  and it was great. And Kaiser Permanente that
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  we already had a significant amount of investment
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  in the infrastructure.
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  So during the pandemic, we went from maybe
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  90% in person
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  and 10% virtual to flipping that to almost
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  98% virtual and 2% inpatient.
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  And luckily, we had a lot of the
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  technologies in place. And so the ability to
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  text patients to let them know that we're
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  ready because during that period of time, remember,
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  people weren't willing to come in the building.
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  And so we'd have people wait in the
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  parking lots in their cars and be able
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  to predict wait times and text them to
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  let them know, yeah, now it's safe to
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  come in and be seen.
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  Having the technological
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  platforms to be able to do deal visits,
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  to be able to make sure that we're
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  able to connect with patients because our organization,
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  we're not just value based care. I like
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  to say we're longitudinal value based care. To
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  see me as a permanent day physician, you
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  have to have KP insurance.
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  So our patients stay in the system for
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  a lot longer. So that way, we're able
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  to deliver on outcomes
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  and drive quality and affordability through that. And
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  so what I oftentimes mean by that, if
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  if a patient's switching helplines every two to
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  three years,
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  it leads to more fragmented care. But if
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  you stay in the system for seventeen years
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  or more, then you really can't understand the
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  return on things like investing,
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  in treating hypertension
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  or a vaccine or preventative screening. And so
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  that really aligns my interest with those of
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  the patients. And why I say that is
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  because that really highlights how we
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  apply technology.
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  So during the pandemic, being able to see
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  somebody
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  through a video visit
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  was really powerful to see the fears that
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  they have in their eyes and the frustrations
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  that they're experiencing allowed me to address their
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  clinical need, but also the needs that they
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  may not be aware of. But then you
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  fast forward it to what we're doing today.
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  So I say we're longitudinal value based care,
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  but we are a relationship based organization, primarily
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  that relationship between a physician and the care
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  team and a patient,
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  but even between
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  us and our regulators,
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  us and our payers. So we've applied technology
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  over the past couple of years to be
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  able to augment that. I mean, one of
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  the big things that that we've really highlighted
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  out there is our ambient AI technology.
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  So we know that there's pain points. There
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  are problems that our physicians are asking us
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  to solve in regards to burnout and not
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  having that connection with the patients. But we
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  also hear that from our patients.
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  We ask them about the experience. Like, how
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  was your time with your physician?
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  It was frustrating for me to hear that
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  sometimes my patients would say, doc,
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  you're spending more time on the computer than
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  you are with me. And that's heartbreaking. Right?
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  Because everything I'm putting into that computer really
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  is to take care of that a patient.
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  But using
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  ambient AI dictation systems
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  allow me to sit need in a face
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  to face with my patient and have a
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  really
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  connected conversation
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  where I'm not worried about the time of
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  the day. Am I gonna be able to
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  capture everything by by keystrokes?
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  Allowing the technology
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  to do that for me, not only improve
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  the documentation,
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  but also improve the experience with our patients
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  so that they have more confidence, more understanding
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  what we're trying to do.
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  On the front end of a lot of
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  these things, something that we're really excited about
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  is we were able to come up with
• 8:55
  something called the KP intelligent navigator or the
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  Kaiser Permanente intelligent
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  navigator.
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  When I first started practicing
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  over twenty years ago, the predominant interaction with
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  face to face visit. But through some of
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  the technology that I just mentioned, there's so
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  many different tools that we have available now
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  to be able to meet our patients' needs,
• 9:14
  whether it be face to face visits, mid
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  visits, telephone, email, chat, you name it. This
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  can be overwhelming for our patients because most
• 9:22
  of them are not medically trained.
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  So when they interact with us, whether it
• 9:26
  be through our portal or one of our
• 9:28
  call center agents,
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  they just tell us what's going on with
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  them. But how do we connect them with
• 9:32
  the right resource? Because they don't know if
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  this is something they need to go to
• 9:35
  the ER for or if this is something
• 9:36
  that can just do an EVA zip for.
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  Right? But using large language models, we were
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  able
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  to leverage the experience of our physicians in
• 9:45
  getting our patients to the right resource. And
• 9:47
  so we've been excited because for our 4,900,000
• 9:50
  members in Southern California, we've deployed this technology,
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  and it's able to get the patient to
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  the right place at the right time with
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  almost a 98%
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  accuracy and also also almost a 9% increase
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  in patient satisfaction
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  when we look at these things. And it's
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  caught some pretty scary things
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  for patients that are
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  really interacting the portal virtually and just typing
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  things in. We've been able to catch things,
• 10:12
  minding the patient's chart and saying this patient's
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  at high risk for a cardiac event. We
• 10:16
  need to get them to the ER. And
• 10:18
  so there's been really some wonderful things that
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  have come out in how we're applying artificial
• 10:22
  intelligence really to augment the relationship,
• 10:25
  let our patients know that we know them
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  even at the point of booking,
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  leveraging all their past data, what the words
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  that they're using to be able to make
• 10:32
  sure that they're able to navigate the system
• 10:34
  in a seamless fashion. Because we don't want
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  our patients spending their discretionary energy trying to
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  figure out where do I need to go.
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  We wanna connect them, make sure that we're
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  able to address the concerns that they have.
• 10:45
  Yeah. I think that's great. A lot of
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  times when we talk with system leaders, you
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  know, their focus
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  in utilizing AI is kinda just system wide
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  for efficiency. So it's I I think it's
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  wonderful to hear how patient
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  focused, yours has been. And
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  as virtual
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  care expands from AI enabled tools and remote
• 11:03
  monitoring to to broader digital health platforms, introducing
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  new technology
• 11:08
  brings challenges. So what advice do you have
• 11:10
  for leaders trying to navigate
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  everything from governance
• 11:14
  to patient engagement? And can you share an
• 11:17
  example of how your organization has balanced innovation
• 11:19
  with operational constraints?
• 11:22
  Yeah, Scott. That's wonderful question because I think
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  you articulated a lot of the challenges. Right?
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  So as you bring on all these different
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  address pain points, one of the things uniquely
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  for us is, you know, Kaiser Permanente, we're
• 11:35
  an integrated system. So we have the health
• 11:36
  plan. We have a hospital system and delivery
• 11:38
  system and the physician groups. We're able to
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  look at that and say, how do we
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  integrate this into a unique patient experience?
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  Because it's not the technology
• 11:47
  and the people and the facilities
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  and the experience that are separate. Right? All
• 11:51
  these elements have to come together if done
• 11:53
  well to create a cohesive
• 11:55
  experience.
• 11:56
  Because in as you bring in different technologies,
• 11:59
  as we adopt change, everybody knows the hype
• 12:01
  curve. There's a point where it gets more
• 12:03
  complicated as you add more on and before
• 12:05
  it becomes seamless,
• 12:07
  And the patients can get lost in that.
• 12:09
  So for us as an organization, we always
• 12:11
  try to take a step back and say,
• 12:12
  what's the problem that we're trying to solve?
• 12:15
  And then go from there. And then what's
• 12:16
  the role of each of the elements of
• 12:19
  the solution, the facilities, the people, the space,
• 12:21
  staff, the stuff, the technology,
• 12:23
  and then we try to bring it together
• 12:24
  cohesively.
• 12:26
  The governance is critically important because we have
• 12:29
  the technology arms in the organization, the clinical
• 12:32
  arms, the health plan,
• 12:34
  and you called out, like, if it's focusing
• 12:36
  on efficiency or revenue or outcomes, it really
• 12:39
  does dictate a different solution, but we try
• 12:41
  to balance that. So
• 12:43
  the seven principles that we really focus on
• 12:45
  are transparency,
• 12:46
  accountability,
• 12:47
  safety,
• 12:48
  equity, quality, privacy,
• 12:50
  and clinician oversight, and we try to balance
• 12:52
  that. So even right before this, I was
• 12:55
  on our AI council. We're looking at some
• 12:57
  different technologies and saying, how do we apply
• 12:59
  this? And everybody got to give their perspective,
• 13:01
  be able to find what's the right solution.
• 13:04
  So I talked about the ambient dictation. There's
• 13:06
  a quality element to that.
• 13:08
  And so how long do you hold hold
• 13:10
  these things? How do we check things? Because
• 13:12
  as you introduce new technologies,
• 13:15
  it oftentimes isn't a replacement. Hopefully, it's an
• 13:17
  augmentation.
• 13:18
  But if you're not thoughtful about how this
• 13:20
  impacts cost, affordability,
• 13:22
  quality, experience,
• 13:24
  then it can go sideways pretty quickly. We
• 13:27
  also leverage our patient advisory councils where we
• 13:29
  ask our patients to give us input really
• 13:31
  early on and say, help us understand what
• 13:33
  you think about this. How would this be
• 13:35
  received well or not? And also our care
• 13:37
  teams as a whole. And so those are
• 13:39
  some governance and operational principles.
• 13:41
  But it oftentimes will come down to change
• 13:44
  management.
• 13:45
  Technology and we oftentimes when we talk about
• 13:48
  artificial intelligence, we'd like to say that it's
• 13:50
  augmented intelligence.
• 13:51
  Because if you don't frame it right, it
• 13:53
  can be something that's quite fearful.
• 13:55
  You and I were talking earlier about, you
• 13:57
  know, what what's the health care environment like?
• 13:59
  And I said, when are things gonna get
• 14:01
  back to normal? The people that are taking
• 14:03
  care of our patients on the frontline are
• 14:05
  feeling that same angst. I mean, we still
• 14:08
  hear hear about burnout and a lot of
• 14:10
  fear and anxiety.
• 14:11
  And so you introduce more change that does
• 14:14
  it heighten the fear and anxiety, or does
• 14:16
  it leave it? If applied right, if they
• 14:19
  know that we're trying to solve their pain
• 14:20
  points, then hopefully should leave it, but also
• 14:22
  get them allow them to be engaged. So
• 14:25
  that's why we we shift oftentimes from saying
• 14:26
  artificial intelligence, which can be sound scary, to
• 14:29
  augmented intelligence because we wanna be able to
• 14:31
  augment our people. But then we have to
• 14:33
  be able to connect with them and understand
• 14:34
  how much discretionary energy. If they're solving for
• 14:37
  some other clinical implementation,
• 14:39
  a quality program that we're trying to put
• 14:41
  in place, do they have the discretionary energy
• 14:43
  to implement something around technology?
• 14:46
  Do they understand the long game? Because in
• 14:48
  that high curve, there's a period where it's
• 14:50
  gonna be inefficient before it gets efficient. And
• 14:52
  we have to bring them along in that
• 14:53
  journey, help paint that picture so they understand
• 14:56
  the impact to them them. So
• 14:58
  while it's about technology,
• 15:00
  there's also a lot of elements about basic
• 15:02
  management
• 15:03
  at the individual team and also at the
• 15:05
  organizational level.
• 15:07
  Yeah. You know, you just had basically a
• 15:09
  lot of great thoughts and advice on dealing
• 15:12
  with emerging
• 15:13
  tech just there. But if you had to
• 15:15
  kinda zero in on your number one
• 15:18
  piece of advice for health care leaders as
• 15:20
  they prepare for further advancements in technology and
• 15:23
  rising demands for care, what would that be?
• 15:26
  Yeah.
• 15:27
  I mean, I think there's so many different
• 15:29
  things, but one of the things that's being
• 15:31
  trained as clinician, one of the things that
• 15:32
  we would learn in our training is when
• 15:34
  you're running to a code, the first pulse
• 15:36
  you check is your own. Right? So I
• 15:38
  think it's important to know where we're at
• 15:40
  individually as leaders as as an organization.
• 15:43
  If we don't acknowledge the fear or anxiety
• 15:46
  or the overwhelming challenges that we're facing, I
• 15:48
  think we can be dazzled by the shining
• 15:51
  new piece of technology
• 15:52
  and just go down that road and lose
• 15:54
  sight of what we're really trying to accomplish.
• 15:56
  So are we using technology to solve for
• 15:59
  the fears and anxieties that we have in
• 16:01
  an increasing
• 16:02
  volatile marketplace,
• 16:03
  or is it really aligned around
• 16:05
  the pain points
• 16:06
  of applying our our organizational strategies and solving
• 16:09
  for that because the marketplace is looking for
• 16:13
  value. Right? We hear about the struggles in
• 16:16
  decreasing rates. People want a better experience. They
• 16:18
  don't understand why the cost is going up
• 16:21
  and why they can't get in to see
• 16:23
  somebody or get a medication or just get
• 16:25
  an issue met. So I think the big
• 16:27
  keys piece is really understanding
• 16:29
  where we're at and the problems that we're
• 16:31
  trying to solve and then applying the technology
• 16:32
  because you don't want the technology leading. Because
• 16:35
  as you go out there and meet with
• 16:36
  all these great companies,
• 16:38
  they oftentimes will have solutions looking for problems
• 16:41
  versus understanding the problem and applying a solution.
• 16:44
  So definitely understanding what we're trying to solve
• 16:47
  and and how it moves the organization forward
• 16:49
  is probably the key thing that I try
• 16:51
  to keep central as we look at these
• 16:53
  different solutions.
• 16:54
  I think it's a a great number one
• 16:56
  piece of advice for for dealing with for
• 16:57
  further advancements in technology. And, doctor Chang, the
• 17:00
  last thing I want to ask you that
• 17:02
  we ask a lot of leaders on the
• 17:03
  podcast is, how are you evolving as a
• 17:05
  leader?
• 17:07
  Yeah. That's a fantastic question.
• 17:10
  Different
• 17:11
  times require different leadership
• 17:14
  skill sets, and,
• 17:15
  we talked about before the pandemic, a lot
• 17:17
  of it was you know, the solution hadn't
• 17:19
  really changed over many years.
• 17:21
  If we grew a 100,000 members, we knew
• 17:23
  how many hospitals or examiners we need. A
• 17:25
  lot of it was around efficiency.
• 17:27
  There weren't a whole lot of disruptions that
• 17:29
  came about, but the pandemic, if anything, was
• 17:32
  an absolutely great accelerator.
• 17:34
  Today is very, very different than it was
• 17:36
  five years ago. So for me, evolving as
• 17:38
  a leader is really not focusing or balancing.
• 17:41
  We always are gonna need efficiencies,
• 17:43
  but understanding how we focus on transformation.
• 17:46
  And so it's really more about connecting with
• 17:48
  the hearts and minds of people and storytelling
• 17:51
  and bringing them along on the journey because
• 17:53
  we will
• 17:54
  go we will go much further together. I
• 17:56
  think during these periods of uncertainty, it's easy
• 17:59
  to splinter or divide as an organization,
• 18:01
  divide as a team, and that's not going
• 18:04
  to really help us accomplish our mission. In
• 18:06
  Permanente Medicine, we are a large group,
• 18:09
  practice with a social mission. I mean, people
• 18:11
  join us for that mission. And so if
• 18:12
  we stay true to that, I'm confident we
• 18:15
  will be able to really augment the value.
• 18:17
  Because I think during this period of time,
• 18:19
  people need that that belief and that mission
• 18:22
  and trust in that vision. So for me
• 18:23
  as a leader really is how are we
• 18:25
  engaging? How are we telling stories? How are
• 18:27
  we listening is probably the most important element.
• 18:30
  So I'm applying my time is critically important.
• 18:33
  Having conversations like this and getting the message
• 18:36
  out there and highlighting the opportunities is one
• 18:38
  of the ways I look to do that.
• 18:39
  And so it's not necessarily solving as many
• 18:41
  problems as broadening the conversation for me.
• 18:45
  Well, doctor Shane, thanks so much for joining
• 18:46
  us on the podcast. I thought this was
• 18:48
  a great conversation, very informative, and and looking
• 18:50
  forward to working with you again soon. Likewise,
• 18:52
  Scott. Thank you so much for having me.
• 18:53
  I look forward to our future discussions.
• 18:55
  Absolutely.
• 18:58
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• 19:01
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• 19:03
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