Kaiser Permanente's Bernard Tyson makes case for technology in the wake of viral telemedicine story

NEW YORK CITY—About one in five Americans experience a mental illness in a given year, and Kaiser Permanente is working to use analytics to better predict when patients who suffer from depression or other mental health issues might need targeted services and support.

It's just one of the examples where Kaiser sees technology playing a crucial role in helping better address the needs of patients, CEO Bernard Tyson told FierceHealthcare at the Total Health Forum. The forum, sponsored by Kaiser Permanente and the National Basketball Association, focused on strategies to address mental health as part of overall health with a specific focus on adverse childhood experiences.

His talk came just weeks after another use of technology at a Kaiser facility sparked a firestorm of criticism after the story about a family incensed with the use of telehealth to tell a patient about his terminal illness went viral.

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“We invest heavily in technology and we do a lot with telehealth that complements the practice of medicine,” Tyson said, while also noting that technology has never been a substitute for “high-touch” healthcare. "That was not an accurate reflection of what happened,” Tyson said of the original reporting. “As we have always said inside Kaiser Permanente, we believe in high tech and high touch.”

Here’s more from our conversation.

FierceHealthcare: Kaiser Permanente has launched major social determinants initiatives, including investing in affordable housing to address homelessness. What is the business case for these investments?

Bernard Tyson: We consider a return to be much more than just financials. Financials are necessary, but we think about how we return a person to the community in good health. That’s what we’re in the business of, health. We work hard to show the formula works. … Our financial return is very direct; we can invest in the infrastructure and support of our members in communities and see the direct returns on the economics of how much it costs for us to provide care and coverage to our population. And there is also our mission to focus on affordability. When we make the returns on the savings, they don’t go to shareholders, they go back into the rates with the aim of lowering the rates to provide as many people as possible with high-quality, affordable healthcare and coverage.

FH: What are your ambitions for Kaiser Permanente’s growth nationwide outside of California?

BT: In many markets outside California, we hospitalize our patients in community hospitals in a partnership which is, by design, intended to make sure we establish a long-term relationship to ensure the Kaiser Permanente practice is being carried out. We have hospitals that we own, and those are predominantly in California but also in Hawaii and in the Portland marketplace in the Northwest. And we have a new arrangement where we run the hospital for the community, and that’s in Maui. That’s a community hospital that we have taken over for the state, and we manage that as we would any other Kaiser hospital. We don’t have to have all of the physical aspects. In fact, even in California, there’s a certain percentage of our members who are hospitalized in community hospitals, not a Kaiser Foundation hospital. We will continue to do that. We are not opposed to building hospitals if we have the critical mass that would warrant that and the communities are lacking the hospitals, but we don’t have that situation now, or in the foreseeable future. It is to the collective advantage of the community and our members that we maximize the resources available and that’s been our approach outside our hospital-based regions.

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At the same time, one thing we introduced in the mid-Atlantic region is our high-tech comprehensive centers. Those are facilities that we call in between a medical office building and a hospital. We can keep patients up to 23 hours and do procedures that used to be done in a hospital setting. Now, there are competitors copying our model of 23-hour comprehensive centers because it’s a great place to get high-quality care and it doesn’t have all the overhead of a hospital.

FH: What do you think about efforts by the Trump administration and Congress to address high drug prices?

BT: I don’t think pointing fingers is going to solve it. The reality is there are medicines that have done amazing work to result in better outcomes for people. At the same time, a pricing strategy that has no guardrails gets away from the total responsibility that we all have toward making healthcare more affordable for everybody. Right now, we need to put some mechanisms in place, and not in any way to destroy the business model of the pharmaceutical industry, but that allows more competitive pricing, more transparency and ultimately a clear sign that we’re all in for innovation and affordability. What good is a drug if it’s priced at a point no one can afford it except the super-rich? I don’t think we collectively want to live in that kind of society where some will not have the same opportunity for good health because they can’t afford it. I think we need to come up with rational solutions, and it’s not going to happen with finger pointing.

FH: Public and political support for a single-payer healthcare system seems to be growing. What are your thoughts on a single-payer system?

BT: We have been very clear that we believe in universal coverage, because coverage is the key to the front door of the American healthcare system. At the same time, I don’t think there’s just one way of delivering universal coverage. We like choices in America; you certainly can have universal coverage while also having a diversity of choices in how to get that. I also question the idea that aggregating everything under one roof, if you will, will be the formula to drive affordability. I know from our work within Kaiser Permanente that it’s much more than that. It is clear that we have a way to go with universal coverage. We have 35, maybe 40 million, out of the 325 million, who are not covered. The question is, do you blow up the whole coverage side of the healthcare equation to figure out what to do with the 35-40 million? I would offer that the real work ahead of us is how do we continue to transform the care side, because there’s a difference between affordability of coverage and affordability of care.