Creating Innovative Healthcare for All

On this episode, Tom talks with Kevin Hart, SVP of Strategic Development and Technology, Northern California at Kaiser Permanente. Together they discuss his work in creating inclusive healthcare spaces for all patients, leveraging technology within human-centered design, and what it means to serve communities the way they want to be served. 

Transcript

Tom 01:13
Welcome, Kevin Hart.

 Kevin 01:15
Hey, there, Tom. Good to be here.

Tom 01:18
Excellent. So Kevin, how have you brought your unique blend of expertise and experiences into this role you have at Kaiser?

 Kevin 01:25
Well, Tom, I, as you know, I go back to sort of my days as an engineer, working at Bechdel, in the big design construction firm. And that sort of background helped me to understand how to solve problems at scale. And it was on a global scale. But it also allowed me to get that understanding of both the business and technology and integrate it together to be innovative and solving problems, then I go from that experience to, as an entrepreneur, trying to start my own companies, doing several startups with friends and colleagues, that got me that whole focus on the integrated team and the value of everybody on the team to commit to a goal and go get it done. And then finally, in my experience at Kaiser Permanente, starting in national facilities, where I got to be a part of a team that built 27 hospitals, and more than 100 medical office buildings, you got to see the end to end business, from the health plan side, the clinical care side, and then how it all shows up. And the human centered design that was used to develop the spaces integrated with the technology. And then that led me to my current role as a strategist, understanding how we get to the future of health, and Kaiser Permanente’s role in that.  

Tom 02:52
Yeah, one of my favorite quotes and listening to some of the things that you've said, or that you've written is, “I believe that innovation is not about appointing an innovation officer. It's about creating an innovative culture.” Can you expand on that? Cause I just love that statement.

Kevin 03:06
Yeah. I mean, the reality is that – at least I've found in my career of innovation is – the folks who do it every day, and enabling them, creating environments for them to think about the possible, ‘What could I? What might I? How could that be better?’ And if you have folks that sort of do the job every day, and then you create the environment where you expose them to different things, they themselves could say, ‘Oh, they did this in high tech, why can't we do this in healthcare? Oh, they did that in heavy construction, why can't I do that in high school? Oh, they did that in finance, why can't I do that?’ So that environment that opens up the aperture of everybody doing the work, and then giving them the space to say, ‘You know what, we all like to be successful. We all don't like to fail, but the right types of failure creates the opportunity for the future.’ And I think that environment breeds innovation, where everybody feels valued and appreciated for bringing their thoughts to the table. I love that.

Tom 04:19
That's fantastic. Yeah. Kaiser to me – when you say innovation – Kaiser to me is a great example of that in our healthcare industry. I've always been impressed by both the simplicity but also the consistency of the Thrive initiative. And I'm kind of curious, how has Kevin been able to put some of his fingerprints on Thrive, whether it's in a design capacity or an implementation capacity?

Kevin 04:47
Sure, I think that you know, me personally, bringing sort of my full life experiences to work every day and being at Kaiser Permanente for 17 years, I bring my full, authentic self to Kaiser Permanente every day. And when I think about Thrive, I think about total health, I think ‘people living their best lives,’ and I think ‘health equity,’ And as an African-American man and growing up in Baltimore City, and having two Black male sons, understanding disparity and understanding what it means to walk down the street not knowing if you're accepted or worrying about whether you're going to live or die, that ability to make sure that everybody feels like they don't have to deal with that when they come to Kaiser Permanente is sort of my personal imprint on Thrive. So creating opportunities, through the way we design buildings, or leverage technologies, or the teams that we hire, that interface with the wonderful patients and members and communities we serve. So that you create this open environment, that values every human being, is how I bring my personal piece to what I like to say, thrive and it's evolution to total health.

Tom 06:14
This is, something that – what you've just said is powerful. It is also, I find, an organizational challenge, to try to bring it every day. Talk a little bit about the conversations inside Kaiser, right, both headwinds and tailwinds of actually bringing that to fruition because we need to do a better job in healthcare as a right for everyone. Quality health care for everyone. It's also a challenge that we find in our industry of diversifying our workforces to be representative of the colors and shapes that we see in society. 

Kevin 06:48
Yeah. And I love the way that our CEO, Greg Adams talks about it every day, which is – we have more than 200,000 employees at Kaiser Permanente – and when we talk about equity, diversity, inclusion, equity, and the most important thing: the belonging, making that a priority of what we do aligned to our mission, and then providing training and development for over 200,000 people to make that at the forefront, and then actually looking at multiple levels of the organization, and then looking in the communities that we serve, and then understanding where there are gaps and opportunities for those folks in that community to be a part of our – not only workforce – but our leadership team, and then by leading every day in a sort of ethical and in a culturally sensitive way. So you serve the communities the way they want to be served. It's sort of how, as part of the mission and the DNA of Kaiser Permanente, that we go about it every day, it's not always easy. It is difficult. And at the same time, I think the mission and the wonderful people that work with Kaiser Permanente, and the reason why I stayed for 17 years, there's joy, to just go through that tough journey together, because the outcome is just amazing.

Tom 08:16
You just said something there that has always stood out to me, and I've been a Kaiser customer several times over the course of my adult life. ‘The way that patients want to be served,’ right? It's something that really kind of stands out. I mean, there's a lot of players in healthcare that really kind of push back on, ‘you can't use traditional CRM thinking.’ And Kaiser to me has been absolutely very adaptive of that type of thinking. So as you think about, sort of Kaiser's focus, right? Thrive is about being well, staying well, and then if you need the health care system, or sick care system support, it's there for you, whether it's with Kaiser or through one of its partners. Where's Kaiser going in the next couple of years as we continue to face huge challenges in the healthcare ecosystem in our country here?

Kevin 09:02
Yeah, yeah. I would say, Tom, that over the next couple of years – and we started this, even prior to the pandemic – but that mission around affordable, high quality with outstanding outcomes, as well as exceptional experience for all is where we're going. And that exceptional experience piece, and that affordability piece is really key. And aligned with that affordability and exceptional experience is the health equity piece. The fact that African American moms have lower mortality than any other moms is something that we have the power to change. And as we think about affordable, high quality care, that equitable care that goes to that exceptional experience has to be at the forefront. And so when we think about the next couple of years, one of the things we've learned from the pandemic, is that the preventative care works. And when you have those couple of years where people are afraid to come in because of the pandemic, and they don't get that preventative care, they have more things wrong with them. And so it requires actually more care, because they were afraid to come in because they didn't want to catch COVID. So now getting back and getting an even further upstream of that preventive care in terms of total health, the physical and mental health – that's the behavioral health as well – and don't forget about the environment, when you talk about the social determinants of health. Where you live, whether you have a roof, whether you have food, so those things are even more prominent now that we've been through the last three years than they were prior to the pandemic.

Tom 10:53
Yeah, what are the key lessons for Kaiser, coming out of the pandemic? And then I'll say, put it into context – maybe you just answered this a little bit in the context of health delivery and health care, wellness – and the second part is technology's potential role to deliver great care and to make it equitable care for everyone. I'd be interested Kaiser's lessons learned for three years.

Kevin 11:23
Sure. I think one of the things that the entire health care system learned is that going fully digital is not the answer, right? Everybody did what they had to do, but then the wave happened, and then it receded. And then what came out of that wave of everybody having to be virtual, because we couldn't be in person, is just understanding the journey of any person when they're getting their health care. And when we look at it, as Kaiser Permanente, that journey includes the insurance part, the hospital part, the clinic part, you need skilled nursing, home care, so that end to end piece, and then how do you have the right combination of, I like to say, virtual and physical, the in-person, plus the consumer choice where virtual when they need it, or when they have it, so now you get that exceptional experience, and you do that in a very equitable way. So in communities where they can’t afford broadband, and you know this well, Tom, how do you ensure that they get that same experience and that same care. So that combination of the physical and the virtual is something that is at the forefront, as we come through the pandemic, and then you align that with the social determinants of health, so that whole person view, including the fact that I ‘may be homeless, and I have mental health issues, and because I do that, I can't get to the clinic.’ ‘How can I help you get your needs met? So that then, you can get to help?’ I think we learned a lot about ‘How do we continue to look at end-to-end, the care and the coverage, and then that benefit that comes with focusing on equity for all.’

Tom 13:20
Yeah, I've always thought that Kaiser having that end-to-end view, both sides as both the payer organization [and] provider gives it a unique perspective that I know that I've always tried to learn from in our opportunities, where we've been able to talk and work together. All have this technology – you're providing a lot of choice, and I'm sure you could give us great numbers on which of your patients are taking advantage of the choice of technology – how does an organization like Kaiser think about the data opportunity and the data challenges, talk a little bit about your data strategies as an organization and how you balance the opportunity with the risks around around health-related data?

Kevin 14:02
Yeah, and you know as well, Tom, especially with the areas that you lead, especially in the healthcare data field. I think one of the things that we've always started with as a foundation is that the member, the patient data, it’s paramount that it is protected. That it is their data, not our data, and that we make sure that it is protected. And then based on what we need to do to provide the care and coverage for that member, for that patient, that's how the data gets used. And so as part of that, and this is the beauty of our integrated delivery system, is that we can protect it in our integrated delivery system. I think lots of opportunities for malfeasance or bad actors happen when you have these leaks, or things can get outside. And so through partnerships, where we, all together in a partnership, agree to certain technology and security standards to ensure everything's secure and we follow those rules and guidelines. That enables us to number one, protect the data. But then to leverage the insights – I use the perfect example of the Unitas platform where we work with nonprofit so that we can now take social information, combined with health data, to help in the primary care office visit, help solve the social issues of that member patient based on them agreeing that they need and want the help. So that's a perfect example of when you talk about that broader data. And then making sure that you leverage it for the right reasons. We always focus on the right reasons and the right outcomes.

 Tom 16:01
So I'm curious because you know, in the circles that I'm working in, there's a lot of talk about data. You spoke to, ‘the data is the patient's data, your organization is trying to protect it,’ but also a lot of talk about biases in the data and perpetuation of health disparities, rather than the closing of gaps. Talk a little bit about what that conversation looks like within Kaiser-

 Kevin 16:27
Oh absolutely, I think that the beautiful thing is that one of the foundations of the founding of Kaiser Permanente that started with Dr. Sidney Garfield, working with Henry J. Kaiser, is that he was really visionary, and leveraging technology and information and data at that very early stage and focused on evidence based medicine. Right. And as you and I know, Tom, the evidence goes down to the individuals who are sort of providing the results, and determining the rules for how you provide the results. And so sometimes there can be biases in the development of those rules. And especially when those rules guide the software that then produces the outcomes. So how do you get down to that foundational level of the people making the rules and having an inclusive, diverse, ‘focused on belonging,’ in the rulemaking? So this is where, when we get down into systems, and you know this well, Tom, how do we bring a perspective that is inclusive of folks that normally wouldn't get invited to the room, and they're the ones at the underlying rulemaking of developing that code and the guidelines for how it gets done? And you're working on some great stuff with the UC system to do that. I know OCHIN is working on some wonderful stuff and we are as well at Kaiser Permanente, but foundationally, that approach is really going to be how we change the whole world. And really, when you talk about equitable outcomes with an equitable lens, is something that has to be done.

Tom 18:13
Why should the next generation want to join you and become part of the future of health and technology?

Kevin 18:22
I sponsor, as part of Kaiser Permanente in Northern California, I sponsor administrative fellowships, where we take folks finishing master's degrees, usually in healthcare management or other fields, and we bring them in for 12-18 months to let them get exposed to the end-to-end system. And I would say that more than anything in the last five years, for the folks that have been through the fellowship at least, when you get into the healthcare system, and you really understand it at its base level, and you know anything about technology, it is so wide open for the possibility for technology to revolutionize it. I mean, what happened in the high tech industry with retail, and even if you look at the airline industry, and you look at cars, and you know, self-driving cars, all that stuff still hasn't been done yet in healthcare. And for young folks looking for that career with technology and health, I think it's a perfect time to be here. 

Tom 19:35
Yeah, and I think one of the things that's interesting about health care, right, is four of the top ten Fortune 500 companies are health care companies now. So if you're driven by ‘where is their opportunity, and where the dollars are flowing,’ healthcare is a place that you'd want to be if that's your motivation, but maybe more importantly, and I think Kevin and I, and people who are in the industry, it's a mission driven industry. 

Kevin 20:00
Yes. 

Tom 20:01
And some people connect with that mission at 22. And some people it's 62. But no one on this planet is not touched by health care, the health care system, disease, and so we can all identify it as a person level, or as a ‘someone very close to me’ level. And so, I think when people connect with that mission, the want to contribute is really, really strong. And to Kevin's point about the need to have diversity within our ranks as an industry, it's incredibly important because the cultural background that comes with the patient is so important as part of the interactions and the care and the follow up, and who's part of the conversation. And so I think when you kind of put it as like, ‘this is an industry that is high growth and scale, and also something that everyone can connect to why it's important,’ it makes it a reason why everyone should look at it. Certainly we have a lot of students who’ve expressed an interest, even at an undergraduate level. The subscriptions for our health informatics undergraduate course is oversubscribed, every time we offer it. So we find even young people are very interested to understand this field. And certainly in the data space, Kevin, it's amazing how much it's like, ‘they want to understand the data that's in this space.’ Because when they think about machine learning and data science, they want to get into playing with that data, ‘what might I be able to do?’ 

Kevin 21:34
So awesome.

Tom 21:35
I'm just kind of curious that you brought up the genetics to 3D-printed organs, does Kaiser see themselves in that business, or is that kind of, ‘we're going to let the academic medical center or specialty practices for doing those things, practice that type of – do that type of procedure.’ Just kind of curious.  

Kevin 21:55
As you probably know, Tom, I also sit on our – I'm going to say – investment arm of Kaiser Permanente, we have an investment arm where we invest in companies that impact the healthcare industry. So from the perspective of being a part of what that future is going to be, – meaning that we don't have to do it ourselves – but we may want to influence it so that others can, and just like we, with Mayo, partnered to invest in Medically Home. And we are now somewhere close to 400 patients, where we're doing procedures that would normally be done in an OR, we're doing it in their homes. And so the investment part is the influence part. So that now we get to influence from an equity lens and affordability lens, so that it's available for all, so you don't get the haves and the have-nots. So it's not necessarily us doing it or getting into it, but it's us directing and guiding so that when it does become commonplace, everybody gets the benefit and value. So that's how we plan it right now.

Tom 23:15
Yeah, so it's kind of like Kaiser influencing the ecosystem. You don't draw your boundaries just around what your organization is, it's where you can affect investment, future ways that people could deliver care, even if it's not through you.

Kevin 23:33
Like food is medicine, it's just huge. And so lots of investments in lots of these startups that are really taking food and literally replacing the pharmacist because you eat the right foods. I mean, it's just huge for the future. And so playing in all those spaces are things that we do.

Tom 23:51
So I always love talking to you, Kevin, because it's almost easy to forget that you have strong technology in your background. But the last question I'm going to give you today is actually to put that technologist hat on and say, “Okay, go 5 and 10 years out, what technologies that you're excited about can make the biggest impact in healthcare for all?”

Kevin 24:12
Yes. Tom, I think one of those technologies that I've been thinking about over the last four or five years, and it's getting better and better every single year, is really that focus on precision medicine, genetics, and that capability to really get upstream by studying the genome. And when you think about that capability combined with the ability – and some of this is starting to happen now – that leveraging my DNA to have a 3D-printed organ of a heart or a lung or something like that, and just imagine if you do that in a way where you don't have to be wealthy, or you don't have to have ‘Cadillac’ health insurance, and you can get a kidney transplant or lung transplant, I just think the possibilities in that entire space, it's just going to be amazing. Another area that from a technology perspective, that I'm really, really keen to see it really get to the next level, is – we're really starting to see – and you do a lot of this too, with the work that you do – is artificial intelligence and machine learning, for good. And that is ‘how do we really have it be an enabler? And have it be a support function for the clinicians, for the staff, for the system, to reduce waits, to do the checking, so you get to higher quality and also to take out the administrative burden so it is more affordable. So I just think that as we do that the right way, that's going to be huge in the next few years as well.

Tom 25:53
That's fantastic. All right, well we're gonna leave it there for today. Kevin, thank you so much for joining us. Working with you on the OCHIN board has just been a joy and a pleasure. And I love what you bring to our conversations there. And I love what you brought to our conversation here. So thank you for being with us today. 

Kevin 26:09
Thank you so much, Tom. Have a great day.

Editor’s Note: According to the Centers for Disease Control and Prevention, in 2021, the maternal mortality rate for non-Hispanic Black (subsequently, Black) women was 69.9 deaths per 100,000 live births, 2.6 times the rate for non-Hispanic White (subsequently, White) women (26.6) (Figure 1 and Table). Rates for Black women were significantly higher than rates for White and Hispanic women.