April 16, 2009 
I had the privledge of previewing George Halvorson‘s new book “Health Care Will Not Reform Itself” this week. My book cover quote would go something like this:
“Opinions supported by facts all wrapped up in a narrative. It’s like a fireside chat with one of the greatest leaders in healthcare.”
I won’t pull things from the book yet, but I found it a logical follow-up to his other book “Health Care Reform Now! A Prescription For Change“. He talks about the need for bold goals and a clear set of metrics to drive change. He talks about why healthcare costs go up and the fact that we need universal coverage. And, he also hits on what seems to be the key theme of the day – reducing costs while improving outcomes.
While I was at the WHCC09, I got to sit down with George Halvorson and talk about healthcare for an hour. It was a great privledge that I enjoyed a lot, and I could have talked for hours. We hit on a bunch of topics so let me share some of them.
- We talked about him writing books. I was commenting on how much I like his writing style and was intrigued to learn that he said some professors don’t like using his books because they’re “too easy to read”.
- We had a fascinating discussion around leadership and diversity and how he has created a very diverse leadership team at Kaiser. I was also impressed to hear that one member of team does an international fellowship each year where they spend time abroad learning about how healthcare is delivered and managed in other countries. [very progressive]
- We talked about how healthcare was going to change. He spent a lot of time on the need to create aggressive goals especially around the 10-20% of things that drive 80% of the costs. For example, he asked why we don’t try to reduce asthma attacks or congestive heart failure by 90%. And, he pointed out the fact that we don’t have a common set of goals that allows enterprises to reverse engineer the process and identify points of variance. Without that process analysis and a specific goal, it is hard to drive improvements.
“We need to change our expectations of what is possible.”
- We talked a little bit about where innovation will come from. He talked about how Deming, a statistician, revolutionized manufacturing as a lead into the point that innovation will likely come from outside the industry. [I think this is interesting as I have seen more and more executives at healthcare companies that are coming from outside of healthcare. I also think things like the X-Prize may attract others to try their ideas.]
- He gave some great examples of how Kaiser has deployed their 30 black belts. The one I quickly jotted down had to do with how nurses change shifts. This shift change is where all the information was exchanged about different patients and when accidents sometimes happened. By changing the process, they dropped the accident rate and reduced the communication time from 40 minutes per shift to 12 minutes per shift.
- We also talked about HIT (Healthcare Information Technology) and the need not only to drive utilization but to mandate system integration. This tied in with an earlier conversation where we spoke about coordinated care versus uncoordinated care and the need to create a “virtual Kaiser”. I think there is a lot to learn from the Kaiser model and some of the things they are doing with technology to drive care. [I was pleasantly surprised that he believes physicians will embrace technology as a tool to help them standardize care. I think that is critical path to successfully reducing costs while improving outcomes.]
- I couldn’t jot down all the statistics fast enough, but he talked about how they were testing different “panel systems” in different geographies to see what the best process and technology solution would be. They had had some great results. [One fact he shared that jumped out at me was that 25% of people over 65 that break a bone die within a year.]
- The last thing we talked about was probably the most insightful to me. Given the amount of money spent in the last months of people’s lives, I was interested in his global perspective on whether that was a cultural issue. He said that he thinks it is mostly that the care system in the US lacks honesty or the ability to be brutally honest. We talked about one scenario where people who do nothing live an average of 140 days and those that get invasive surgery live an average of 100 days…but they are hoping to be that 1 in a 1,000 that live an extra year. [Is it worth all that pain, surgery, and medicine for the last few months?] We also talked about the new $100,000 breast surgery drug which extends the patient’s life on average for 1 month. [Again, is that an appropriate use of money? Would we spend it if it came out of our pockets?]
When the book comes out, I will try to pull out some of the key points, but I would recommend you pick it up and read it for yourself. I think you will really enjoy it.
Enabling Healthy Decisions 
Shame on you Mr. or Ms. “KP Executive” for throwing such un-referenced vitriol at Kaiser Permanente and for not throwing it with attribution of who you are. You sound like a sour-grapes KP employee to me, one who does not understand how Kaiser works to improve the health status of its members–or how Kaiser is the only true model we have that could implement true healthcare reform short of national health.
I worked for Kaiser on both its insurance side (KP Health Plan) and on its medical group side (TPMG). While the insurance side does function like a typical insurance company, needing to price right and ensure economic viability, the medical group delivery side is constantly searching ways to improve quality of care. George Halverson is indeed a visionary and from both sides of KP’s house (insurance and medical group)
BTW,I was let go from KP after 10 years there; I still love the organization and pray that I will be able to keep my KP insurance through the termination of my COBRA benefits. No one is working harder at improving health status than the physicians and administrators at Kaiser Permanente; no healthcare model is more perfect for healthcare reform–true reform.
When discussing health care reform and labeling George Halvorson as some kind of visionary leader, why is it that the failures and scandals of his very own health care organization, Kaiser Permanente, are overlooked as if they don’t exist? Kaiser has been fined millions of dollars in recent years for its disastrously poor response to patient complaints, and has lost several lawsuits for retaliating against its own physicians and employees for pointing out internal problems to management in an effort to improve things. The KP San Francisco kidney transplant center debacle immediately comes to mind as one egregious example when complaints were ignored for years, many people died, and everyone within the organization who tried to address the problems was either fired or forced to resign.
Kaiser Permanente was also recently investigated and fined for illegally rescinding policies, right along with several for profit insurers, proving KP is just one of the gang.
Halvorson doesn’t have to wait for “health care reform” on a national scale to reform his own organization, yet he does nothing of the sort — opting instead to write books about what other people should be doing to fix a system he helped to break, and to hire more PR people to deal with the scandals.
Be careful what you wish for, because you and the rest of us might just get it.
Martin C.: The answer to your question is very simple: Kaiser cannot reform because reform it is NOT on their best interest. You’re absolutely right, I am a current executive at KP and must tell you the George H. and his gang have taken full advantage of the regulatory vaccuum of the Bush era to line up their pockets and secure their bonuses, even at the expense of the unaware members who on a daily basis put themselves at risk.
The fix is on at KP. The fix is on. When might is right, then Kaiser is always right.
The might of $37 billion in annual revenue and growing, the might of hiding behind a not for profit “at the service of the community” public face and the private deep pockets of a ruthless business, the might of an effective lobby that encapsulates the very definition of “thrive” in the free-for-all Bush era and the might of making up and compensating for fraud, waste and abuse by passing on the associated, significant costs to us — the members — in ever increasing premiums.
The fix is on at Kaiser in its own particular version of the Fantastic 4.
Like Mr. Fantastic, KP has the ability to stretch and modify the facts into incredible lengths and shapes beyond any recognition.
Like the Invisible Woman, KP has the ability to render invisible any problems, any issues and project impenetrable force fields of denials, spin and propaganda.
Like the Human Torch, KP will burn to cinders anyone who dares to oppose or challenge it.
Like the Thing, KP will use the full force of its might to squash anyone — friend or foe, employee or member — who it perceives as a threat to the status quo.
The fix is on at Kaiser by carefully managing its public image and any regulatory agencies that come their way and fully taking advantage of the 8-years of the regulatory vacuum that the Bush era was.
The fix is on at Kaiser by its propensity, willingness and active goals of hiding the truth, distorting the facts at all costs, including member safety.