The finding points to a broader health care transformation grounded in medical excellence: using advanced tools and richer data to personalize disease detection. It also helps move medicine closer to the goals of value-based care: delivering the right care to the right patient at the right time.

“Breast cancer risk tools can help identify high-risk women who are most likely to benefit from more frequent breast cancer screening or risk reduction with medications,” said lead author Vignesh Arasu, MD, PhD, a research scientist at the Kaiser Permanente Division of Research and a radiologist with The Permanente Medical Group. “Our study shows that each of the 3 tests identifies a unique group of women, and that when all 3 risk tests are used we increase our ability to differentiate high-risk and low-risk women and provide more personalized screening recommendations.”

Related health care innovation story: Why health care innovation is essential during uncertain times

Combining risk scores strengthens breast cancer risk prediction

Published in the Journal of the National Cancer Institute, the study is one of the largest and most diverse to evaluate how well 3 scores predict breast cancer risk. Those scores included:

• Mammography AI algorithm, which predicts 5-year breast cancer risk based on the presence of imaging biomarkers. The technology assists radiologists by scanning mammography images in seconds to identify tiny, subtle lesions or calcifications that might be missed by the human eye.
• Polygenic risk score, which is determined by the presence or absence of 313 single nucleotide polymorphisms (SNPs) that prior studies have found to be associated with breast cancer.
• Clinical risk score, which considered factors such as age, race or ethnicity, family history of breast cancer, breast density, and body mass index.

The study included 82,957 women enrolled between 2003 and 2020 in the Kaiser Permanente Research Bank, a national biobank that includes medical records, survey, and genetic data from more than 400,000 Kaiser Permanente members. All study participants had a recent mammogram with no signs of breast cancer and no known genetic mutation or prior diagnosis that increased their risk.

Over a decade, 2,471 or 3% of the women in the study were diagnosed with invasive breast cancer or abnormal, cancerous cells in the lining of the milk ducts, but that had not spread to surrounding breast tissue. The model that combined all 3 risk scores was the most accurate, with a Concordance Index score of .70, indicating the predictive model has good accuracy. A score of .5 is equivalent to a coin flip, while 1.0 represents perfect accuracy. By comparison, the clinical risk tool scored .62, the polygenic test scored .61, and the combined clinical and polygenic risk scores reached .66.

Among women at the highest risk of developing breast cancer, the clinical risk score alone identified 19% of the women who developed breast cancer over a decade while the combined model identified 26% of these women.

Related value-based care story: How value-based care improves breast cancer survival rates

Personalized screening advances health care transformation

That ability to better match screening intensity to individual risk reflects a meaningful shift in health care transformation — one that brings together new tools, prevention, evidence-based medicine, and a commitment to improving care quality. It is also central to value-based care, where innovation is used to make care more precise, proactive, and personal.

The new research builds on prior research led by Dr. Arasu showing that AI-based mammography risk assessment more accurately predicted a woman’s future breast cancer risk than a clinical risk model.

“Our previous study showed that an AI risk score was slightly more accurate than a clinical risk score,” said Dr. Arasu. “This new study shows that by combining them, and by adding a polygenic risk score, we make a substantial improvement in accurately assessing risk.”

Read the full story on the Kaiser Permanente Division of Research website.

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OAKLAND, Calif. (June 16, 2025) — National health care leaders from Kaiser Permanente and the American College of Physicians will present a free Permanente Live webinar on Thursday, July 2, 2026, to explore how clinicians can stay grounded in evidence, navigate conflicting guidance, and maintain patient trust in an increasingly complex health care environment.

Amid rising misinformation, deepening public mistrust in science, shifting federal policy, and the rapid evolution of clinical research, physicians today face mounting pressure to make high-stakes decisions while preserving patient trust and protecting time to focus on patients. Delivering clear, evidence-based guidance increasingly requires new strategies to identify reliable sources of information, respond to uncertainty with confidence, and focus on what matters most: caring for patients.

This webinar will address timely questions about public skepticism, the evolving role of medical associations and states, and what health care leaders can do to reduce confusion for both physicians and patients.

Who:

• Jason M. Goldman, MD, MACP, immediate past president, American College of Physicians; internal medicine physician
• Letitia Bridges, MD, MBA, executive vice president and chief quality officer, The Permanente Federation
• Stephen Parodi, MD, executive vice president, The Permanente Federation (moderator)

What:

“Evidence under pressure: Medical excellence in an era of misinformation” webinar attendees will learn:

• Where physicians look for trusted guidance as confidence in federal agencies shifts
• What’s driving public skepticism and how physicians can approach conversations with patients
• Steps federal institutions can take to regain the medical community’s trust

When:

• Thursday, July 2, 2025
• 10:00 a.m. PT / 12:00 p.m. CT / 1:00 p.m. ET

Where:

Register to attend this complimentary virtual one-hour event and for access to the recording.

Join the conversation on social media using the tag #PermLiveLeadership.

To learn more about Permanente Medicine, visit permanente.org.

About the Permanente Medical Groups

Permanente Medical Groups provide award-winning care to Kaiser Permanente’s 12.6 million members. More than 25,000 primary care physicians and specialists are dedicated to the mission of providing high quality, affordable care to all our patients and communities. Our ethical, compassionate approach to value-based care is physician-led, patient-centered, and evidence-based. We work collaboratively, supported by state-of-the art facilities and technology, to provide world-class primary, complex, and chronic care in 8 states — from Hawaii to Maryland — and the District of Columbia. Find out more at permanente.org.

About The Permanente Federation

The Permanente Federation is the national leadership and consulting organization of Permanente Medical Groups, which provide high-quality, affordable health care to the members of Kaiser Permanente. The Federation works to spread the ethical and compassionate value-based care we call Permanente Medicine. Our model of care is physician-led, patient-centered, and team-delivered. We foster and accelerate medical research, clinical innovation, and performance improvements. With Kaiser Foundation Health Plans and Kaiser Foundation Hospitals, we’re expanding the reach of Kaiser Permanente’s unique approach to integrated care delivery, transforming health care in America. Find out more at permanente.org.

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High-quality care is not defined by the number of services delivered or the speed of a single appointment, but by how effectively care is connected across time, teams, and settings. The best systems, Dr. Davidoff wrote, are built around prevention, coordination, and a deep understanding of each patient’s needs, creating a continuous care experience rather than a series of disconnected transactions.

“Achieving this requires a value-based care approach that aligns financial incentives across the entire health care system – including care teams, health plans and hospitals – so that all decisions are made with the patient’s best interests at the center,” he wrote.

Related value-based care story: Why physician-led, value-based care leads to better outcomes

The high cost of a system built for volume, not value

Dr. Davidoff contrasts this model with traditional fee-for-service medicine, which rewards volume over value and leaves patients to navigate a maze of specialists, appointments, repeated tests, and separate bills.

In these fragmented systems, data is scattered, communication breaks down, and patients often shoulder the burden of coordinating their own care. The result is not only frustration, but rising costs and lower-quality outcomes. He notes that total U.S. health care spending has climbed from about $3.6 trillion in 2016 to a projected $5.9 trillion in 2026, underscoring the unsustainability of a system designed around more interventions rather than better ones.

To show what value-based care looks like in practice, Dr. Davidoff highlighted Kaiser Permanente’s AI-powered patient portal, the Kaiser Permanente Intelligent Navigator. The tool helped identify a postpartum patient’s chest pain and shortness of breath as a medical emergency, prompting her to seek immediate care rather than schedule a routine visit. She was later diagnosed with a heart attack and treated in time.

Related value-based care podcast: Why the best integrated health care systems are built for health care’s future

How strengthening relationships improves long-term health

He also emphasizes that value-based care supports stronger, longer patient relationships, which in turn improve prevention and chronic disease management. Because physicians in these models can follow patients over many years, they are better positioned to intervene early, prevent complications, and improve health over time.

Dr. Davidoff points to Kaiser Permanente’s 2025 HEDIS® performance — leading the nation in 71 effectiveness-of-care measures — as evidence that better-designed systems can produce measurably better results. The closest national competitor led in only 30.*

“This is why I am deeply committed to investing in a value-based approach to care,” he added. “To set an example that benefits the patients we care for, the communities we serve, and other health care delivery systems across the country and the world.”

Read the full commentary here.

*Kaiser Permanente 2025 HEDIS® scores. Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compass® and represent all lines of business. Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality. The source for data contained in this publication is Quality Compass 2025 and is used with the permission of NCQA. Quality Compass 2025 includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass® and HEDIS® are registered trademarks of NCQA. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality.

The post The life-saving power of connected, value-based care appeared first on Permanente Medicine.

That future is already taking shape. Over the next decade, $1 trillion in annual spending is expected to shift from fragmented, transactional health care systems to more efficient, digital-first, value-based care models. Dr. Ansari and Dr. Davidoff wrote that leading this transition will require a safe, supportive environment where clinicians are heard and empowered to help reshape the industry.

Drs. Ansari and Davidoff wrote that the shift to value-based care will succeed only if physicians and care teams deliver meaningful value for patients and the health system. To support that effort, the co-CEOs outlined five strategies physician leaders can use to help clinicians lead this transformation.

1. Listen first, then lead. Earning trust through servant leadership starts with listening to clinicians’ perspectives then using their feedback to implement meaningful changes, such as the deployment of ambient AI for notetaking during clinic visits. Such ambient AI listening has been shown to save doctors up to an hour a day at the keyboard and reclaim valuable time otherwise lost to manual data entry. This shift helps reduce administrative tasks that contribute to burnout.
2. Build trust through transparency. By sharing the data and the reasons for evolving policies, and by openly acknowledging uncertainties, leaders can provide concise, relevant communication to demystify policies. This transparency empowers clinicians to share accurate, evidence-based information with patients.
3. Ensure safety to enhance care quality. Maintaining calm and safe clinical environments requires training in de-escalation techniques, security measures, community outreach, and prompt responses to safety concerns, enabling clinicians to focus on what matters most: patient health.
4. Cultivate resilience, advance career growth. Reducing administrative burdens and offering mental health and leadership development programs can strengthen clinician well-being and improve retention. It also supports value-based care leadership, which is a key driver for system transformation.
5. Empower clinicians to tackle tough challenges. Physicians and clinicians who feel supported and empowered have shown they can lead innovation such as cancer screening programs, point-of-care testing, remote patient monitoring, and AI-driven patient communication tools that improve patient experience and care efficiency.

As health care shifts to value-based care, success will depend on building systems that harness physician expertise and use technology to refocus care on patients.

Read the full commentary here.

The post Drs. Ansari and Davidoff on leading the shift to value-based care appeared first on Permanente Medicine.

OAKLAND, Calif. (June 8, 2026) — Maria Ansari, MD, FACC, co-CEO of The Permanente Federation at Kaiser Permanente, has been named to Modern Healthcare’s list of 50 Most Influential Clinical Executives for 2026. Dr. Ansari was honored for her continued strategic guidance of Permanente Medical Groups, which includes delivering outstanding patient care, championing value-based care, improving operational efficiency and clinician wellness, and increasing the clinician pipeline.

Andrew Bindman, MD, executive vice president and chief medical officer for Kaiser Foundation Health Plan, Inc. and Hospitals, was also named to the list.

Modern Healthcare recognizes physicians and clinicians in senior executive roles for improving patient care and outcomes, driving operational success, leading innovation and demonstrating outstanding leadership both within their organization and their communities.

“This honor recognizes the commitment our physicians and care teams bring to fulfilling the promise of Permanente Medicine — care that is patient-centered, compassionate, evidence-based, and integrated,” Dr. Ansari said. “Physician leadership is fundamental to maintaining clinical autonomy, which is essential for building patient trust, empowering us to act in the best interests of our patients, and delivering high-quality care.”

With Federation co-CEO Ramin Davidoff, MD, Dr. Ansari leads Permanente Medical Groups, where more than 25,000 physicians deliver value-based care to 12.6 million Kaiser Permanente members in the United States.

Dr. Ansari is also CEO and executive director of The Permanente Medical Group (TPMG), president and CEO of the Mid-Atlantic Permanente Medical Group, and CEO of Northwest Permanente, three of the largest and most accomplished medical groups in the country. Together, Permanente Medical Groups and Kaiser Foundation Health Plans and Hospitals comprise Kaiser Permanente.

Dr. Ansari’s successes include:

• Guiding the highest-quality care. Kaiser Permanente Northern California achieved 5-star National Committee for Quality Assurance (NCQA) ratings for both Medicare and commercial plans — one of only two U.S. health plans to do so in 2025.
• Advancing Permanente Medicine’s commitment to high-value, quality-driven care through a strategic affiliation with Northwest Permanente in 2025.
• Guiding the rollout of RESET — a physician-led redesign of primary care aimed at reducing burnout and improving quality — to more than 3,100 physicians and medical assistants at Kaiser Permanente Northern California. This innovative care model “Rewards Efficiency” with greater autonomy and flexibility, ‘Sets priorities” using a transparent scorecard, and “Empowers Teams” by streamlining workflows. The Permanente Journal published research showing RESET contributed to lower burnout, greater professional fulfillment, improved patient care, and greater retention and recruitment of adult and family physicians.
• Improving community health by strengthening the clinician pipeline to address one of healthcare’s most urgent issues — clinician shortages — and by expanding sustainable access to care.
  • As a board member of the Kaiser Permanente Bernard Tyson School of Medicine, Dr. Ansari champions training programs, tuition assistance, and community partnerships to support the next generation of health care professionals.
  • Additionally, Dr. Ansari helped grow the mental health workforce through the Kaiser Permanente Health Scholars Academy, the KP School of Allied Health Sciences, and the KP Northern California Psychiatry Residency Program. Since 2020, KP has invested more than $2 billion and increased our mental health workforce in California by 25%.
• Enhancing physician wellness. The Permanente Medical Group (TPMG) received the 2025 AMA Joy in Medicine Gold Award for reducing physician burnout and improving well-being.

In addition to these accomplishments, Dr. Ansari also leads the Kaiser Permanente Division of Research (DOR), a top research center with a large team of investigators and clinician-researchers. The DOR publishes nearly 1,000 research articles annually

The complete list of honorees and their profiles are available at 50 Most Influential Clinical Executives 2026 – Modern Healthcare and in the June 8 issue of Modern Healthcare magazine. A digital subscription is required to view the online profiles.

To learn more about Permanente Medicine, visit permanente.org.

About the Permanente Medical Groups

Permanente Medical Groups provide award-winning care to Kaiser Permanente’s 12.6 million members. More than 25,000 primary care physicians and specialists are dedicated to the mission of providing high quality, affordable care to all our patients and communities. Our ethical, compassionate approach to value-based care is physician-led, patient-centered, and evidence-based. We work collaboratively, supported by state-of-the art facilities and technology, to provide world-class primary, complex, and chronic care in eight states — from Hawaii to Maryland — and the District of Columbia. Find out more at permanente.org.

About The Permanente Federation

The Permanente Federation is the national leadership and consulting organization of Permanente Medical Groups, which provide high-quality, affordable health care to the members of Kaiser Permanente. The Federation works to spread the ethical and compassionate value-based care we call Permanente Medicine. Our model of care is physician-led, patient-centered, and team-delivered. We foster and accelerate medical research, clinical innovation, and performance improvements. With Kaiser Foundation Health Plans and Kaiser Foundation Hospitals, we’re expanding the reach of Kaiser Permanente’s unique approach to integrated care delivery, transforming health care in America. Find out more at permanente.org.

The post Kaiser Permanente physician leader Maria Ansari, MD, FACC, selected for Modern Healthcare’s 2026 list of 50 Most Influential Clinical Executives appeared first on Permanente Medicine.

The power to rapidly change and innovate has become a must-have for health care leaders working in the new normal of uncertainty. Tackling challenges like reductions from government payers and a tight workforce market requires a special leadership mindset, said Stephen Parodi, MD, executive vice president, The Permanente Federation, on a recent Becker’s Healthcare Podcast episode.

“Leading with authenticity, being willing to listen, being willing to pivot, being willing to admit when you’re wrong — all of those things are essential in this day and age,” said Dr. Parodi.

How health care innovation can enhance the workforce

As an aging workforce retires and physicians step away from patient care earlier in their careers, the U.S. faces an estimated shortage of between 20,000 and 40,000 primary care doctors by 2036. This is a space where all types of innovations — not just AI-driven tools — can step in to help with the issue, added Dr. Parodi.

Talking about efforts to integrate technology to enhance the workforce and improve care delivery, Dr. Parodi highlighted how health care innovations like telehealth platforms can augment the skills of care teams — no matter where they are located. This includes Permanente physician leaders exploring how to use the skills and availabilities of a medical workforce on different schedules across time zones.

“That means you have to have the technological platforms in place, but then you have to think about licensing, credentialing, and how do you make that more seamless and easier so that a clinician can be licensed in multiple states, for example,” said Dr. Parodi.

Related telehealth story: “Improving cancer care through expert virtual reviews”

How disruptive innovations can bring value and transform health care

Responding to uncertainty also means finding the right tools to improve care and being willing to embrace positive disruption, Dr. Parodi said. One example is the Advanced Alert Monitor system used at Kaiser Permanente in Northern California, a region served by The Permanente Medical Group. The early-warning program identifies patients at high risk of adverse events, prompting changes such as adding advanced practice nurses and palliative care specialists to care teams to improve outcomes.

“You have to integrate new team members and new workflows and new scripting and new conversations,” said Dr. Parodi. “All of that results in the ultimate outcome, which is that we’re able to save 500 lives a year in Northern California alone.”

Listen to the full Becker’s Healthcare Podcast episode with Dr. Parodi here.

The post Why health care innovation is essential during uncertain times appeared first on Permanente Medicine.

In this episode of the Permanente Medicine Podcast, Chris Grant speaks with Ameya Kulkarni, MD, executive medical director of the Mid-Atlantic Permanente Medical Group, about the future of physician-led, value-based care.

Dr. Kulkarni shares how integrated care models can improve access, affordability, and quality while reducing friction for both patients and physicians. The conversation also explores physician well-being, the importance of meaningful work in medicine, and how Permanente Medicine supports clinicians through community and purpose-driven leadership.

Dr. Kulkarni also discusses why trust between patients and physicians may be one of the most critical factors shaping the future of health care. From preventive care to innovation and leadership, this episode highlights how value-based care can create better outcomes for patients and care teams alike.

Watch the full episode on YouTube:



Connect with Chris Grant by following him on X at @cmgrant or LinkedIn.

Follow us: Subscribe to the Permanente Medicine Podcast on your favorite streaming platform.

Podcast transcript

Transcript is autogenerated. Although edited for clarity, it should not be considered an exact replication of the podcast and may also be updated as needed.

Ameya Kulkarni, MD: Everyone is obsessed with longevity now. You hear about it every day, but what are the best biohacks you have? It’s vaccines, it’s cancer screening, diabetes control, hypertension, and cholesterol control. If you do those 5 things well, you’ll live 6, 8, 10 years longer. And we know that because if you’re a Kaiser Permanente patient, you do.

Chris Grant: Welcome to the Permanente Medicine Podcast. I’m your host, Chris Grant, the chief operating officer at Kaiser Permanente, The Permanente Federation. Today I’m joined by Dr. Ameya Kulkarni, executive medical director of the Mid-Atlantic Permanente Medical Group. In this role, Dr. Kulkarni oversees more than 1,800 physicians caring for more than 740,000 members in Kaiser Permanente’s Mid-Atlantic States. As such, Dr. Kulkarni is responsible not only for clinical excellence, but for advancing access, affordability, and sustainable growth within an integrated value-based care model. As the health care landscape grows more complex for patients, physicians, and communities alike, the question on the minds of many isn’t just about how we ensure people get the care they need, but how we can do it responsibly. This means making care easier to get, delivering measurable value, and creating an environment where clinicians can lead and excel. Today, we’ll explore what that looks like in practice from integration and access to affordability, culture, and leadership in a rapidly evolving environment.

Dr. Kulkarni, welcome. We’re so happy to have you on the podcast.

AK: Oh, thank you so much for having me. I’m excited to talk medicine with you.

CG: Before we get into the conversation, I thought let’s let our audience hear a bit about your journey into medicine and what ultimately drew you into the medical leadership role that you’re in.

AK: When I was a kid, I wanted to be president of the United States. When I was five years old, that’s what I wanted to be. And then when I was about 7, I had typhoid fever and I was actually in the hospital for 18 days. And I went into the hospital, wanted to be president of the United States and I came out wanting to be a doctor. And so that’s my formation story, if you will. And it’s interesting because I was sort of going through the course of undergrad and med school. I’m probably the one Indian kid whose parents didn’t want them to be a doctor. My dad wanted to be an entrepreneur, so I went to business school as an undergrad and I always liked the sort of 2 sides of medicine, the chance to care for patients at the bedside and really make an impact on an individual patient.

And then the chance to influence how health care looks in America and the world. I always thought that physician leadership was critical if you wanted good health care. And so when I got out of training, I started looking for places where the physician voice mattered a lot and I found Permanente [Medical Groups]. And the rest is history. I started solving problems early in my career for the medical group. And if you solve one problem, people ask you to solve more and I found myself doing more and more. And now since January, I’m in this role.

CG: Let’s continue down that leadership pathway. You’ve stepped into a significant and important role. Kaiser Permanente has been caring for people in the Mid-Atlantic region since 1984, over 40 years. From your perspective, what has contributed to the staying power of Kaiser Permanente and what will help you not just continue to lead in that region, a critical region of the United States, but grow?

AK: I actually think the staying power of Kaiser Permanente in the Mid-Atlantic States is the same staying power in California or Oregon or Washington, anywhere else we are. Because when it comes down to it, patients want simple things. They want a doctor they trust to help them guide them through their care journey. They want care to be easy. It shouldn’t be that hard to get. They want it to be affordable and they want to know they’re getting really good care, high-quality care. And so if you put that equation together, it’s high-quality, high-service, trusted care led by physicians that’s affordable; that’s us. And so I think that patients who choose us see that and they stick with us. And the reason for that is that if you’re a Kaiser [Permanente] baby and you grow up, you realize just how wonderful it is to have a trusted physician backed by this incredible system offering high-quality care at a good price.

And how we’re going to grow is just letting the world know that’s what we do. I think you and Chris, you and I talk about this all the time, the outside world is so fragmented. Patients are so frustrated by all of the opposites of what I just said. They’re not sure if the quality of care they’re getting is great. Their doctors don’t talk to each other. It’s either unaffordable or they don’t know how much things cost because pricing is not transparent and it’s the opposite of who we are. And so patients are looking for us. And so I think if we get the message out in the Mid-Atlantic, they’ll come.

CG: I think that’s a great point. And we all hear horror stories from family members, relatives, neighbors about navigating the health care system and the health care environment. And to your point, trying to figure out what is the right doctor to see or getting a surprise bill that they didn’t expect. In Kaiser Permanente, we solve for those things. And your description, Dr. Kulkarni is so spot on of really it’s high-quality care that you can just be assured that it’s the greatest quality, but it’s also in the hands of doctors in a partnership decision between the patients and the physicians. Like all Permanente executive medical directors, you lead within a value-based system and what you’re describing is a value-based system. Practically speaking, what does that mean for physicians and patients and what role does integration of care and services play?

AK: So I’ll start with what it means for a physician. I think for physicians, it means that you get to hone your craft with minimal interruption. But when we’re doing it right, physicians get to care for patients and they have to worry about very little else. They don’t have to worry about prior authorization because we’re an integrated system. We don’t have to worry about which medications are on the patient’s formulary because our clinical leaders have those conversations ahead of time. We agree ahead of time to say, this is the clinically indicated path for medications. You don’t have to worry about how I’m going to get my patient to a specialist on time or whether I’m going to hear what happened at specialists because we’re in a single integrated electronic medical record [system]. And so I think that for physicians, you get to practice medicine. I call it like the village doctors for the 21st century.

We get to practice the best version of that Andy Warhol painting of the classic doctor, but with all the 21st century tools. That’s for the physician. And for the patient, it means care that’s simple and easy to access that doesn’t have to be that hard and that’s super high quality. And what’s super interesting is that we often talk about quality and we don’t always put a fine point on it, but you think about what quality of care means. Quality of care to me at a system level means that we are continuously monitoring the things that drive longevity. Everyone is obsessed with longevity now, like you hear about it every day, but what are the best biohacks you have? It’s vaccines, it’s cancer screening, diabetes control, hypertension, and cholesterol control. If you do those 5 things well, you’ll live 6, 8, 10 years longer. And we know that because if you’re a Kaiser Permanente patient, you do.

CG: You’re so spot on and there’s a lot of very strong proof points and defensible data around the risk of mortality from heart attacks or cancer externally versus compared to within Kaiser Permanente and demonstrably greater longevity and reduced late-stage cancer diagnosis or cardiovascular risk. So everything you described is spot on.

AK: It’s so funny, every time I see a headline or read an article about what’s wrong with American health care, and there’s one every day, I always think, look, we solved that problem already. And we’ve been thinking about that for 40 or in some cases 80 years and prior auth, we’ve solved that problem already. We know how to do it because if you have smart, thoughtful clinicians who have a conversation with our colleagues on the payer side upfront and have the real conversation about what’s the right thing to do for patients, then you get a formulary that works for physicians, for patients, and for a system. That’s how you keep care affordable and high quality.

CG: I’m going to continue on this thread. One of the things you sometimes hear from patients is that health care feels really complicated. How are you thinking about simplifying it? How do you define access beyond just an appointment availability?

AK: I’ve been thinking a lot about this concept called minimally disruptive medicine. The idea is that when a patient is seeking care or going through a condition treatment journey, that they have a certain amount of capacity to apply effort to their care and that capacity has to be deployed to the work of getting their care, making the appointments, doing the follow-up, getting all the information, understanding the information, then the actual illness recovery and then all the emotional and mental weight with their family. So those 3 things, they have to have the capacity to manage all of those. And if we ask patients to invest all of their capacity on just getting the care that they need, that they have nothing left in the tank to make sure that they’re having a salad every day so that they reduce their A1C or make sure that they’re going to the caregiver meetings.

And so how I think about access is really about minimally disruptive medicine. And so then what does that mean practically? So obviously access to appointments is really important, but it can’t just be that you get an appointment very quickly. It has to be easy to get the appointment. When you get the appointment, it has to be easy to do the next thing like if you need testing, getting the testing done quickly. If you have to go to the hospital, it should be a quick process for the hospital. You should be reconnected to your health care system afterwards. All those things contribute to access. My favorite example of this is, so about a decade ago we started our transcatheter aortic valve program. I’m an interventional cardiologist by practice and we started our transcatheter aortic valve program, our TAVR program. And at the time it took an average of 12 weeks for a patient to get all the testing they needed.

They had to see a bunch of different physicians or a bunch of requirements. And so we decided that when we launched our TAVR program, we were going to make the attempt to make it a one-day TAVR evaluation because the majority of patients undergoing TAVR are in their 80s or 90s or in their hundreds and they have a caregiver most of the time. So we said, if we can make it one day, even if it’s a hard day, that one day of getting all the testing you need done is the right way to offer access to care. That integration and coordination effort, to me, that’s what access is, that you’re thinking about how much disruption to the patient and their family’s life is required to get the care they need.

CG: I love it because you’re really thinking about the whole individual, the physical ailment or challenge or diagnosis, but also emotionally, mentally and their family. And how do we organize care in a way that really is seamless and frictionless for them that can just change not only that patient’s life in a profound way, but also affect their families.

AK: I want to just say it again. The time that a patient waits to hear an important diagnosis, whatever the diagnosis is, the days in between when they think they may have something and they found out they have something, those days are the hardest days of their life. The faster we can get them to diagnosis, to treatment, back to their lives, that’s part of healing.

CG: Let’s continue down this kind of consumer-patient centricity. Affordability is also top of mind for patients and health care delivery system leaders. How do you balance delivering high-quality care, that care that you just described, including all the elements of access and experience with being financially responsible within the health care system on behalf of the communities we serve?

AK: Yeah. I think this is the biggest secret of Permanente Medicine is that high-quality care is affordable. I think that it’s worth saying twice, that high-quality care is affordable. Let’s talk about cancer diagnoses. Early detection of cancer is not only better for the patient, it’s going to make them live longer. It’s also cheaper. And again, cardiologists, managing diabetes and hypertension, we always joke that a cardiologist’s job is to make your job irrelevant. That’s what I hope long-term. And so primary prevention is so powerful as a tool of cost control and also the way we think about access is different. The rest of the world is thinking about access in terms of how many appointments can I maximize because that’s their sort of stream of revenue. It’s not that they’re bad doctors or bad at their job, but think differently, but they’re just incentivized to have more appointments.

We’re incentivized to care for the patient holistically because that’s how our payment model is. And so what that means for us is that we think about access in terms of affordability naturally. And so if there’s a conversation that can be had in person in an appointment, or I can just pick up the phone and call you now rather than having you wait 2 weeks for the appointment, that’s better for you and that’s a more affordable way to deploy access. Now there’s times when they’re in conflict and this is where physician leadership is really important because the number one goal that we have is to offer high-quality care. And sometimes that care is more expensive, it’s still the right thing to do and we have to be okay saying that. And you know who’s really good at saying that? It’s doctors. Physician leaders are really good at advocating for patients in those moments where there’s a tension between the cost of care and the quality of care. We adjudicate that very well.

CG: That’s one of the nice things about the system is that the end decision around clinical care is really in the hands of the doctor. There’s not an administrative review or approval or denial. When talking with you, Dr. Kulkarni, I feel this excitement and this real true love of medicine and joy. So let’s talk about that for a minute. The environment clinicians work in, what does it take to create a culture where physicians and care teams can find meaning in practicing medicine?

AK: Good question. Yeah. It’s funny because I think that there was a time where the primary marker of this was joy, like happiness in medicine. The reality is that our jobs are hard. We care for patients at their most vulnerable moments and we carry a lot of burdens with us. And so I think singular joy is not always possible, which is why I love you asked the question about how do we create meaning in medicine, which is actually what people want. And so in our practice, we have a strategy for how we think about building meaning in medicine and it consists of 3 elements. So the first element is minimizing the friction of giving care, because if your job is harder than it needs to be, then no matter how fulfilling it is, it’s not fulfilling for a long time. And so we have a committee that’s dedicated to minimizing the friction of giving care.

And sometimes they’re big things, like how do you do message management or how do you make sure that patient phone calls are answered on time in a way that doesn’t tax physicians, how do you minimize pajama time. But some things are small little pebbles in shoes that irritate the way that a physician goes through their day that we can solve pretty quickly. The second part is building community. It’s funny in another life, I ran one of our wellness teams and I wrote an essay that actually ended up in the New England Journal [of Medicine] about the loneliness epidemic in medicine. And in that article, I talked about how like when you’re a resident, you have a doctor’s lunch. The doctor’s lounge is like your place of solace at the community. So we are spending a lot of time thinking about all the different ways in which people build community in our practice and how can we make that easier for physicians and staff and how can we maximize it?

So I’ll give you an example. I love community service. It’s just something that my family and I really like doing. We do it often. And so this year we’re doing volunteer with me. So 3 sessions over the course of the year and 3 of our geographies where our physicians can come and work at a food bank with us and that’s a way of building community. I’m also a runner. I run marathons and we have a running club. So ways to build community and the things you care about. The third thing that’s really important in meaning in medicine for me is purpose, because I think what happens in medicine is when you start as a resident, you have a lot of sense of purpose. And then over the course of the years, the actual day-to-day eats away at that purpose a little bit.

So we’ve developed these sort of clinical pathways, first we call them Permanente Pathways because we love alliteration. And they’re about if you’re interested in being a lobbyist, a physician lobbyist, we’re actually working with [The Permanente] Federation on a program on that. If you’re interested in media, we have a vehicle for you to get in front of media. If you’re interested in research, we have programs. So all of the things that satisfy physicians that are physician-practice adjacent, but that fill your cup when clinical practice may not, that we want to create opportunities for that. And then for those for whom clinical practice is the thing that fills their cup, we want them to be the sort of folks who teach us, who show us the new technologies and help us decide what the right thing to do is in terms of guidelines and practice.

So I think that’s how those sort of 3 phases, reducing the friction, really thinking about community and building purpose. I think that’s how you get to the meaning. So that was a long answer, but you can tell I care a lot about it.

CG: I like how you’ve reworded meaning in practicing medicine versus kind of the more code word joy of medicine. I often use the same language that you do that it might have been a difficult week, it might’ve been a complex kind of set of factors that we were dealing with, but was it purposeful? Did you get to the end of the week, the end of the month, and was the work that you did purposeful? Did it have meaning? Did it pull at your heartstrings? And the environment that you just described, Dr. Kulkarni, to me, if I’m a resident or a fellow listening to this podcast, I would be saying, “That’s what I’m looking for. Looking for great environment.”

AK: I think all the Permanente [Medical Groups] are recruiting…

CG: You just described the environment that we work every day to try to maintain and even make better. It’s not perfect all the time, but as you, in your leadership role and all of your peer executive medical directors work every day to really make this the best place to practice

AK: And it’s amazing, I think you have commented on this before, just how similar the medical groups are to each other. There’s a Permanente physician archetype and I think you could drop one of us in any of the Permanente Medical Groups. And it’s because again, we go back to the thing we talked about at the beginning is we had the same sort of set of values that we believe in that we share together around physician leadership, around high-quality, affordable care, about thinking about service to patients beyond just service to appointments. And I think that those are shared across from [Washington,] D.C. to Hawaii and everywhere in between.

CG: We often think about some of these geographies as so unique and different and they are, right? There’s local cultures, there’s local customs, there’s things that are certainly different in Washington, D.C. than they might be on the west side of Maui, but the care needs and the diagnosis and the application of technology and applying the best quality is identical and we can learn from each other.

All right, I want you to pull out that crystal ball of yours. And looking into that crystal ball, what is going to be most important to delivering great care of the future?

AK: So I’m going to go a little counterculture here and I’m not going to say AI, because everyone says AI.

So I actually think the most important thing to delivery of care in the future is going to be trust actually. I think over the last 10 years, I think COVID accelerated it, but even before then there has been this erosion of trust between the doctor and the patient. And so I think no matter how good your technology is or no matter how good the AI is at diagnosing a condition, when it comes down to it, a patient has to make a decision on a treatment plan. I have to make a decision every day about the things, whether they’re going to do their 10,000 steps and whether they’re going to manage their diabetes or take their pills. All those things are not dependent on any technology, they’re dependent on trust. And so I actually think the most important factor in whether health care is going to be good or not in the next 5 or 10 years is how good a health system is at strategically investing in building trust between their physicians and their patients.

And I’ll tell you, in our practice at MAPMG on my executive team, I have a chief trust officer because I actually believe so much that this is important to the future of medicine that I’ve appointed a physician executive to build our strategy around how we are going to invest in restoring trust between patients and physicians, between physicians and each other, between physicians and the community. I think there’s so many opportunities. And it’s interesting is that if you look on the trust spectrum, Permanente physicians are on the high end, but there’s still opportunities for us to invest in that. So that’s where I think our worthy investments are.

CG: Wow. A CTO with a whole new meeting, chief trust officer. I really like that because you’re right, physicians from a profession and a societal perspective, they do tend to be among the most listened to and appreciated and trusted, but often when you take things for granted, they erode and certainly there’s lots of things, lots of environmental factors in health care right now and through the pandemic and COVID that risk the trust between patients and clinicians and physicians. So the fact that you see this as essential, the most essential important factor in the future of care, I think is brilliant because I agree with you. I think maintaining that incredibly trusting relationship between the patient and the physician is everything. The ability to have the dialogue that’s needed to convey and motivate a patient, it has to start with trust. So kudos to you.

Dr. Kulkarni, as we wrap up, for me, it’s clear that delivering high-quality affordable care isn’t about one solution. In listening to you, it’s about bringing together the right model, the right culture, and the right leadership to meet the moment. I want to thank you for sharing your perspectives and for your work and your team’s work to make care in our communities in the Mid-Atlantic States so amazing.

And I want to thank all of our listeners to the Permanente Medicine Podcast. If you enjoyed this episode, be sure to subscribe, share it with your colleagues and stay tuned for more conversations with great physician leaders like [Dr.] Ameya Kulkarni, who will share their insight into the future of care delivery. Until next time, I’m Chris Grant. Thanks for listening.

The opinions expressed on this podcast are those of the speakers and are not necessarily the views of Kaiser Permanente, the Permanente Medical Groups, or The Permanente Federation.

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News of the hantavirus outbreak aboard a cruise ship is a pointed reminder of protecting progress in the fight against lethal diseases, wrote Stephen Parodi, MD, executive vice president with The Permanente Federation, in a recent Physicians Weekly commentary. Despite growing mistrust in science, Dr. Parodi shared his optimism that the medical community has an opportunity to talk about trustworthy medical information in new ways and highlight the value of preventive medicine.

Dr. Parodi, an infectious disease physician himself, explored the power of prevention and vaccinations for once-commonplace diseases. While there is no hantavirus vaccine, existing immunizations are recognized as one of the most powerful tools of prevention and are estimated by the World Health Organization to have saved 154 million lives since 1974.

“But there is a catch. Vaccines only work if people have access to them,” said Dr. Parodi. “And then they need to choose to take them. We face a supreme challenge in restoring public trust and support in these life-saving preventive treatments.”

The power of prevention by the numbers

Despite COVID-19 vaccines saving an estimated 3.2 million lives in the first 2 years after their introduction, public skepticism around vaccines and public health has grown significantly in recent years, added Dr. Parodi. Estimates show only around 50% of children received a vaccination for influenza for the 2024–2025 season, down from 62% in 2019 — while pediatric deaths from influenza recently hit a 15-year high.

Related vaccines video: “Vaccines, variants, and trends for respiratory virus season”

Dr. Parodi shared the development of the human papillomavirus virus (HPV) vaccine, which prevents infections that can lead to cancer, as another example of prevention driving the delivery of high-quality medicine. The Kaiser Permanente model of value-based care puts a priority on preventive, evidence-based medicine, which reduces health risks, improves early detection of diseases, and increases overall quality of care.

Because surveys show most Americans still turn to their doctor as a trusted source of guidance on vaccines, Dr. Parodi argues there’s opportunity in this moment for physicians to communicate the safety and effectiveness of vaccines in innovative ways. This can include building a robust social media presence and using new AI tools to counter vaccine misinformation online.

“Now more than ever, we have an opportunity to engage patients in informed decisions — saying yes to prevention, yes to vaccination, yes to freedom from these diseases,” said Dr. Parodi. “It is equally crucial that we meet people where they are, listen to their concerns, and do so without judgement, creating space for honest dialogue and understanding.”

Read the full commentary in Physicians Weekly here.

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900+ health leaders and national experts joined our last webinar 

What happens when patients no longer know which institutions, guidelines, or voices to trust? How should physicians respond when evidence-based recommendations become politicized, challenged, or rapidly changing?

Join our next fireside chat, “Evidence under pressure: Medical excellence in an era of misinformation” to explore how physicians can continue delivering high-quality care during times of uncertainty while maintaining trust and transparency. The conversation will examine the evolving role of specialty societies, medical boards, health systems, and public health agencies in supporting physicians and reducing confusion for both clinicians and patients.

This Permanente Live webinar will feature:

Stephen Parodi, MD, executive vice president of The Permanente Federation (Host)

 Letitia Bridges, MD, MBA, executive vice president and chief quality officer of The Permanente Federation

 Jason Goldman, MD, FACP, president of The American College of Physicians

The discussion will also address practical questions physicians are facing today:

• Where should physicians look for trusted, evidence-based guidance when confidence in institutions is shifting?
• How are misinformation and changing recommendations affecting patient conversations and clinical decision-making?
• What responsibility do health systems have in helping physicians navigate uncertainty?
• How can physician leaders strengthen trust while continuing to deliver evidence-based care?

When: July 2, 2026, from 10-10:45 a.m.

Where: Online webinar

Register

The post Register now for our next Permanente Live webinar appeared first on Permanente Medicine.

900+ health leaders and national experts joined our last webinar 

What happens when patients no longer know which institutions, guidelines, or voices to trust? How should physicians respond when evidence-based recommendations become politicized, challenged, or rapidly changing?

This fireside chat will explore how physicians can continue delivering medical excellence during times of uncertainty while maintaining trust, transparency, and high-quality patient care. The conversation will examine the evolving role of specialty societies, medical boards, health systems, and public health agencies in supporting physicians and reducing confusion for both clinicians and patients.

Join use for our next Permanente Live webinar on what distinguishes genuine breakthroughs from solutions that fall short, featuring:

Stephen Parodi, MD, executive vice president of The Permanente Federation (Host)

 Letitia Bridges, MD, MBA, executive vice president and chief quality officer of The Permanente Federation

 Jason Goldman, MD, FACP, president of The American College of Physicians

The discussion will also address practical questions physicians are facing today:

• Where should physicians look for trusted, evidence-based guidance when confidence in institutions is shifting?
• How are misinformation and changing recommendations affecting patient conversations and clinical decision-making?
• What responsibility do health systems have in helping physicians navigate uncertainty?
• How can physician leaders strengthen trust while continuing to deliver evidence-based care?

Attendees will hear perspectives from physician leaders across organized medicine and integrated care delivery while exploring strategies to support trust, communication, and medical excellence in a rapidly evolving environment.

When: July 2, 2026, from 10-10:45 a.m.

Where: Online webinar

Register

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OAKLAND, Calif., May 7, 2026 — A study published today in The Permanente Journal sheds light on what’s driving physicians to leave clinical practice early — and how those reasons are shifting. Researchers from the American Medical Association (AMA) analyzed survey responses from 971 clinically inactive physicians across all specialties who completed residency between 2000 and 2022. Their findings offer insights into why physicians are stepping away from patient care — or not entering the clinical workforce at all — especially as the nation faces a growing physician shortage.

“We hope that by better understanding what drove these physicians away from the clinical practice of medicine, we might uncover meaningful insights that will help us improve physician professional satisfaction and retention,” said Sea Chen, MD, PhD, the paper’s corresponding author. Chen works for the AMA in Chicago. The paper, “Why Have All the Doctors Gone? Insights Into Early Clinical Departure Among U.S. Physicians: A National Survey,” is the only study of its kind to be published in the United States in well over a decade. It is available open access.

Seeking to ascertain reasons for the “enlarging leak in the pool” of clinically practicing clinicians, the investigators found that a “somewhat surprising proportion” of participants were fully residency-trained physicians who never entered the clinical workforce. The researchers suggest that additional studies are needed to understand why.

Of those who entered clinical practice, the researchers identified a shift in motives among those who left the profession compared with earlier findings. Data from 2008 show that early departure was more likely to be due to personal health issues, rising malpractice insurance premiums, perception of hassle, and lack of professional satisfaction. Updated findings show that rationale focuses more on burnout, chronic workplace stress, administrative burden, and unrealistic patient expectations.

As Americans feel the strain of ongoing and anticipated physician shortages, the AMA research is timely, pointing to a need for hospital systems to bolster retention strategies.

“As the health care system works to further expand the physician pipeline by opening new medical schools and adding more residency slots, it’s worth asking whether we should also focus on supporting physicians who are already trained,” Chen said.

The researchers also evaluated gender disparities in physician decisions to exit clinical practice.

“The women in our study left clinical practice earlier than men, and they left due to pressures like caring for young children or other family members more often than men,” Dr. Chen said. “Addressing these issues — through better childcare access, flexible work policies, and equitable treatment — could help retain more women in the physician workforce.”

About The Permanente Journal
The Permanente Journal, published by The Permanente Federation, is a premier publication for content related to health care delivery science, value-based and high-value care, and clinical and applied research. A diamond open-access publication, The Permanente Journal has been publishing research on the practices of high-quality, evidence-based, equitable, and value-based and high value care since 1997.

About The Permanente Federation
The Permanente Federation is the national leadership and consulting organization of Permanente Medical Groups, which provide high-quality, affordable health care to the members of Kaiser Permanente. The Federation works to spread the ethical and compassionate value-based care we call Permanente Medicine. Our model of care is physician-led, patient-centered, and team-delivered. We foster and accelerate medical research, clinical innovation, and performance improvements. With Kaiser Foundation Health Plans and Kaiser Foundation Hospitals, we’re expanding the reach of Kaiser Permanente’s unique approach to integrated care delivery, transforming health care in America. Find out more at permanente.org.

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During a recent Becker’s “Leadership Unscripted” podcast, Maria Ansari, MD, FACC, co-CEO of The Permanente Federation, discussed how her discovery of Kaiser Permanente’s value-based care model changed her career path.

“I had planned to spend my whole life in academics, doing research, training folks, and practicing medicine,” she said. But while conducting research at Kaiser Permanente — “because that is where a lot of medical informatics is and a lot of patients are” — she had a light bulb moment that changed her professional journey.

“I learned that if you’re a Kaiser Permanente member, and you live in Northern California, you’re about 30% less likely to die of a heart attack or stroke,” she said.

She reflected on how physicians and clinicians working in clinical practices outside of Kaiser Permanente are paid for every individual service rendered – such as tests, visits or procedures, rather than a flat fee. In contrast, Kaiser Permanente’s value-based care approach ties payments to patient health outcomes and quality, rather than the volume of services delivered.  As a result, Permanente Medical Group physicians and clinicians emphasize disease prevention and physician-led decision-making.

With this realization, Dr. Ansari said, “I left academic medicine and I joined Kaiser Permanente.” Now, 2 decades later, she hasn’t looked back.

Related value-based care story: Dr. Davidoff spotlights value-based care and workplace safety

Addressing America’s health challenges

As a result of physician ownership of The Permanente Medical Group in Northern California, physicians generally enjoy a high degree of clinical autonomy over their practice. However, this autonomy is balanced with strong group accountability and adherence to evidence-based medicine. Another compelling feature of the Kaiser Permanente model is “the integration with a hospital and health plan system, so that all our incentives are aligned for the best interest of the patient,” she said.

Dr. Ansari added that health care systems across the country need to shift to value-based models to address increasing U.S. health care costs as well as poorer health outcomes compared to other high-income, wealthy nations. According to the National Institutes of Health, Americans experience lower life expectancy and higher rates of chronic disease, such as obesity and diabetes, compared to citizens of other peer nations.

“Within the older population, we’re seeing most patients over 65 with 2 or 3 chronic conditions,” she said, adding that even the young and healthy are not so healthy. “Disease burden is up, costs are up, utilization is up. And it doesn’t seem like there’s an end in sight.”

Related value-based care podcast: Dr. Parodi on trust, innovation, and the shift to value-based care

Collaboration drives quality care, better outcomes

She said Kaiser Permanente’s value-based care system doesn’t make money by doing more, but by doing better — focusing on quality, prevention, and efficiency.

“We actually have the most affordable health care with the best outcomes,” she said. “And our patients live on average about five years longer, with 30% less heart attacks and 25% less cancer [than others in their communities].”

Dr. Ansari attributes such successes to collaboration across the system.

“Because all of our colleagues work together, if you come into the dermatologist for a rash or psoriasis, the team there is going to ask you, have you had your colon cancer screening? Have you had your flu shot? We’re all working together in a collaborative way.”

Dr. Ansari is eager to see more health care organizations embrace value-based care, and to that end, Kaiser Permanente is taking its evidence-based approaches and best practices to Federally Qualified Health Centers and other county hospitals.

“The next step is to improve the health care in communities beyond the Kaiser Permanente system and its membership,” she said.

To hear the full interview, visit Becker’s Healthcare Podcast.

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OAKLAND, Calif. (April 23, 2026) — Maria Ansari, MD, FACC, and Ramin Davidoff, MD, co-CEOs of The Permanente Federation, were named to Becker’s Hospital Review 2026 “Great leaders in healthcare” list. The co-CEOs were recognized for enhancing clinical outcomes, improving patient access and experience, ensuring industry-leading care quality ratings, advancing new technology, and supporting the clinician workforce.

Greg A. Adams, chair and CEO of Kaiser Foundation Health Plan and Hospitals, was also named to the list.

The annual Becker’s “Great leaders in healthcare” list recognizes leaders who are taking an active role in transforming health care and innovating to adapt to the rapidly changing industry landscape.

Becker’s recognized Drs. Ansari and Davidoff for advancing new AI tools, overseeing efforts to support clinician wellness, and leading policy advocacy on behalf of Permanente physicians, among many transformative initiatives.

In addition to serving as co-CEOs of The Permanente Federation, Dr. Ansari and Dr. Davidoff each oversee three medical groups. Dr. Ansari is CEO and executive director of The Permanente Medical Group; president and CEO of the Mid-Atlantic Permanente Medical Group; and CEO of Northwest Permanente. Dr. Davidoff serves as executive medical director and board chair of the Southern California Permanente Medical Group and as board chair and CEO of both The Southeast Permanente Medical Group and The Hawaii Permanente Medical Group.

Under their leadership, Kaiser Permanente has continued to achieve industry-leading outcomes:

• Kaiser Permanente members are 20% less likely to lose years of life due to cancer and 33% less likely to lose years of life due to heart disease, as compared with non-members in their communities.
• Kaiser Permanente’s national cancer expert review program expanded access to virtual specialist consultations for 11 cancer types.
• Kaiser Permanente has received the highest or tied for the top National Committee for Quality Assurance ranking in every region served.
• Ambient AI scribe technology was made available to more than 25,000 physicians nationally in the largest rollout of ambient AI technology in history and was shown to save clinicians an average of one hour in administrative documentation time. The initiative aims to improve physician wellness by reducing time spent on administrative tasks, enabling them to focus more fully on patient care.
• Five Permanente Medical Groups were awarded the American Medical Association’s Joy in Medicine Health System Recognition Program in 2025. The program highlights medical organizations committed to improving physician satisfaction and wellness and reducing burnout.

These physician leaders are advancing health care in the U.S. by championing a physician-led, value-based care model focused on patient outcomes, leveraging technology to deliver accessible and efficient care, and driving innovation and quality in medicine.

The complete list of Becker’s 2026 “Great leaders in healthcare” honorees and their profiles are available here.

To learn more about Permanente Medicine, visit permanente.org.

About the Permanente Medical Groups

Permanente Medical Groups provide award-winning care to Kaiser Permanente’s 12.6 million members. More than 25,000 primary care physicians and specialists are dedicated to the mission of providing high quality, affordable care to all our patients and communities. Our ethical, compassionate approach to value-based care is physician-led, patient-centered, and evidence-based. We work collaboratively, supported by state-of-the art facilities and technology, to provide world-class primary, complex, and chronic care in eight states — from Hawaii to Maryland — and the District of Columbia. Find out more at permanente.org.

About The Permanente Federation

The Permanente Federation is the national leadership and consulting organization of Permanente Medical Groups, which provide high-quality, affordable health care to the members of Kaiser Permanente. The Federation works to spread the ethical and compassionate value-based care we call Permanente Medicine. Our model of care is physician-led, patient-centered, and team-delivered. We foster and accelerate medical research, clinical innovation, and performance improvements. With Kaiser Foundation Health Plans and Kaiser Foundation Hospitals, we’re expanding the reach of Kaiser Permanente’s unique approach to integrated care delivery, transforming health care in America. Find out more at permanente.org.

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In a recent commentary in the Journal of Healthcare Management, Maria Ansari, MD, FACC, co-CEO of The Permanente Federation, shared her perspective on a growing challenge facing clinicians: moral injury. Moral injury is the distress that physicians feel when they cannot practice medicine in a way that aligns with their personal and professional values. Dr. Ansari argues that addressing the root causes of moral injury — rather than simply urging physician resilience — is essential to keeping doctors from leaving health care at a time when they’re badly needed.

Moral injury has become an urgent issue within modern medicine. According to a recent JAMA Network study, nearly 40% of physicians say they have experienced high levels of moral distress, more than workers in many other fields. This kind of distress has serious consequences, including burnout, thoughts of cutting back hours, or leaving the profession altogether. The study concluded that health care leaders and organizations will have to tackle the structural drivers — such as restrictive policies, excessive bureaucracy, and resource limitations — to truly address the problem.

Finding moments of inspiration

In the commentary, Dr. Ansari observed that most physicians enter the profession with a shared purpose: to help people heal. However, a disconnect between what patients need and what the system allows them to provide, a rise in administrative burdens, inbox messages that follow them home, and concerns about workplace violence all serve to undermine that calling.

Dr. Ansari noted that despite the challenges, she draws inspiration from colleagues who find ways to pursue their passions. She mentioned Stella Dantas, MD, who recently completed a term as president of the American College of Obstetricians and Gynecologists, where she championed physician well-being and fought medical misinformation.

Related podcast: Stella Dantas, MD, on physician leadership, burnout, and the future of women’s health

Patient stories provide similar moments of inspiration, like the 80-year-old patient returning to weightlifting after heart valve replacement and the premature triplets thriving after complex neonatal care. Such moments, Dr. Ansari wrote, “reconnect us to why we entered this profession.”

Structural solutions to fixing the moral injury problem

At the same time, Dr. Ansari argues that a larger shift toward value-based care, which rewards outcomes rather than volume, may help reduce the friction between what physicians believe patients need and what the system incentivizes.

Ultimately, addressing moral injury will require changes at multiple levels, from technology and care models to workplace safety and leadership culture. But Dr. Ansari remains optimistic that meaningful reform is possible.

“Moral injury is real,” she said. “But so is our collective ability to confront it.”

Read the full commentary here.

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In a recent panel discussion published in The Permanente Journal, industry experts unpacked causes for the shortage, the places and specialties most impacted, and ways to expand the pipeline for future physicians.

Most importantly, the panel examined how the shortage could impede the provision of and access to high-quality care. The discussion was moderated by Ted O’Connell, MD, FAAFP, national medical director of Permanente’s Institute of Medical Education, professor at University of California San Francisco School of Medicine, and family medicine physician at The Permanente Medical Group.

Dr. O’Connell was joined by Lupe Alonzo-Diaz, MPA; Theresa Azevedo-Rousso, MPA; Julie Byerley, MD, MPH; Alexa McKinley Abel, JD; Michael B. Rothberg, MD, MPH; and Kevin Smith, MD, FACOG.

Related podcast: Preparing the next generation of physician leaders

What’s causing the physician shortage

Panelists agreed the limited number of residency slots is a factor in the United States’ ability to field enough physicians into the workforce. As the nation’s population ages, many patients could be unable to access the quality care they need. “The fact remains that nobody can become a practicing physician without completing a residency, and we cannot create new residency slots,” said Dr. Rothberg, vice chair for research at the Primary Care Institute at Cleveland Clinic.

Rural regions are among the hardest hit by the physician shortage. “Physicians may be leaving rural areas to pursue practice elsewhere because they don’t feel supported in their rural communities,” said , government affairs and policy director at the National Rural Health Association, citing smaller care teams and a reduced ability to refer for specialty care as meaningful reasons. McKinley Abel also pointed out that students who come from and train in rural areas are more likely to enter clinical practice in rural settings. However, she added that the federal student loan caps introduced in 2025 will be an impediment for such students considering medical school.

Financing medical education also remains a big challenge among underserved communities, said Alonzo-Diaz, president and CEO of Physicians for a Healthy California and vice president of medical education for the California Medical Association. . “This … [reinforces] what we know about communities that do not have the same level of affluence or access to assets and resources,” Alonzo-Diaz said.

Related story: Experts discuss benefits, challenges of anti-obesity drugs in The Permanente Journal

For certain medical specialties, the physician shortage is even more pronounced. “The pediatric workforce is challenged more now than it was before,” said Dr. Byerley, president of Geisinger College of Health Sciences, dean at Geisinger Commonwealth School of Medicine, and executive vice president and chief academic officer at Geisinger. Subspecialty areas within pediatrics face a greater shortage than primary care pediatrics, she explained, stating that it “often has inherent financial disincentives” regarding nonprocedural specialties in particular.

Potential solutions to closing the physician workforce gap

Expanding training and responsibilities among allied health professions and enabling them to practice at the top of their license is often hailed as a path to reducing access challenges. “As physicians, we have created these barriers that are essentially protectionist,” said Dr. Rothberg. “We could also be a lot more creative in terms of letting other allied health care professionals do things that physicians do,” suggesting that others on the care team could be trained in certain procedures, such as colonoscopies, to free up physician availability.

Despite the ongoing challenges, panelists agreed there has been progress in the last decade, particularly on the graduate medical education (GME) front. “We at the California Medical Association are proud of taking this conversation to voters,” said Alonzo-Diaz, noting that California’s proposition 56 and 35 have raised nearly $340 million combined for direct investment into GME programs. “Finding these kinds of opportunities is certainly part of the long-term solution,” she said.

Read the full expert panel discussion Online First in The Permanente Journal.

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OAKLAND, Calif. (April 13, 2026) — Khang Nguyen, MD, medical director for Care Transformation, Southern California Permanente Medical Group, and chief medical officer for Care Navigation, The Permanente Federation, was named by Modern Healthcare to its 2026 Innovators Awards list.

The award honors 30 healthcare leaders and organizations driving innovation that improves care, achieves measurable results, and contributes to clinical and financial goals. Dr. Nguyen was recognized for leading development of technology tools to facilitate care access, simplify communication, and effectively optimize member experience and care outcomes.

“This recognition pays tribute to our value-based, physician-led, prepaid model that supports innovation and the integration of technology to enhance the patient experience, and drive high-quality care and outcomes,” Dr. Nguyen said. “It also honors Permanente physicians and care teams for continuously working to better meet the changing needs and expectations of our members and patients.”

Modern Healthcare selected Dr. Nguyen for his leadership role in four technology initiatives:

• Kaiser Permanente Intelligent Navigator (KPIN), a tool that allows patients to describe their care needs in their own words, not via preset menus. KPIN then recommends the most clinically appropriate action, watches for high-acuity symptoms and, if needed, advises seeking immediate attention through a nurse triage line for evaluation. Findings in a 2025 Nature article showed the KPIN platform detected urgent medical cases with 97.7% accuracy and increased patient satisfaction by 8.6%. More than half of patients who used KPIN made timely and appropriate appointments. In comparison, across the entire health care industry, only 3 out of 10 patients who attempt to book appointments online are successful. The abandonment rate was just 3% with KPIN, compared to the e-commerce average of up to 70%.
• Smart Messaging Tool (SMT) uses natural language processing to categorize messages by clinical and operational topics, helping clinicians effectively manage their inboxes and enabling faster review of high-acuity messages. A study on SMT published in JAMA Network Open in 2025 examined the processing of 3 million messages from 1 million unique patients. The study demonstrated that SMT achieved a classification accuracy of 81%, significantly higher than the legacy system’s 44%. SMT was also associated with a 17-hour reduction in the duration of time between when high-acuity messages were sent and their initial review by a clinician.
• Get Care Now, a 24/7 virtual urgent care service, allows Kaiser Permanente patients in Southern California to connect with clinicians in under 2 hours via phone or video visits, achieving an industry-leading Net Promoter Score of 87 for patient experience, according to an NPJ | digital medicineIt enables patients to receive care at more appropriate, integrated care settings instead of visiting an emergency room.
• Ambient AI listening technology captures and transcribes conversations between patients and physicians — with permission — in the exam room. The physician then reviews the transcribed clinical notes for accuracy. Dr. Nguyen played a key role in deploying this tool to more than 8,000 physicians in Southern California. This effort was part of a national rollout to help clinicians focus on patients while technology assists with documentation, a key source of physician burnout.

The complete list of Modern Healthcare honorees and their profiles are available at Innovators Awards 2026 – Modern Healthcare.

To learn more about Permanente Medicine, visit https://permanente.org/.

About Permanente Medical Groups

Permanente Medical Groups provide award-winning care to Kaiser Permanente’s 12.6 million members. More than 25,000 primary care physicians and specialists are dedicated to the mission of providing high-quality, affordable care to all our patients and communities. Our ethical, compassionate approach to value-based care is physician-led, patient-centered, and evidence-based. We work collaboratively, supported by state-of-the art facilities and technology, to provide world-class primary, complex, and chronic care in eight states — from Hawaii to Maryland — and the District of Columbia.

About The Permanente Federation

The Permanente Federation is the national leadership and consulting organization of Permanente Medical Groups, which provide high-quality, affordable health care to the members of Kaiser Permanente. The Federation works to spread the ethical and compassionate value-based care we call Permanente Medicine. Our model of care is physician-led, patient-centered, and team-delivered. We foster and accelerate medical research, clinical innovation, and performance improvements. With Kaiser Foundation Health Plans and Kaiser Foundation Hospitals, we are expanding the reach of Kaiser Permanente’s unique approach to integrated care delivery, transforming health care in America.

The post Modern Healthcare Names Southern California Permanente Medical Group’s Khang Nguyen, MD, to its 2026 Innovators Awards List appeared first on Permanente Medicine.

What: Attendees will gain industry-leading perspectives on

• Ways to reimagine strategy, structure and clinical leadership to meet evolving health care demands.
• What’s next in AI and other innovations transforming health care
• How to maintain clinical excellence in the rapidly changing health care policy landscape

Where: Hyatt Regency Chicago, 151 E Wacker Drive, Chicago, Illinois

Who:

• Maria Ansari, MD, FACC, Co-CEO, The Permanente Federation; CEO and Executive Director, The Permanente Medical Group; President and CEO, Mid-Atlantic Permanente Medical Group; CEO, Northwest Permanente
  • Keynote panel: Top Health Systems’ Plans to Innovate and Win the Next 5 Years
  • When: Monday, April 13, 2026, 8:50 – 9:30 a.m. CDT
  • Room: Grand Ballroom (East Tower – Ballroom Level)

• Nolan Chang, MD, Executive Vice President, Strategy, Corporate Development, and Finance, The Permanente Federation; Regional Medical Director, Business Management, Southern California Permanente Medical Group
  • Semi-keynote panel: Decade-Defining Healthcare Innovations on the Horizon
  • When: Tuesday, April 14, 2026, 3:15 – 3:55 p.m. CDT
  • Room: Grand I (East Tower – Ballroom Level)

• Nkem Chukwumerije, MD, MPH, FACP, President and Executive Medical Director, The Southeast Permanente Medical Group
  • Semi-keynote panel: The Evolving Role of Effective Healthcare CEOs
  • When: Wednesday, April 15, 2026, 8:30 – 9:10 a.m. CDT
  • Room: Grand I (East Tower – Ballroom Level)

• Ramin Davidoff, MD, Co-CEO, The Permanente Federation; Executive Medical Director and Chair of the Board, Southern California Permanente Medical Group; Chair of the Board and CEO, The Southeast Permanente Medical Group; Chair of the Board and CEO, Hawaii Permanente Medical Group
  • Keynote panel: C-suite Reboot: What Health Systems Need for the Next 5 Years
  • When: Monday, April 13, 2026, 9:40 – 10:20 a.m. CDT
  • Room: Grand Ballroom (East Tower – Ballroom Level)

• Brian Hoberman, MD, Executive Vice President, Information Technology and Chief Information Officer, The Permanente Federation; Chief Information Officer, The Permanente Medical Group
  • Panel: AI and the Future of Work
  • When: Monday, April 13, 2026, 8:00 – 8:40 a.m. CDT
  • Room: Michigan 1B (East Tower – Concourse Level)

• Leong Koh, MD, Executive Medical Director, Northwest Permanente
  • Semi-keynote panel: The Next Evolution of Clinical Leadership
  • When: Monday, April 13, 2026, 2:20 – 3:00 p.m. CDT
  • Room: Grand I (East Tower – Ballroom Level)

• Stephen Parodi, MD, Executive Vice President, External Affairs, Communications, and Brand, The Permanente Federation; Executive Vice President, External Affairs and Corporate Development and Associate Executive Director, The Permanente Medical Group
  • Panel: Emerging Policy and Compliance Issues for Tomorrow’s C-suites
  • When: Monday, April 13, 2026, 9:40 – 10:20 a.m. CDT
  • Room: Gold Coast (West Tower – Concourse Level)

To learn more about Permanente Medicine, visit permanente.org.

About the Permanente Medical Groups

Permanente Medical Groups provide award-winning care to Kaiser Permanente’s 12.6 million members. More than 25,000 primary care physicians and specialists are dedicated to the mission of providing high quality, affordable care to all our patients and communities. Our ethical, compassionate approach to value-based care is physician-led, patient-centered, and evidence-based. We work collaboratively, supported by state-of-the art facilities and technology, to provide world-class primary, complex, and chronic care in eight states — from Hawaii to Maryland — and the District of Columbia.

About The Permanente Federation

The Permanente Federation is the national leadership and consulting organization of Permanente Medical Groups, which provide high-quality, affordable health care to the members of Kaiser Permanente. The Federation works to spread the ethical and compassionate value-based care we call Permanente Medicine. Our model of care is physician-led, patient-centered, and team-delivered. We foster and accelerate medical research, clinical innovation, and performance improvements. With Kaiser Foundation Health Plans and Kaiser Foundation Hospitals, we’re expanding the reach of Kaiser Permanente’s unique approach to integrated care delivery, transforming health care in America.

The post National Permanente physician leaders to share insights on health care’s future, new technology, and value-based care at Becker’s 16th Annual Meeting appeared first on Permanente Medicine.

By Brent Johnson

The Permanente Federation

Doris Dillahunty remembers the date: “July 6 is when I became very ill,” she said. “My stomach was killing me by the time I got to the hospital.”

Doris learned she had an intestinal infection, an acute illness that usually means days spent in a hospital bed. But she was offered an alternative approach.

“The next day, they came in and talked to me about Advanced Care at Home,” Doris recalled. “I told them I would love it. There’s nothing like being at home when you’re sick.”

Advanced Care at Home is Kaiser Permanente’s program to deliver closely supervised medical care in the home of an eligible patient. Permanente physicians across Kaiser Permanente markets led the development of the program, working closely with hospital and health plan colleagues.

“We’ve taken a model and transformed it to capitalize on Kaiser Permanente’s strengths as an integrated delivery system,” said Dan Huynh, MD, who helped establish an advanced care at home program in 2013 for Southern California Permanente Medical Group and now serves in a leadership role overseeing hospital-based services, as well as the advanced care at home program, in Orange County.

“Many people heal best in familiar settings, in the comfort of their own homes,” said Hemali Sudhalkar, MD, national medical director of Strategy for Kaiser Permanente Care at Home and medical director at The Permanente Medical Group. “Advanced Care at Home gives eligible patients the option to receive advanced medical care in their homes, rather than stay at the hospital.”

Related Advanced Care at Home podcast: Dr. Hemali Sudhalkar on the future of care at home

Advanced Care at Home doesn’t replace hospitals and it is not a hospital program. The program expands options for Permanente physicians to deliver care to patients who need advanced medical treatment and close oversight, but don’t require an inpatient setting.

Since 2022, the program has delivered over 30,000 episodes of care to Kaiser Permanente members, according to internal program data. An “episode of care,” a measure commonly used in value-based care models, reflects all the health services a patient receives for a specific condition or procedure during a certain time period.

For Doris, the difference showed up in access, flexibility, and responsiveness. “Whenever I’m in distress or need to talk to a doctor or nurse, I can always call them, 24/7,” she said. “Even when they brought in the X-ray machine, it didn’t take more than 5 minutes. It was like, oh wow.”

Integration makes Advanced Care at Home possible

Concepts of providing advanced care at home have been discussed for years, but making such clinical experiences consistent and safe at scale calls for more than video visits. It requires tight, sophisticated coordination of physicians, care teams, and clinical infrastructure. The preconditions for effective implementation pose steep challenges to many U.S. health organizations because traditional care is often fragmented among specialized roles across the continuum of care.

Kaiser Permanente’s integrated, value-based care philosophy and practice — called Permanente Medicine — connects all aspects of a patient’s course of care by supporting clinical accountability and seamless transitions. Permanente physicians can provide acute care safely in patients’ homes because the clinical, operational, and coverage components are in place.

Ehrine Deloriea, MD, helped establish Northwest Permanente’s home care program in 2020. Today, as regional chief of Hospital Medicine, she sees how Kaiser Permanente’s integration brings together clinical teams who deliver advanced home care every day.

“This is one of the most collaborative groups I’ve ever worked with — physicians, nurses, paramedics, health plan partners,” she said. “There’s an enormous amount of work happening in the background that patients never see.”

That collaboration enables a new kind of medicine. “Although I’m a hospitalist, Advanced Care at Home also provides me the opportunity to treat patients in their homes.” Dr. Deloriea said.

The future of U.S. health care

The broader implication for care delivery is clear: Many forms of acute care can occur in a clinically safe, non-hospital space. Advanced Care at Home offers a practical response to the multiple pressures facing U.S. medicine, such as capacity constraints, rising costs, and patients who desire convenient, high-quality care.

“If a patient doesn’t need to be in a hospital bed surrounded by alarms and hallways, we should be asking whether there’s a better place to heal,” Dr. Sudhalkar said.

Dr. Huynh added that the program can expand access to advanced medical care without standing up new facilities. “Just in Southern California alone, we’re enrolling enough patients to fill a small facility,” he said.

Dr. Deloriea agreed that health care will occur where patients live. “The future is virtual,” she said. “We’re probably going to see this kind of care continue to grow.”

Related innovation story: Driving health care innovation in 10 steps

Preserving well-being for both patients and physicians

While patients remain the focus of Advanced Care at Home, the model can benefit physicians as well.

For Dr. Deloriea, Advanced Care at Home preserves what she values most about advanced medicine — its speed, impact, and measurable improvement — while offering flexibility in how care is delivered.

“To be able to sit in front of a screen and still deliver advanced medical care, and see results in real time, that’s really amazing,” she said. “And physicians … get more diversity in how they practice. From a work-life balance perspective, it’s been great.”

In the end, the program’s success is best measured by whether patients feel safe, supported, and able to heal comfortably. Results of internal surveys show that 86% of patients who’ve experienced Advanced Care at Home would seek similar care again.

Count Doris among them. “I think Kaiser Permanente has an excellent program,” she said. “I can be in my own bed, around my family, my kids, grandkids — and that important environment helped me heal well.”

The post Advanced Care at Home: Expanding options for at-home recovery appeared first on Permanente Medicine.

The Federation also partnered with Kaiser Foundation Health Plan National Security Services and Permanente Medical Group leaders to integrate physician input and help align and shape enterprise security policies, practices, and priorities — strengthening protection and safety for clinicians and staff.

Advancing Permanente Medicine

The Federation External Affairs, Communications, and Brand (EACB) team played a major role in informing the PMGs and their physicians about ongoing shifts in federal policies, from vaccines to gender-affirming care. The team provided more than 18 physician FAQs and 7 leadership communications to support PMG operations.

EACB also continued to showcase PMG physician leaders in 2025, including all-PMG communications featuring Federation co-CEOs Maria Ansari, MD, FACC, and Ramin Davidoff, MD, who updated the PMGs about key priorities of the executive medical directors, including why physicians should play active roles in commercial membership growth.

The co-CEOs also took a step forward in externally facing thought leadership pieces on the topic of value-based care, co-authoring 2 articles together in Becker’s Hospital Review and Harvard Business Review.

Other Permanente physician leaders were featured in top-tier news outlets including The Wall Street Journal, Washington Post, STAT, and Newsweek, as well as being recognized for their work by a variety of health and industry trade outlets.

The Federation’s original programming — from the Permanente Medicine Docs Chat to the Permanente Medicine Podcast to the Permanente Live webinars — drove strong growth on YouTube with steadily increasing views and expanding subscribers from 1,000 to more than 10,000 by year’s end.

Several PMG leaders were also honored in several national lists, including Dr. Ansari in the 2025 Modern Healthcare 50 Most Influential Clinical Executives; Dr. Davidoff as one of The CEO Forum’s Top 10 CEOs Transforming Healthcare in America; and Drs. Ansari, Nolan Chang, Nkem Chukwumerije, Davidoff, Nancy Gin, Brian Hoberman, Leong Koh, and Stephen Parodi who were all named to the 2025 Becker’s Hospital Review Great Leaders in Healthcare honorees.

A constant flux of health care policymaking and its resulting challenges to public health made for an active year for the organization’s Government Relations teams. Year-round advocacy engagement included a Washington D.C. fly-in event that included all 8 Permanente Medical Groups and their leaders. Executive medical directors and physician Government Relations leaders met with 30 Congressional offices to advocate for the responsible use of AI to reduce administrative burden and enhance care quality, expanding health care workforce programs and alleviating physician shortages, and extending the enhanced premium tax credits (ePTCs) to maintain patient access to care.

Throughout the year, the Federation Government Relations team advanced the EMDs’ policy priorities using a wide-ranging approach that included meetings with Centers for Medicare & Medicaid Services officials and a record-setting Permanente Action grassroots campaign to protect Medicaid and ePTCs.

The post Lifting the physician voice to improve Kaiser Permanente and health care appeared first on Permanente Medicine.

Improving business capabilities

The council also continued to identify ways to use medical products more effectively, safely, and cost-efficiently across care delivery through its Value-Based Use (VBU) program. The goal of the VBU program is to ensure that clinicians have the right product for the right patient at the right time — while reducing unnecessary variation and waste. The NPC doubled the savings from 2024 to 2025 and plans to expand the program in 2026 with the launch of 25 new initiatives.

The PMG External Provider Management Community of Practice (CoP) met quarterly to share best practices for provider contracting and network management. Building on prior years’ discussions on behavioral health provider contracting and Medicare clinical documentation, the CoP expanded its focus to referral management strategies with contracted providers and modernizing provider contracting and network management systems.

In 2025, Kaiser Permanente took a significant step forward in modernizing contract systems to support network growth and value-based contracting by selecting a vendor for an enterprise-wide Contract Lifecycle Management System. This system enables the management of provider agreements, and PMG leaders played an integral role in vendor selection. They will also continue to collaborate with KFHP/H teams in planning the system’s implementation and deployment.

Ongoing labor activities

For much of 2025, the Federation’s labor relations activities centered on negotiations with the Alliance of Health Care Unions, which represents more than 60,000 clinicians and employees across the regions. Along with PMG colleagues, the Federation team helped to lead those negotiations and worked with Federation co-CEOs Maria Ansari, MD, FACC, and Ramin Davidoff, MD, to formulate strategy and partner with KFHP/H leadership. The negotiations carried into 2026 with no new agreement.

In addition to collective bargaining, the Federation partnered with KFHP/H colleagues to work with the unions in labor management partnership activities, including the Competitive Task Force, a joint committee negotiated with the Alliance back in 2021. The task force, co-sponsored by Federation Chief Operating Officer Chris Grant, is designed to responsibly look at opportunities to reduce costs, and in 2025 led to savings of $64.5 million through October.

The post Working toward a sustainable future appeared first on Permanente Medicine.

Improving the care experience

In 2025, the PMG Access and Experience leaders prioritized work on improving the new member experience and getting patients to the right care, at the right time, in the right place, and to the right clinician. Building on the successful “focused learning group” approach used in previous years, the leaders launched 2 dedicated groups to accelerate learning and adoption of innovative initiatives in these 2 priority areas through multiple learning sessions and at the third annual PMG Access and Experience Leadership Summit. As a result of these collective efforts, all PMGs committed to adopting or adapting at least one key practice from another region in both priority areas to be implemented in 2026.

The PMG leaders also participated in Kaiser Permanente’s selection of a vendor for an enterprise-wide member feedback platform — advancing the opportunity for a unified listening platform to gain insights and advance the member experience.

Federation teams drove strategic growth and sharpened PMGs’ external value story by producing actionable and aligned data analyses and reporting to inform access strategy and elevate the rigor and consistency of business‑to‑business reporting.

Strengthening the Medicare pipeline

In the organization’s efforts to support the Medicare line of business, the Federation analytics team developed new automated KPI delivery processes to strengthen visibility into Medicare performance and supported high-priority Medicare turnaround efforts.

The organization expanded specialized Medicare programs for dual-eligible members (those covered by Medicare and Medicaid) in Colorado and Georgia, delivering integrated care and enhanced benefits to vulnerable populations. An advanced program development with full regulatory approval in the Maryland market is slated for 2026.

Driving commercial growth

In support of commercial growth, the Federation partnered with national Health Plan to advance important work across product development, sales, and marketing.

In 2025, the Federation team helped to create 35 marketing assets, including the launch of the new Clinical Insights Report (CIR). The CIR is a customizable report with customer-specific data designed to deliver clinical insights unique to an employer group’s population health needs.

To optimize our market-facing physician program, the Federation team worked with a market research firm to conduct 20 in-depth employer group and channel partner interviews focused on the role of PMG market-facing physicians. The interviews covered all KP markets and major commercial lines of business. Initial findings were presented to executive sponsors to inform future planning in support of commercial growth goals.

In the product and benefits arena, the Federation also advanced work to improve the end-to-end process for the implementation of complex new benefits impacting care delivery and contributed to efforts to retain and grow “next gen” members, including partnering with the national Health Plan Product Development team to advance work on a product portfolio strategy.

The Federation’s brand team also provided input and PMG perspective to Health Plan’s new marketing campaign, “A Better Idea for Health Care,” which launched in fall 2025 with a differentiating creative approach that features Claymation-style animation to tell the story of Kaiser Permanente’s integrated care model.

The post Advancing key priorities to position Kaiser Permanente for growth appeared first on Permanente Medicine.

More than 34,000 participants enrolled in 2025, and another 250-plus Permanente physicians participated in aligned quality improvement projects that helped them maintain their board certification while also improving the quality of care they provide.

Leadership and wellness

In 2025, the Federation delivered and began redesigning national physician leadership programs, including the Executive Leadership and Medicine and Leadership programs, strengthening cross–medical group collaboration, expanding coaching and peer networks, and reinforcing consistent leadership practices that support care quality and organizational priorities.

Work also focused on expanding physician well-being initiatives across the Permanente Medical Groups. Initiatives included national summits, recognition and collegiality programs, and participation in the American Medical Association’s Joy in Medicine® Recognition Program and the American Conference on Physician Health. These activities provided Permanente physicians the opportunity to connect, gain practical tools to mitigate burnout, and to align with national best practices in physician well-being.

The post Enriching the physician’s mind and spirit appeared first on Permanente Medicine.

Here’s a look at other care delivery IT projects the Federation supported in 2025:

• California instance simplification (CIS) — The Federation partnered with The Permanente Medical Group, Southern California Permanente Medical Group, and KPIT to successfully consolidate 6 Northern California “instances” in KP HealthConnect into one instance, while simultaneously consolidating 6 Southern California instances into one instance. This effort saves Kaiser Permanente money and time in technical infrastructure and maintenance labor and reduces the organization’s technical complexity within its large electronic health record system, resulting in the ability to adopt more native features within KP HealthConnect that improve clinical quality and workflow efficiencies.
• MyChart and Care Companion— The Federation helped to deliver MyChart Evolution (MCE) to the Mid-Atlantic States, with other markets scheduled to deploy in 2026. Along with MCE, the interactive patient care tool MyChart Care Companion was also delivered to the Mid-Atlantic market for both routine pregnancy care and electronic cancer symptom management. MCE provides patients and care teams with an improved, overall experience and allows Kaiser Permanente to advance our digital toolset for patient engagement and clinical care.
• Enterprise imaging strategy— Work advanced the enterprise imaging strategy by launching the Sectra PACS (Picture Archiving and Communication System) for Radiology in the Mid-Atlantic States and launching digital pathology pilots in Northern and Southern California. The implementation of this system leads to faster, more accurate diagnoses and delivers workflow efficiencies through a robust, scalable enterprise platform.
• Patient/Provider messaging improvements— Launched Epic’s Automated Response Technology (ART), which leverages generative AI capabilities to reduce the cognitive burden on our physicians and clinicians by improving patient secure messaging workflows. ART provides a draft response to a patient, allowing the clinician to focus on the clinical elements and edit as appropriate. So far, 16,000 clinicians in the Mid-Atlantic States, Washington, and Northern California can use ART. Usage is expected to grow as other markets go live with the MyChart communication center.

The Federation Data & Analytics Team modernized critical elements of our reporting and data tools, enabling uninterrupted reporting, improved KPI automation, and future‑readiness for next‑generation analytics platform transition. Key accomplishments — including CIS code remediation, migration of Dignified Journeys measures to the National Cost Accounting system, and upskilling the analytics team ahead of a planned organizational shift of data and analytics work to a cloud-based platform — advanced alignment with the enterprise IT strategy and ensured stability of the data pipeline.

The post An eye on innovation to enhance care delivery appeared first on Permanente Medicine.

Spreading best practices in care and safety

National work to improve medical excellence expanded tools and support for both clinicians and members. For example, the cancer care program created access to virtual second opinions, expanded patient support options by phone and virtually, and created algorithms to identify high-risk cases. In pregnancy care, teams spread perinatal safety practices that prevent maternal deaths, created content for the Care Companion application to guide members through their pregnancy journeys, and integrated doulas into care delivery.

Pediatric work included a new training program to help clinicians and care teams communicate with parents about childhood vaccines. The precision medicine program continued to spread technology tools that enable clinicians to identify hereditary risks and to personalize treatment based on genetics.

To advance safety and make Kaiser Permanente the safest place to deliver and receive care, the Federation co-led regional learning collaboratives to prevent sentinel events, supported safety rounding, and enhanced how it uses data to monitor and reduce safety risks while advancing the organization’s Safety Management System. The team created and maintained a real-time capacity to respond to emerging and urgent issues ranging from national situation management team alerts to shifts in federal policy.

With increasing interest in GLP-1 medications, the Federation worked with clinical partners on a strategy to incorporate these new medications into a comprehensive, sustainable weight-management plan for patients.

Advancing care for Medicare patients

The Federation also successfully expanded the Complex Care Model program to all markets, proactively identifying high-risk Medicare members and delivering early interventions to prevent recurrent crises and reduce avoidable hospitalizations and Emergency Department visits, with most markets exceeding enrollment targets.

A falls prevention program, utilizing an app called “Bold,” was implemented across all markets, providing Medicare members with a digital exercise platform for falls prevention, bladder health, functional fitness, and musculoskeletal pain, with program enrollment (50,000+) and engagement rates (60%) exceeding expectations.

Kaiser Permanente achieved strong Medicare Star ratings across all markets, with all plans earning 4 stars or higher for 2026 (5 stars is the highest rating), and 7 markets earning the distinguished 4.5-star rating, reflecting Kaiser Permanente’s commitment to high-quality care for Medicare members.

Advancing quality through research

Quality improves through the regular flow of research and studies that identify care issues and promote new learnings. The Federation’s Garfield Memorial Research Fund initiated 4 projects for a total of $1.5 million to address important unanswered research questions. The Permanente Journal continued to serve audiences both within and outside of Kaiser Permanente as a diamond open-access publication.

In 2025, The Permanente Journal launched a peer-review mentorship program with a suite of tools to facilitate the learning and practice of peer review. It also updated the content collection on value-based care and deployed 3 calls for papers on the topics of access, value-based care, and physician workforce.

Supporting care programs with data

The Federation’s Analytics and Reporting team delivered enterprise‑wide analytic leadership that strengthened the Permanente Medical Groups’ ability to provide patient‑centered, high‑quality care while modernizing the data infrastructure that supports it.

The team’s work advanced major clinical programs — from Advanced Care at Home (ACAH) to Dignified Journeys — by enhancing dashboards, improving KPI methodologies, and developing predictive models that enabled early identification of high‑risk patients and more proactive care interventions. These efforts supported reductions in avoidable utilization, strengthened palliative and oncology pathways, and ensured equitable, high‑quality care across priority populations, including those receiving gender‑affirming services and maternal health care.

Kaiser Permanente’s ACAH services expanded in 2025 with a launch in Colorado. ACAH will be active in all Kaiser Permanente markets once it launches in Hawaii in the first quarter of 2026. The Federation supported the strengthening of the program infrastructure by integrating clinical and administrative oversight, implementing new technology systems to enhance care coordination, and building operational capacity to support expanded in-home care delivery for homebound members.

The post Quality remains the north star for Permanente Medicine appeared first on Permanente Medicine.

In a Becker’s “Leadership Unscripted” podcast, Ramin Davidoff, MD, co-CEO of The Permanente Federation, said he believes value-based care “absolutely deserves a much brighter spotlight as the answer to the issues that we have around health care in our country.”

Unfortunately, “Much of the care in this country is not based and focused on value,” he said, underscoring the urgency of reform.

Related value-based care story: Dr. Davidoff on rebuilding patient trust through value-based care

At Kaiser Permanente, he added, “Value-based care rewards positive health outcomes rather than volume of services that are provided. It focuses on prevention and early detection of disease; on keeping people healthy proactively; on managing chronic diseases to prevent complications and hospitalizations; and on truly greater health outcomes for our patients and communities, not solely on revenue generation.”

According to Dr. Davidoff, the key to improving health care in the U.S. is aligning incentives by restructuring payment models and organizational goals to reward physicians and clinicians for high-quality, efficient care instead of the quantity of medical visits, procedures, or tests performed. “Aligning incentives to provide outstanding patient outcomes has to be front and center for our country to be successful because the current model is, frankly, absolutely unsustainable and we need to do something different,” he added.

Addressing workplace safety concerns

Dr. Davidoff also talked about another area requiring more focus: ensuring workplace safety amid rising violence in health care settings. An American College of Emergency Physicians’ 2022 survey that showed 85% of emergency physicians believe the rate of violence experienced in emergency departments has increased over the previous 5 years. A more recent poll showed that 91% of emergency physicians said they, or a colleague, had been threatened or attacked in the past year.

Dr. Davidoff himself experienced violence as a practicing urologist, adding that the issue deserves a much larger focus through legislation and through different organizations involved in assuring that violence does not impact the workplace. “Workplace violence in a health care setting impacts the safety and the quality of the care that is provided for patients. And it certainly impacts the safety of our physicians, staff, and nurses,” he said.

Related physician leadership story: Dr. Davidoff on leadership in turbulent times

A safe work environment means higher satisfaction rates for physicians and clinicians and optimal care for patients. To support workplace safety, Dr. Davidoff noted that Kaiser Permanente and the Permanente Medical Groups have taken steps to address such violence, including seminars and training sessions that help physicians and care teams recognize the early signs and signals of potential violence. They also received training in de-escalation techniques.

Additional measures include implementing metal detectors in high-risk areas like emergency departments and enhanced security presence in hospitals and clinics. “We’ve communicated it, and we’ve done our best to deliver on what’s needed to help people feel safe in the workplace.”

To hear the full podcast, visit Becker’s Hospital Review.

The post Dr. Davidoff spotlights value-based care and workplace safety appeared first on Permanente Medicine.

“When I think about burden reduction, I think about navigation, and when I think about AI, I think about having a tool that can process this monumental amount of information and lead to the best possible navigation,” he explained. 

Related AI story: Responsible use of AI in health care 

This vision is about both improving the patient experience and giving clinicians the tools they need to focus on care and building trust. “Just as people trust their doctors today, we want the AI to be an extension of who those doctors are in the future — as long as it’s deeply curated by docs and the delivery system trusts it by constantly scrutinizing it, making sure that it’s doing what we think it’s going to do.” 

Ambient scribe technology: An AI-driven tool that is making a difference 

Ambient scribe technology — AI that “listens” during patient encounters and documents them in real time — has already gained enthusiastic response from Permanente physicians for the time it saves them taking notes during office visits. But this saved time isn’t being funneled into increasing patient panels, it’s being reinvested in quality care. As Dr. Hoberman put it, “Fortunately, the answer that we ultimately all agreed on was no, let’s use the time saved to do better patient care, because nobody’s going to just leave early … Take that burden off their back and watch what happens.” 

The result? Higher patient satisfaction, less provider burnout, and better outcomes. Dr. Hoberman attributes this to the responsible and strategic application of AI, emphasizing that building trust in these technologies requires ongoing feedback and monitoring. He also highlighted the need to balance automation with regulatory compliance and human oversight, particularly in areas like translation services. 

Kaiser Permanente’s approach demonstrates that innovation in health care is about thoughtfully integrating tools that empower patients and clinicians alike. The health care industry would do well to heed his advice: invest in AI not to do more, but to do better. 

Read the full Healthcare Innovation article. 

The post Brian Hoberman, MD, on how AI can redefine care navigation appeared first on Permanente Medicine.

Speaking at the Fifth Virtual Value-Based Payment Summit, Stephen Parodi, MD, executive vice president of External Affairs, Communications, and Brand for The Permanente Federation, talked about the ways an integrated, coordinated approach to patient care can provide the flexibility needed today.

“There’s a lot of uncertainty, which is injecting the need for thinking about this need for efficiency and need for care delivery models that allow for population-based health at scale and doing that on a much more rapid basis,” said Dr. Parodi.

How integrated care coordination speeds up innovation

With demand for telehealth and e-visits booming in recent years, Dr. Parodi raised the challenges of patients finding the right care quickly and being redirected to multiple resources. Responding to this issue and to clinical team feedback, The Permanente Medical Group in Northern California built an AI-powered Point of Contact Resolution system, known as POCR, to more efficiently triage patients and minimize unnecessary escalations.

Analysis of patient interactions showed that half were related to non-clinical questions and around a million involved UTIs and URIs that could be addressed effectively through e-visits. The medical group then collaborated on redesigning venues and creating a system for on-demand video visits to get patients to the right care faster.

This initiative is a powerful example how coordinated care makes it easier to build and implement patient-centered innovations while also creating efficiencies in care delivery.

“That’s an example of responding to the market, responding to physician and clinician actual input — because of course they were getting frustrated by patients bouncing around and not getting the problem taken care of — and also engaging with the clinical teams to actually design some of these systems,” said Dr. Parodi. “That’s what an integrated model looks like.”

Related health care innovation story: AI-powered patient portal enhances access, safety, and patient satisfaction

The advantage of integrated care in Medicare’s future

To address the increasingly complex picture for Medicare Advantage, the conversation turned to how coordinated care systems in the market are approaching recent upheavals. The capacity of these organizations will be challenged by more people seeking access because of rapid growth of older populations and by other health care systems exiting Medicare markets. This will be compounded by pressure from Centers for Medicare & Medicaid Services to constrain costs.

Dr. Parodi highlighted how integration of services helps align incentives and goals across Kaiser Permanente, such as efforts to streamline care delivery, payment, and administration while maintaining quality.

“For Kaiser Permanente, the advantage that we have is that we can talk about this as a system,” said Dr. Parodi. “We can look at this again on the care delivery side and think about what efficiencies need to exist to provide good care to these patients.”

Related Medicare story: Kaiser Permanente among the nation’s best for treatment, prevention, patient experience

Prompted to name the biggest requirement for maintaining integrated care that creates value, Dr. Parodi put forward physician leadership as a cornerstone to delivering efficient, high-quality care.

“You can’t get there without the clinical buy-in, the expertise, the innovation, and the passion,” said Dr. Parodi. “Without that, you can have all the wonderful guidelines in the world, and you won’t get there.”

Watch the archived panel on the Virtual Value-Based Payment Summit site.

The post Why the best integrated health care systems are built for health care’s future appeared first on Permanente Medicine.

For decades, my obesity medicine colleagues and I had limited clinical options to address weight loss beyond intensive lifestyle counseling or invasive surgeries. Then, glucagon-like peptide-1 agonists, more well known as GLP-1s, entered the picture, changing the conversation almost overnight.  

By elongating patients’ sense of fullness, curbing food cravings, and quieting intrusive thoughts known as “food noise,” GLP-1s have become an indispensable tool in obesity medicine. But ultimately, GLP-1s are just that — tools that patients and physicians can use as part of a more holistic approach to weight loss. Long-term success depends not on any one drug, but on the totality of care options provided. This means addressing lifestyle factors like nutrition, exercise, mental health, and social habits. It also means helping patients understand how medications can support weight loss if they choose to use them.  

Related GLP-1 podcast: Prescribing GLP-1s: Evidence, limits, expectations 

GLP-1s are a treatment, not the cure

There’s a good reason to not solely rely on GLP-1s for weight loss. Studies show that more than half of patients who discontinue GLP-1 treatment regain at least some of the lost weight within a year, as hunger, cravings, and “food noise” return and drive them back to unhealthy habits. Patients often have to learn to ignore a deeply ingrained, emotionally driven urge to eat as a reward for a job well done or to self-soothe after a difficult day — something no drug can accomplish without indefinite use.  

Side effects are a concern, as with any other treatment. While the safety profile of GLP-1s is well-established in the treatment of diabetes, their use for weight loss is newer. We continue to study their long-term effects; for example, we know GLP-1s can increase the risk of gastrointestinal complications and pancreatitis. These are serious complications that every physician and patient must consider when beginning GLP-1 medications.  

For most appropriately selected patients, the benefits outweigh the risks. But thoughtful prescribing requires honest conversations. Physicians must evaluate the whole patient: medical history, risk factors, readiness for change, and long-term goals. That holistic approach requires tools, resources, and systemic support.  

Lifestyle medicine is the foundation

In my experience, equipping patients with the tools and resources needed to form lasting healthy habits is the best way to ensure successful outcomes. This is where system design becomes critical. In an integrated, value-based care model like Kaiser Permanente’s, success is defined by long-term outcomes, not short-term results. Value-based care models provide the infrastructure, resources, and collaborative teams physicians need to treat obesity as the chronic, multifactorial disease it is. 

This is particularly important in weight management, where care plans must address both physical and emotional relationships with food. Think support like nutrition literacy, strength training, proper sleep, stress management, and behavioral strategies.  

In other words, without these reinforcements, GLP-1s do the heavy lifting alone. With them, the medication becomes the accelerator.  

The future of obesity medicine is patient-centered and integrated

To optimize success, patient support must extend beyond the physician’s office. Maintaining a healthy lifestyle in the modern world, particularly through nutrition, is not necessarily an inherent or obvious skill everyone possesses. We all have different literacy levels, budgets, ability to prepare food, work schedules, family life, and hundreds of other variables that shape our diets. In-person health education classes are offered to all Kaiser Permanente members — including those using GLP-1 medications — to teach healthy eating, weight loss or management strategies, and more. Classes are available online to ensure patients have access to these resources no matter where they are.  

As Permanente physicians, our ultimate goal is to work alongside patients and those who support them, to build a sustainable healthy lifestyle plan to ensure long-term success, regardless of their choice to use GLP-1s. Our health education programs and unique, whole-person approach are critical to achieving it.  

There’s no doubt that GLP-1s are transforming obesity medicine. They have expanded what is possible for patients who have struggled for years. But patients need more than just the medication. The most effective, sustainable treatment remains a healthy lifestyle supported by education, behavioral change, and medical oversight. Integrating the two is what helps maximize success. 

That is how we move from short-term weight loss to long-term health.   

Sean Hashmi, MD, is the regional medical director of Lifestyle & Obesity Medicine for the Southern California Permanente Medical Group, and national chair of the interregional clinical practice group for Lifestyle & Obesity Medicine, The Permanente Federation. 

The post GLP-1s are powerful weight loss tools, but they’re only part of the plan appeared first on Permanente Medicine.

Dr. Chang, a panelist at the recent 2026 ViVE digital health conference, shared that some AI companies are focusing on unhelpful solutions and instead should prioritize patient-centered approaches.

AI’s role in strengthening the physician-patient relationship

A recent example of an AI tool that is helping physicians focus their full attention on patients while also cutting their administrative burden is ambient scribe technology. This tool documents office visit conversations, capturing details raised by patients that help physicians better understand and diagnose patients, said Dr. Chang. An analysis showed ambient AI scribes saved Permanente physicians in Northern California the equivalent of 1,794 working days in one year and improved physician-patient communication.

Related ambient AI scribe story: Analysis: AI scribes save physicians time, improve patient interactions and work satisfaction

How AI can advance the movement to value-based care

Dr. Chang added that AI applications have the potential to accelerate value-based care models such as Kaiser Permanente’s, which emphasizes health care innovations that improve the quality and sustainability of care delivery.

“If we’re not keeping that population healthy, then they’re going to land in the clinic or the hospital more and utilize services. And so, in that longitudinal value-based system, the more healthy we are able to keep them, the better off we’re going to be,” said Dr. Chang.

An example of patient-centered AI raised by Dr. Chang is the new and improved patient navigation portal available to Kaiser Permanente patients in Southern California. The Kaiser Permanente Intelligent Navigator harnesses physician expertise and advanced AI that allows patients to describe their symptoms in their own words when booking appointments.

Related innovation story: Transforming the patient navigation experience starts at the digital front door

The portal then directs patients to the most clinically appropriate care while watching for high-acuity cases that require immediate attention. A study showed the technology detected urgent medical cases with 97.7% accuracy and increased patient satisfaction by 8.6%.

“Aligning those technologies to be able to make sure we are able to understand the patients and meet them where they’re at, based on the words that they’re using — I think that’s really powerful,” said Dr. Chang.

Read the full article here.

The post How AI in health care can strengthen the patient-physician connection appeared first on Permanente Medicine.

How physicians integrate GLP1s into long-term weight management

GLP-1 medications are reshaping the conversation around metabolic health and weight loss — but questions remain. In this PermanenteDocs Chat, Alex McDonald, MD, speaks with Sean Hashmi, MD, nephrologist and obesity medicine specialist, about how clinicians should prescribe GLP-1 and other weight loss medications as part of a total weight management approach. The discussion explores clinical evidence, common points of failure, lifestyle medicine integration, and how to set realistic patient expectations. Designed for physicians navigating uncertainty, patient demand, and long-term outcomes.

Guest

Sean Hashmi, MD

Podcast transcript

Transcript is autogenerated. Although edited for clarity, it should not be considered an exact replication of the podcast and may also be updated as needed.

Alex McDonald, MD: Welcome everyone to today’s PermanenteDocs Chat. I’m your host, Alex McDonald. I practice family and sports medicine here in Fontana, California. And today we are talking about lifestyle medicine, weight loss, and medication as part of both of those components, and particularly the GLP-1 receptor agonist medications. And we are joined by Dr. Sean Hashmi. So Dr. Hashmi, thank you so much for joining us today.

Sean Hashmi, MD: My pleasure. My pleasure.

AM: So let’s jump in here to talk more specifically about GLP-1s, because I know that’s what our audience is really thirsty to hear about. So from a primary care frontline clinician’s perspective, what do you wish more primary care doctors knew about GLP-1 medications? What’s missing? What do you wish they knew when we’re having these conversations with patients, when we’re learning about these medications and how they fit into our overall treatment plans?

SH: I was asked this question at a conference I just spoke at, and I was listening. I was surrounded by folks that were representing different aspects of health care. Some were from the pharma side, some were other side. And the way that I explained it to the audience there was the same concept. I said, when you look at a carpenter, a carpenter has a tool belt and there’s all these tools. And in those tools, let’s take a hammer, for example.

A hammer can be used to build this house, but just as easily, the hammer can be used to break down the house. The ability for the hammer to do each task is dependent on the user. So when it comes to GLP-1s, GLP-1s are a tool. They’re not the only tool, but they are a tool. The reason that they have gained so much traction so rapidly is because when we talk about why people eat, it actually turns out that the reason that people end up eating is for a few different reasons. The first one is some people eat because when they eat, they never feel the sense of fullness in their stomach. So as a result of it, when they’re finished eating, in 30 minutes, 60 minutes, 90 minutes later, they feel hungry again. They want to eat.

Others are where they crave. There’s a food noise that doesn’t stop and it always exists. And it’s always telling them, “I need sweets. I need something salty. I need something fried.” But that food noise is always there. Then there’s another component of it, and that’s where people end up being what we call emotional eaters. The second that they get stressed, the second that life sort of gives them a curve ball, they turn towards food because food is their friend. And as a result of that, the friend has always been there through good times, bad times. He or she, in this particular case, does not judge them, is always present. And that’s a different type. So when we start to talk about GLP-1s, they don’t solve every problem. They solve a couple of problems. First one they solve is the sense of never feeling full. They slow down food from going through your stomach, so you feel that sensation of fullness.

The second part where they work really well is they’ll go inside the brain and start to tell that food noise to calm down. So that’s another great thing. So as you start to think about it, you say, well, okay, that all makes sense. Then why is it that we should be concerned about issues or once again, the hammer is used properly. The reason for it is when you start to look at the patient’s journey, obesity is a chronic disease. It is not a one-time thing. And so when you have a patient in your office, one, as a primary care frontline doctor, it’s very important to understand, if you don’t set up the patient for success, they will not be successful on bariatric surgery. They will not be successful on GLP-1s or anything else that you decide to do for them. So what does that mean?

First, you have to make sure you understand with GLP-1s, set the right expectations. The faster the weight loss, the faster the weight recidivism or weight regain. So what are we aiming for? We tell patients a healthy weight loss on a calorie-restricted healthy diet is at most we’re aiming for 1 to 2 pounds a week at most. We’re not aiming for 10 pounds or anything crazy like that. And the reason for it is because when you lose weight on these drugs, 30 to 50% of the weight you lose comes from muscle.

The second part of this is the fact that within the first couple of days, you’re looking at almost half the people are going to get some kind of gastrointestinal side effects, nausea, vomiting, diarrhea, constipation. And so you have to set up the patient for success. So what does that mean? Mrs. Jones, when you start to take these things, it’s really important that we start with the lifestyle piece because if you eat foods that are rich in simple sugars, cookies, candies, juices, sodas, alcohol, right? What’s going to end up happening is those with GLP-1s, you’re going to have more GI side effects. If you’re eating fried foods, you’re going to have more GI side effects.

Second part of this that becomes really important is realistic expectations for the patient. Patient comes in and says, look, I saw X, Y, and Z celebrity, certain tennis player or somebody else, certain TV hosts, I won’t mention any names, but I saw somebody and they lost all this weight. I want that. I understand. That’s great. But what we’re going to do for you is we’re going to work with you to design a program that this becomes the very last time we ever talk about quote unquote diets. We’re going to change it into a lifestyle. We’re going to create an entire support system around you. That’s why when you look at all of Kaiser Permanente, every single one of our regions has offerings around health education. We understand the power that lies behind lifestyle, and lifestyle is nothing more than SELF [sleep, exercise, love, and food]. And if we’re able to do that, that sets them up.

And the final piece to this is we are oftentimes starting GLP-1s, but forgetting some of the basics like obstructive sleep apnea (OSA). The majority of our patients are actually dealing with it, and oftentimes is severe. So most people understand that excess weight causes excess fat around the airway, leads to obstructive sleep apnea. What they don’t realize is that OSA causes weight gain. It creates the inflammation, reads the insulin resistance, which then drives any excess calories to get stored, also stimulates your cravings for food. So it’s this vicious cycle. And that’s why GLP-1s are very confusing, but if you want a patient to be successful on them, you want to make sure you’ve got the lifestyle, you got the right expectations, you know what the entry point is, what the duration is, and more importantly, what happens when they hit a weight and quote unquote, what is the endpoint of GLP-1s?

AM: Yeah. You had just hit on so many great points and foreshadowing of multiple questions I have on my list, but I think it’s so important in just setting our patients up for the right expectations. I had a young patient come in who’s struggling with obesity and he said, “Doc, I don’t have time to go to the gym. Can you just prescribe me a medication?” And I said, “Hang on, time out. ” That’s not how this works. It needs to be part of a comprehensive approach. And really setting those expectations and having patients understand that I think is so important. I always will start with diet and exercise. I’ll often have our patients attend nutrition classes before we even talk about medications to build those lifestyle and those support pieces around them, which are going to then make the medications most beneficial.

I’m glad I’m not way off base from what you’re telling me. So let’s say, for example, from a clinical perspective, if a patient in front of us in clinic, how do we determine where we start? Do we start with health education? Do we start with exercise? Do we start with GLP-1? Do we start with another medication for weight loss? How do we decide from a clinical perspective where we start with each patient?

SH: Yeah, this is a great point. So if you look at GLP-1s and you talk about the failure rate of GLP-1s, you’re talking that in 12 to 18 months, 50% to as much as 80% of the people are quote-unquote failing. Whether they’ve stopped losing weight, they have very severe side effects, whatever the reason is, we’re calling it a failure, and there’s patients who are taking these drugs and they’re getting stuck on it. So when you see a patient, we want to do the lifestyle piece first, during, and after. The reason we say we want it first is once again, if you look at setting the patient up for success, if you want them to be able to last on this program long-term, you want them to start to understand how to eat better because if they’re not eating better, you’re setting themselves up for failure.

If you don’t talk about alcohol, the fact that they’re going to go and start drinking while they’re on GLP-1, spending time in the bathroom, having severe nausea, vomiting, diarrhea, or God forbid, if they already have comorbid conditions such as heart failure, et cetera, they’re on diuretics, now they get GI side effects. And what we worry about is acute kidney injury. And that’s something that we see over and over and over again. So once again, if you’re deciding on a GLP-1, is the patient starting to do the right stuff? And if they’re not, what is our opportunity? So health education is the basis of everything. And we have different names for it. In Southern California, there’s one term, but at the end of the day, all of these things are all about the fact that what we’re doing is setting up the patient for success. And for success once again means we address the SELF principle, all four aspects. Now, the exercise component, the reason it’s such a big deal and is forgotten is because when you’re talking about metabolism, every single time somebody loses weight, their metabolic rate drops. There isn’t a single drug on the planet that boosts up your metabolic rate, doesn’t exist.

And so as a result, the only thing we know is if you can create an afterburn effect, what does that? Strength training. If I go walk for an hour, I’ll burn a couple of hundred calories depending on how fast, what’s the incline, blah, blah, blah. But if I do strength training and I’m building lean muscle, that muscle is requiring more energy 24 hours a day, 7 days a week. And if you look at some of the folks when they talk about what is the single greatest variable for how long you live, turns out it’s a marker called VO2 max. Well, what is VO2 max? It’s the ability to be able to take in a whole bunch of oxygen. But what good is oxygen if you cannot use it? And the only thing that’s going to pull the oxygen out of the blood is muscle.

AM: Interesting. You’re talking to a family doc who’s trained in sports medicine also and is constantly preaching to patients the importance of strength training, especially as we accumulate birthdays, I think strength training becomes more and more important. And with GLP-1s, we know there’s a component of, again, as you said, muscle loss and sarcopenia. And to combat some of those muscle losses, I think is really important that we incorporate strength training as part of diet, sleep, exercise, lifestyle, but then also to help improve their, again, metabolic burn, but also minimize some of those side effects from the GLP-1. Because obviously we know, especially some of our older patients, sarcopenia can be a severe problem resulting in balance issues and falls and fractures and you name it, and all kinds of long-term problems.

Okay, so we already talked about some of these medications and setting real expectations. What are the most common side effects? Does it really depend on the person or does it depend on what they’re eating or what they’re not eating? How do you tailor the expected side effects to the individual patient?

SH: So first is, it’s almost like you have to set them up for success, which means if you tell them to expect a certain degree of GI issues, if you tell them they’re not going to feel anything, they’re in for rude awakening. But if you tell them, you can expect this. And the way to be able to do that is a couple of things. First, a couple of days after your first shot, you’re going to feel like the side effects are the greatest. They will taper off. Number two, what you eat matters. Everybody’s going to have birthdays, holidays, Thanksgiving, New Year’s, name your dates. But if you go and have a bunch of high-sugar foods and you’re on a GLP-1, a couple of things happen. First, of course, it’s going to make you spend time in the bathroom. But two, that becomes important is every single time you’re able to eat more, you train this supercomputer that we call your brain, how to overcome the block to cravings that the GLP-1 is creating.

So when patients come back and they say, “Doc, when I started the drug, I used to feel like I had no cravings, and now everything’s back.” And the reason is we are so good at adapting as human beings, as evolution is done, and we are also so good at overcoming things like medications. So that adaptation is real, occurs, and we want to be able to have tricks to go around. And one of those tricks is every single morning when you wake up, you have this little willpower. You have to understand this concept because this is critical to people who’ve been incredibly successful. So what you want to know is if you want to be successful in improving your health, don’t make decisions. Now, I know that sounds crazy. What are you talking about? Don’t make decisions. Don’t make decisions because your little bank of willpower gets exhausted by the first couple of decisions you make in the day.

And what you instead want to do is you want to plan yourself for success. So you should already know I wake up every morning, let’s say I wake up at 6 AM, I go work out. That decision is already made. I don’t have to think twice. I have the shoes next to my bed. I don’t have to think twice. I know what I’m going to do in the gym. In my case, I have a gym in the house. I know exactly the workout I’m going to do. Breakfast, I already know what I’m going to eat. I’m not going to go there and start looking at the refrigerator and say, “This sounds really good today.” Because whenever you start doing those conversations, you have the good side and maybe a little bit not the good side and they’re fighting and your willpower goes down. Now, let’s say you go to work and the boss is like, whoever your boss is, talking about GLP-1s, you’re like, “Oh my God, somebody wants GLP-1. They’re mad about it. Oh, I’m so stressed. Lunchtime. I got to eat something bad because I need that sugar because I deserve it. It’s been a really hard day.” Well, your willpower is already gone.

But if you already knew this is what I do for lunch, the beauty of life is that there are so many places to find pleasure. So if you think food is the only thing that gives you pleasure, let’s reframe that. What’s your circle of trust? What’s your friends? What’s your family like? What are you doing that brings you joy? There’s a very good coach who does wrestling, and I was listening to this speech and he said, the reason that a lot of wrestlers, they struggle with the training, this wrestling training is incredibly hard. They struggle because they only look at the training right now. If you reframe that and you look past the training at the person you’re going to be a month from now, 6 months, 12 months, you start to forget the immediate pain and you start to see the pleasure in whoever you’re about to come.

And that’s the thing that I try to express to patients is you are beautiful, you deserve happiness. Our job is how do we make a team? We create a circle of trust. How do we make it so that you feel that this is a safe space for you? And if I don’t know the answers, I will find the right member to make sure we can find the answer to support you on it.

AM: I love so much about what you just said and what you talked about in creating habits and creating systems. One of my biggest pieces of advice for folks who have trouble, for example, exercising is I tell them to go meet a friend. Go meet a friend for a walk or go meet a friend at the gym. We are social creatures and creating habits that involve with being with other people. My patient walked in the other day, has a t-shirt that says, “Run with friends, it’s cheaper than therapy.” And I think that sort of cathartic benefit, again, thinking about the whole person, not just the physical activity, but the emotional outlet that can be used and utilized when you’re exercising with a friend and you’re talking and you’re socializing. And so I think making it fun, building systems and support people around you so that you don’t have to decide to get up and go meet your friend to go for a walk, it’s already decided ahead of time.

So I love that. Don’t make choices. I think that’s a great piece. I want to chat about, you mentioned a little bit about diet and obviously some new guidelines came out regarding the food and nutrition from the Secretary of Health and Human Services. And I want to delve into that. You talked about there’s a million diets out there and there’s a million different people out there. And how do you help a person decide, again, what’s going to work for them? One of the things that I always tell patients is food and diet is very individualized. There’s no one size fits all. And unfortunately, we have to do a little bit of trial and error to find the right fit for the right person. But I want to know from your perspective and all the research you’ve done around diet and dietary guidelines, what do you tell patients and what do you recommend that doctors tell their patients?

SH: This is an excellent question. When we look at the 2020 to 2025 guidelines, and then we compare that to 2025, moving on to 2030, there’s a couple things that I think a lot of people are missing. It’s very easy to look at something and say, “Oh my God, this little piece of the pie looks different. In this case, there was a pyramid this way, there’s a pyramid this way.” The thing about pyramids though is the idea behind the pyramid was that it would make it easier for people to visually understand. It never had that impact. It really didn’t. So if you go back several years, you’ll see that there was a change across all sorts of national bodies, including within our organization as well, where we looked at what do we do to make it simpler for the patient to understand? Patients are not supposed to be doctors or dieticians or trainers or so forth.

So when a patient is looking at their plate, a plate does not look like a pyramid. And so what can we do to make it easier? And so we talked about this concept of a healthy plate. And what’s a healthy plate? Well, half your plate is things like fruits and vegetables. A quarter of your plate is things like whole grains, brown rice, et cetera. And then the quarter of your plate is protein. Protein can come from a variety of sources. It can come from things like tofu, it can come from beans, it can come from lentils, it can come from chicken, it can come from fish, it can come from eggs, it can even come from things like red meat. What you’ll find both in the new guidelines and the old guidelines is that there’s still an emphasis on whole foods, minimally processed, fruits and vegetables are still on there, and those items are very, very important to the foundation of the healthy plate.

SH: So instead of us getting into the weeds and getting stuck there, I can tell you as a patient, not as a doctor, but I’m a patient too. As a patient, when I look at my plate, I get lost. And so when I talk to my patients, they love the idea of a healthy plate. They love the idea that all I really need to think about is if food is coming in packages, is it really healthy for me? And there’s nothing in the new guidelines and nothing in the old guidelines that contradicts that. Even things like when we talk about fruits and vegetables, fruits and vegetables are an amazing source of antioxidants. They’re an amazing source of vitamins, minerals, fiber. All of those things are there. So with the new guidelines, fiber still continues to be an important part of it. It’s written in the statement of fruits and vegetables.

Other things like alcohol. When we look at the data around alcohol, we know that yes, a lot of people enjoy it, but there’s really no real safe drinking limit. And if you’re going to have it, we have some guidelines around it that are still endorsed by a number of national bodies. So less is always going to be more when it comes to things like alcohol. And there are things that if you’re the numbers type of guy and you want a specific number, we can give you those numbers. If you’re somebody who gets overwhelmed, then it says less is more. There’s really no safe limit in terms of drinking. If you can stay away from it, great. If you have to drink it, here’s the amount that gives you the least risk possible. So when you look at the new versus the old guidelines, instead of us always focusing on what’s different, how about we start to focus on what can we tell the patient to create less confusion?

How can we guide them from thousands and thousands of studies that are done from different populations in different groups that starts to say the same concept, which is once again, whole, minimally processed foods are still healthy things and things that are round and have another circle in between aren’t going to be on any dietary guidelines as recommended foods.

AM: I always like telling my patients that anything that comes in a box, a bag, or a package probably has more salt, sugar, and chemicals than anything else. So the important thing to remember about food labels is to avoid foods that have labels and boxes and packages. And that’s I always like telling my patients, but I love that. I love that emphasis on a whole food plant-based diet. That’s really important.

I want to touch base really quickly on something you said earlier regarding food as pleasure and the joy of eating. You alluded to this earlier. Most cultures, food is a place of enjoyment and family and connection. And a lot of our core memories growing up involve holidays and foods and things. How do we help our patients figure out other ways to deal with their stress or to express joy or pleasure or celebration other than food?

Because I think especially in our culture, something great happens, you go to dinner or you have some birthday cake, and that’s fine in moderation, but I feel like a lot of my patients I’ve experienced have an unhealthy relationship with food and how do we help them start to unpackage that because it can be really complicated.

SH: It can be complicated. The first part of thinking about that seeking pleasure or avoiding pain is when people talk about how eating that food gave them pleasure, let’s take a step back. If you sat there and ate food, let’s say I wanted a chocolate cake and I really think I deserve it. I ate it. That’s two seconds of pleasure that I had from it and then it’s gone. But when we do it within the company of people, you forget that it’s not that the chocolate cake tasted better in the company of those people, it’s that the company of those people made you feel good, and that’s why the food tasted better. So in other words, you can take the food part out of it and realize the company’s very important. Number two is the people that you bring into your circle. Those have to be people that you talk about your goals, your desires, your dreams.

Dr. McDonald, let’s say you’re my brother. We’re sitting down together. Alex, you and I, I wanted to share with you, I’m really trying to be healthy. I got kids now, I’m getting older, and I really want you to know I’m going to be working on this diet and when we go out, if you can just support me on this because I’m going to need that help. Now I have my own family member right there saying, “You know what? I get it. I love the fact that you’re trying and you’re now motivating me. I want to try too.” So instead of feeling like you’re the oddball out that you’re not the joy of the party because you’re not having that, what you’re doing is sharing your dreams, sharing your hopes, sharing the person you’re trying to become with them because the people who love you, they will start to realize that.

Now, it might not work the first time. They might be like all sorts of things, but you know what? Realize that the people you have in your circle are the ones that make your success. I never saw an athlete become successful by themselves. There were coaches, there were family members, the parents who took time out of their work to drive them. It takes a village to create success. So why don’t we build the ideal village instead of feeling ashamed that we’re eating healthy or feeling like we’re not part of the cool crowd? Instead, we are the example. If you want to change the world, start with yourself and then share that experience and say, “Look, I love you and I want you to be around and I’m changing myself and I want you to join me. ” That’s it.

AM: I love that. This has been such a great conversation. I do have two key questions I want to get to before we wrap up here, although this is wonderful. Regarding GLP-1 specifically, so obviously physicians are extremely busy. How do we balance having these conversations, having these interactions with patients, responsible prescribing of medications as part of a weight loss journey and a lifestyle journey? So my two questions specifically is, how do you talk about duration of therapy when we’re talking about GLP-1s? Is this something patients are going to be on forever? Are they going to be on it for a year, for 2 years? How do we measure success and duration of therapy? And then probably most importantly, if we stop a medication, how do we deal with weight regain? Because I know that can be an issue for some folks.

And some of my patients who have been on GLP-1s for a number of years and done very, very well, they are terrified of stopping their medication because they are terrified of regaining the weight. And how do you address that as a frontline physician? I know that’s a lot loaded into that one question, but please help us out.

SH: So first part of this is because we’re so busy and we might have 10 minutes, 20 minutes, whatever the time it is that you have in your clinic, you can’t possibly address everything. No.

That’s why you have to realize that as an organization, you have all these tools available to you. You want to encourage the use of health education. If you look at kp.org, there’s so many health and wellness and fitness resources that are free of use available to our members. We want to encourage that. What we’re trying to go after is the idea that a physician visit is one visit and then there’s a break, sometimes three months, sometimes six months. In between, we can have an RN do a check to see how things are coming, make sure everything’s okay. We can have a pharmacist do a check to see how things are going. We can even have our back office staff to do a check. So the concept here is we’re trying to create touchpoints. The second part of this is we are trying to take Kaiser Permanente and come into their home through digital tools, kp.org, on your phone.

We can do the visit without you having to come in. Those things set you up for success. Now, the second part is, well, what about duration? So obesity is a disease and it is a chronic disease. And that is really key to understand. That means that unfortunately it’s going to be with you for the rest of your life. That does not mean a GLP-1 has to be the chronic only treatment. There are other medications that have been around for a while. We can use those. We talked about this concept of habits. Habits take anywhere between 2 weeks or 14 days up to 255 days. That’s why people quote the 66-day number. 66 days is incorrect. It is a false statement. Each person is different between 14 days and 255 days. So knowing that, the more we can take the decisions away from you, the more we can build consistent, steady patterns, the more likely you are to be successful.

That means that you have to know Christmas is going to come every single year. Your birthday is going to come every single year. What are you doing for that social moat? What are you doing to create that circle of trust around you? And the most successful people I know who have gone off GLP-1s, who have lost an enormous amount of weight and kept it off without it. They still have a routine. They still work out regularly. They still eat whole foods, minimally processed, predominantly plants. The reason they do all of these things, they focus on their sleep is because they know that the secret to their success wasn’t one drug. It was systems and all they needed was a little help to go through the door and the door to success. Now that they’re in it, they figured out that once again, the tool, the hammer in your tool belt, can build you or can break you.

We still don’t know if there’s going to be any long-term issues. We’re targeting the pleasure centers of the brain. There were some concerns over suicide risk that came up early in the GLP-1 starting era. Those things now, the data shows that that’s not necessarily the case, but we still caution because there’s a risk of increased depression in vulnerable patients and there can be suicidal ideation. So we don’t want to wait. We want to know that blocking your pleasure centers does affect other aspects in vulnerable populations. So the point here is it’s not that GLP-1s are for eternity. It’s that if you think of obesity as a chronic disease and you have all these tools, including GLP-1s, our job is to figure out the best tools with the least side effects, the most safety. So in other words, still making sure there’s quality, still making sure that we are putting the patient in the middle and doing this for the long run.

AM: Yeah. And I think honestly, I’m super proud of Kaiser Permanente for our patient-centered approach. Just like you talked about, we can have touchpoints with nurses and nutritionists and pharmacists and physicians and LVNs. It’s really a team-based approach that can wrap around the patient and help that patient build their system and build their team however it fits them individually as a patient as opposed to a one-size-fits-all, which we know does not work. Dr. Hashmi, thank you so much for joining us. This is a phenomenal conversation. I feel like we need another hour to go into more of these details, but for the sake of brevity and our listeners out there, I have one last question. This is my favorite question. What makes you most proud to be a Permanente physician?

SH: I think the biggest thing is my daughters were born here. The greatest testament you’ll ever have of an organization is it’s like the hair club for men. I’m probably not the best person to answer this, but not only am I the spokesperson, but I’m also one of the members. That’s exactly it. All of our physicians are members. Most of us, we’ve seen my parents get care within [Kaiser] Permanente. My daughters were born here. They go get their treatment. They see the sports med guys a lot because they do wrestling and they get injured a lot. So if we don’t believe in it, we wouldn’t be part of it. And that’s what makes this organization so unique and so beautiful is not only are we the spokespeople for it, we’re also the hair club for men users for it.

AM: My wife told me I had a receding hairline the other day. I got very offended, but it is what it is. Well, thank you so much for joining us. We really appreciate your time and energy and passion around this topic.

SH: You got it. Thanks for having me.

AM: Yeah. And most importantly, thanks for all of you out there listening. We really appreciate your ideas and content. So make sure you reach out to us, subscribe to the YouTube channel, smash that like button or whatever the kids are saying these days. And if anything else comes up in questions, reach out to us. We want to know what you want to hear about on this podcast. So thanks all.

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Speaking with Becker’s Health IT, Khang Nguyen, MD, chief medical officer for Care Navigation at The Permanente Federation and chief healthcare information officer at SCPMG, shared more about this health care innovation driven by a team of Permanente physicians and other experts. The Smart Messaging Tool uses natural language processing to categorize messages by topic and flag high-acuity cases as top priorities, enhancing the patient experience by addressing safety concerns associated with online interactions.

“I’ll give you a good example: A patient who says, ‘I’m having weakness and I can’t move my arm.’ They may not know that they have a very short window to get to the ER,” Dr. Nguyen told Becker’s. “So, this system pulls that to the top. We get to them quick.”

Related AI story: Transforming the patient navigation experience starts at the digital front door

A study published in JAMA Network Open showed that the Smart Messaging Tool achieved 81% classification accuracy compared to 44% for the legacy system.

The findings also showed that the tool reduced the time it took clinicians to receive and read high-acuity messages by 17 hours — from 22 hours to just 5.

“If we’re looking for financial ROI, I would actually say we haven’t found one,” said Dr. Nguyen. “But the long-term ROI is basically patient quality of life, salvaging that clinical situation, saving someone from having a major stroke.”

Dr. Nguyen has also emphasized that the interoperability of new AI tools with existing technologies is key to support their long-term success. For example, integrating the Smart Messaging Tool with the existing Centralized Messaging Hub platform and with an automated routing solution now in development could produce a scalable, centralized communication network to manage a broader range of messages, freeing personnel to focus on other work.

Read the full article in Becker’s Health IT here.

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OAKLAND, Calif., Feb. 9, 2026 — Molly Tolins, MD, an emergency medicine physician with The Permanente Medical Group (TPMG), was named to Modern Healthcare’s 2026 40 Under 40 list. Dr. Tolins was recognized for leading an impactful program that fosters a culture of empathy and resilience among physicians and care teams. The annual award highlights individuals who have measurably and positively influenced the health care industry as a whole or helped their organization achieve financial, operational and clinical goals.

Dr. Tolins created and leads the Peer Outreach Support Team (POST) program within TPMG, the largest physician-led medical group in the United States, with nearly 10,000 physicians caring for more than 4.6 million members in Northern California. By connecting with trained peer supporters, the POST program assists colleagues going through potentially traumatic work experiences, such as unexpected patient deaths and difficult interactions with patients or family members.

As an Emergency Department physician, Dr. Tolins understands the critical role of mental health and peer support among health care professionals. She pioneered this program to address the stress and trauma that can arise in the medical field, promoting well-being and job satisfaction across the medical group.

“Talking about challenging experiences together helps us get through them, stay grounded in our humanity, and express empathy for our patients,” said Dr. Tolins. “When clinicians feel supported, they are better equipped to deliver compassionate, high-quality care.”

Medical group leaders credit POST with fostering a more collaborative and caring work environment.

“Dr. Tolins and the POST program exemplify the importance we place on physician wellness and leadership,” said Maria Ansari, MD, FACC, co-CEO of The Permanente Federation and CEO and executive director of TPMG. “Giving physicians the opportunity to innovate and lead the promotion of supportive environments is one of the cornerstones of providing high-quality care through the Permanente Medicine model.”

Peer supporters are nominated through an anonymous survey. Participants undergo an initial 4-hour training covering active listening, coping and resilience coaching, risk management and confidentiality assurance. The program also covers how to conduct red flag assessments to identify those who may benefit from a higher level of care.

POST is available in 15 medical centers in Northern California, with more than 400 POST-trained physicians and staff embedded across departments to provide proactive one-on-one emotional support to their colleagues after difficult clinical experiences.

In its first 5 years, POST had more than 550 successful physician interactions in Kaiser Permanente’s East Bay service area alone. An extraordinary 98% of participants surveyed said their interaction with POST was helpful, and 84% reported improvements in well-being.

Dr. Tolins was also named a 2025 Sidney R. Garfield, MD Exceptional Contribution Award honoree. The award honors TPMG physicians instrumental in creating and sharing ideas and programs that have a significant impact on patients, colleagues and the broader community.

Read more about Dr. Tolins in Modern Healthcare’s 2026 40 Under 40 report.

To learn more about Permanente Medicine, visit permanente.org.

About the Permanente Medical Groups

The Permanente Medical Groups are self-governed, physician-led, prepaid, multispecialty medical groups composed of more than 25,000 physicians. We are dedicated to the mission of improving the health of our patients and communities. Together with the Kaiser Foundation Health Plans and Kaiser Foundation Hospitals, we are Kaiser Permanente — an award-winning health care system that delivers Permanente Medicine, care that is person- and family-centered, compassionate, evidence-based, technology-enabled, culturally responsive, team-delivered and physician-led, to 12.6 million Kaiser Permanente members. We work collaboratively, enabled by state-of-the art facilities and technology, to provide world-class preventive and complex care centered in eight states — from Hawaii to Maryland — and the District of Columbia.

About The Permanente Federation

The Permanente Federation LLC is the national leadership and consulting organization for the Permanente Medical Groups, which, together with the Kaiser Foundation Health Plans and Kaiser Foundation Hospitals, comprise Kaiser Permanente. The Federation works on behalf of the Permanente Medical Groups to optimize care delivery and spread Permanente Medicine — care that is person- and family-centered, compassionate, evidence-based, technology-enabled, culturally responsive, team-delivered and physician-led. The Federation, based in Oakland, California, fosters an open learning environment and accelerates research, innovation, and performance improvements across the Permanente Medical Groups to expand the reach of Kaiser Permanente’s integrated care delivery model and to lead the nation in transforming health care delivery.

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2025 was a whirlwind of a year for health care. Rapid changes to federal policy and widespread adoption of artificial intelligence and other technologies occurred simultaneously and at an unprecedented pace — which meant physicians, clinicians, and health care leaders had a lot to learn, process, and ultimately decide on how to take action.

At Kaiser Permanente, I’m privileged to be surrounded by incredible leaders, innovators, and healers who devote themselves to finding solutions to the challenges we face — and who share those insights for the betterment of not only our patients but the entire U.S. health system.

As we begin 2026, I’d like to share some insights from 2025 that I’m carrying into the new year.

Commitment is our superpower

Kaiser Permanente communities in Southern California began 2025 facing disaster amid two of the most destructive wildfires in the state’s history. The Southern California Permanente Medical Group, in partnership with Kaiser Foundation Health Plan, sprang into action to protect the health and well-being of their community. Jeremy Maggin, MD, and Christopher Subject, MD, joined the PermanenteDocs Chat podcast to discuss their response to the crises.

Their conversation reminded me of something I’ve long known: Health care professionals across the board are deeply committed to the people and patients they serve. If you are dedicated to restoring health, you can’t resist the call to help others and contribute to the strength and resilience of those that surround you. Throughout 2025, I saw this dedication exemplified industry-wide and across Kaiser Permanente as we navigated health care funding cuts, disease outbreaks, and more. We persevered, prioritized people, and adapted to what seemed to be ever-changing circumstances.

Clinical integration will unleash technology’s potential

I had the pleasure of moderating a discussion on digital health and artificial intelligence technologies during a December Permanente Live webinar. Our guests, Kristine Lee, MD, associate executive director of The Permanente Medical Group, and Caroline Pearson, executive director of the Peterson Health Technology Institute, shed much-needed light on health technology’s potential as health systems race to adopt it.

Intentional integration of new technology into existing systems that are already achieving excellent results and establishing a shared method to evaluate their performance will ensure technology is built on a strong foundation. Rather than slapping tech on top of clinical programs like a bandage, we need to incorporate it into programs that are designed by well-meaning, well-intentioned, and well-informed humans. As Dr. Lee and Ms. Pearson pointed out, digital health technologies like wearables can produce rich data. Accompanied with a defined purpose informed by clinicians, the abundant, newly accessed information will amplify the reach of our workforce that has been strained by the challenges of increased demand for health services.

Pediatric care is community care

When a community doesn’t have a pediatrician, it’s missing a critical source of trusted medical information. In this age where people don’t know where to turn for the latest reliable information, we know people still trust doctors and nurses as key professionals who can help them make decisions about themselves and their family. We are all working to overcome the increasing volume of misinformation. That has never been more apparent with the increased volume of questions regarding childhood vaccinations. With the return of diseases we only used to read about in textbooks, the medical and parental communities are all asking how we can best protect ourselves and our communities. The best antidote to confusion is ensuring every parent has access to speak with a physician before making decisions about their child’s care, no matter where they live.

Eloa Adams, MD, shared on a PermanenteDocs Chat podcast episode how Kaiser Permanente is not just prioritizing pediatric care but prioritizing young people and children in the communities they serve. By living and working in these localities, Permanente physicians become a part of the community itself. Their trusted voices help protect each patient, each family, and the entire region that we serve.

Millennials and Gen Z will usher in a new engaging era of health care

Millennials and Gen Z are emerging as the primary consumers of health care and are shaping its future. At the same time, the traditional doctor-patient relationship is fundamentally changing with the presence of generative AI and online search. No longer are professionals the sole source of information or authority in an exam room. While these changes may seem disconcerting to some, it is truly an opportunity to redefine how patients and physicians access information through advanced techniques, while still retaining the humanity that is so important to healing. Young people expect the same level of engagement they receive in retail, which heightens the stakes for health care systems to get it right. The organizations that best respond to those expectations will thrive by meeting the complex health needs of new generations.

In this Harvard Business Review article published in December, my colleagues Ramin Davidoff, MD, and Maria Ansari, MD, FACC, co-CEOs of The Permanente Federation, made a clear case: Health care for millennials and Gen Z can’t be built on legacy models. The trust these generations want comes from care that is preventive, affordable, digitally seamless, and grounded in mental health, supported by AI and virtual tools that enhance the human connection. When we listen, simplify, and meet younger patients where they are, we don’t just modernize care, we make it work.

Physician leaders create the right environment to deliver high-quality care

Heading into the new year, I’m grateful to Letitia Bridges, MD, executive vice president and chief quality officer for The Permanente Federation, for a very important reminder: The infrastructure we create as physician leaders has incredible influence over the quality of care physicians can provide. Quality is an expectation by all of us, and we can’t take it for granted.

On the Permanente Medicine Podcast, Dr. Bridges explained that true excellence in clinical quality requires physician leaders to create an environment conducive to it. Ultimately, it’s up to us to set our patients and physicians up for success.

Looking ahead

I’m grateful to those guests who shared their insights on our programs and the teams that brought these shows to life. The future of health care will be shaped by leaders and clinicians grounded in reality and inspired by the hope we can create a new way to care for each other.

I look forward to this year’s thoughtful, physician-led dialogues on the issues shaping our profession. The challenges ahead — technological, clinical, and systemic — require collaboration, humility, and leadership rooted in practical care delivery. I’ll be keeping an eye on Permanente Insights for more. I hope you will, too.

The post Five lessons I learned from Permanente physicians in 2025 appeared first on Permanente Medicine.

As executive medical director, Dr. Kulkarni will lead the Mid-Atlantic Permanente Medical Group, one of the East Coast’s largest multispecialty medical groups. The medical group employs more than 1,800 physicians who practice across more than 65 medical and surgical specialties, delivering nation-leading health care to approximately 750,000 Kaiser Permanente members in Maryland, Virginia and Washington, D.C.

“For over a decade, Dr. Kulkarni has been a leader at Kaiser Permanente, earning a reputation for guiding teams to deliver extraordinary care that is easy and fast for patients to access,” said Maria Ansari, president and chief executive officer of Mid-Atlantic Permanente Medical Group, CEO and executive director of The Permanente Medical Group and CEO of Northwest Permanente. “Appointing him to be the next executive medical director reflects our commitment to shaping the future of health care, with a focus on surpassing the expectations of the patients we serve.”

A board-certified cardiologist, Dr. Kulkarni joined the medical group in 2013 and has held several key leadership positions, including chair of the Cardiovascular Institute. He spearheaded programs to manage complex conditions, including congestive heart failure and end-stage renal disease. Most recently, as associate medical director, his portfolio included leading Kaiser Permanente medical specialties, urgent care services, patient care experience and hospital strategy.

“As we celebrate Dr. McCarthy’s retirement and thank him for his years of service, we are pleased to welcome Dr. Kulkarni as our new executive medical director,” said Emily Holliman, interim regional president, Kaiser Permanente of the Mid-Atlantic States. “Dr. Kulkarni is a proven leader and a highly respected physician who combines clinical excellence with a deep commitment to top-notch care. His experience navigating the complexities of health care will be invaluable as we advance our mission to deliver high-quality, affordable care to our members across the Mid-Atlantic region.”

Dr. Kulkarni’s leadership at Kaiser Permanente has resulted in significant improvements in patient experience and outcomes. For example, he pioneered a one-day evaluation system for transcatheter aortic valve replacement, streamlining what is typically a multiweek process. His enhancements to acute care services have reduced unnecessary hospital admissions and improved outcomes for patients.

“Our mission at Kaiser Permanente is to revolutionize health care across the Mid-Atlantic region,” Dr. Kulkarni said. “We are committed to making exceptional care easy to access because that is what patients and our communities deserve. We are dedicated to removing obstacles in healthcare. At Kaiser Permanente, our patients will discover it’s easy to get great care.”

Dr. Kulkarni received his medical degree from Yale University School of Medicine, then completed his internal medicine residency at Columbia University Medical Center. He went on to pursue a cardiology fellowship at the University of California, San Francisco, with a focus on adult congenital heart disease, and then completed an interventional cardiology fellowship at Massachusetts General Hospital.

Dr. Kulkarni continues to practice medicine, and in 2025, was named a Top Doctor by Washingtonian Magazine, Northern Virginia Magazine and Arlington Magazine. He also regularly shares his expertise with the community through podcasts, media interviews and public presentations.

Outside of his role with the medical group, Dr. Kulkarni is currently serving a two-year term as president of the American Heart Association Greater Washington Region Board of Directors, where he leads initiatives to improve community health through better access to nutritious food, expanded CPR education, hypertension prevention, and support for overall well-being.

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and nonprofit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 12.5 million members in 8 states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists, and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery, and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education, and the support of community health. For more information, go to about.kp.org.

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Dr. Davidoff was selected for his leadership in deploying advanced precision-medicine pathways, 24/7 virtual urgent care, and AI-powered scribe technology. He was recognized for this honor at the recent virtual 5th Annual Healthcare Transformative CEO Summit.

During a panel at that summit, Dr. Davidoff said the U.S. health care system is shifting from fragmented, fee-for-service models to value-based care models, which emphasize prevention, personalization, and high-quality outcomes. He cited Kaiser Permanente as a longstanding example of value-based care.

“Our Kaiser Permanente system has been in place for 80 years, so it’s been 8 decades of building on a value-based care model that’s still in practice today,” Dr. Davidoff said during the panel. “That model is based on the concept of being prepaid, capitated, and designed to keep people healthy — not just treat them when they get sick.”

Related value-based care story: Unlocking the potential of value-based care

To shift to value-based care, Dr. Davidoff said health care organizations must align incentives and prioritize patient values, needs, preferences, and experiences.

“Everyone can win if we align the incentives between the medical groups, the hospitals, the health plans, the care delivery models, in a patient-centered way that produces high-quality outcomes,” Dr. Davidoff said. This approach is fundamental to Kaiser Permanente’s value-based care model, which emphasizes care coordination, disease prevention, early detection, and population health management.

He also underscored the importance of focusing on key health care performance indicators. “Time to diagnosis is absolutely a key part of that but resolving the actual issue — as opposed to creating multiple encounters and touch points — is the key to improving the health care system in terms of affordability as well as quality in this country.”

Dr. Davidoff noted that value-based care organizations make significant upfront investments to redesign processes, establish care coordination programs, and upgrade health IT infrastructure. Examples of these investments include electronic health records, which give care teams real-time access to complete patient health information and connect visits, prescriptions, and test results in one place. This coordination helps reduce errors and improve outcomes. They also invest in AI-driven analytics to help track patient outcomes, identify care gaps, and manage population health more effectively.

Dr. Davidoff said these types of investments are central to advancing personalized medicine, especially in cancer care. Examples include AI algorithms trained on mammogram images to predict breast cancer risk, computer vision for analyzing pathology slides, and automation in radiology and lab result processing.

Related value-based care story: Dr. Davidoff on how value-based care incentivizes smart investments in AI

Successfully shifting to value-based care also requires health systems to address the challenges of care access and patient motivation, Dr. Davidoff said.

Fortunately, Kaiser Permanente has been continuously working to expand care access through virtual and in-person care as well as a suite of digital tools that help patients manage their health care efficiently. These include a mobile app and online portals for appointments, refills, secure messaging, and to view test results and personal health records.

To motivate patients to engage in their own health care, Dr. Davidoff said, “we have robust educational programs around diabetes, hypertension, heart failure, renal failure, and smoking prevention programs. We believe if these are provided in a culturally sensitive way and in multiple languages, they truly do motivate people to seek health, to prevent disease, and to go for the resources that are available through systems like ours.”

Watch a recording of the virtual panel here.

To learn more about Dr. Davidoff, check out the Winter issue of The CEO Forum magazine. Subscription may be required.

To see a summary of The CEO Forum list, visit Becker’s Hospital Review.

The post Ramin Davidoff, MD, named among Top 10 Health Care CEOs appeared first on Permanente Medicine.

Dr. Davidoff was selected for his leadership in deploying advanced precision-medicine pathways, 24/7 virtual urgent care, and AI-powered scribe technology. He was recognized for this honor at the recent virtual 5th Annual Healthcare Transformative CEO Summit.

During a panel at that summit, Dr. Davidoff said the U.S. health care system is shifting from fragmented, fee-for-service models to value-based care models, which emphasize prevention, personalization, and high-quality outcomes. He cited Kaiser Permanente as a longstanding example of value-based care.

“Our Kaiser Permanente system has been in place for 80 years, so it’s been 8 decades of building on a value-based care model that’s still in practice today,” Dr. Davidoff said during the panel. “That model is based on the concept of being prepaid, capitated, and designed to keep people healthy — not just treat them when they get sick.”

Related value-based care story: Unlocking the potential of value-based care

To shift to value-based care, Dr. Davidoff said health care organizations must align incentives and prioritize patient values, needs, preferences, and experiences.

“Everyone can win if we align the incentives between the medical groups, the hospitals, the health plans, the care delivery models, in a patient-centered way that produces high-quality outcomes,” Dr. Davidoff said. This approach is fundamental to Kaiser Permanente’s value-based care model, which emphasizes care coordination, disease prevention, early detection, and population health management.

He also underscored the importance of focusing on key health care performance indicators. “Time to diagnosis is absolutely a key part of that but resolving the actual issue — as opposed to creating multiple encounters and touch points — is the key to improving the health care system in terms of affordability as well as quality in this country.”

Dr. Davidoff noted that value-based care organizations make significant upfront investments to redesign processes, establish care coordination programs, and upgrade health IT infrastructure. Examples of these investments include electronic health records, which give care teams real-time access to complete patient health information and connect visits, prescriptions, and test results in one place. This coordination helps reduce errors and improve outcomes. They also invest in AI-driven analytics to help track patient outcomes, identify care gaps, and manage population health more effectively.

Dr. Davidoff said these types of investments are central to advancing personalized medicine, especially in cancer care. Examples include AI algorithms trained on mammogram images to predict breast cancer risk, computer vision for analyzing pathology slides, and automation in radiology and lab result processing.

Related value-based care story: Dr. Davidoff on how value-based care incentivizes smart investments in AI

Successfully shifting to value-based care also requires health systems to address the challenges of care access and patient motivation, Dr. Davidoff said.

Fortunately, Kaiser Permanente has been continuously working to expand care access through virtual and in-person care as well as a suite of digital tools that help patients manage their health care efficiently. These include a mobile app and online portals for appointments, refills, secure messaging, and to view test results and personal health records.

To motivate patients to engage in their own health care, Dr. Davidoff said, “we have robust educational programs around diabetes, hypertension, heart failure, renal failure, and smoking prevention programs. We believe if these are provided in a culturally sensitive way and in multiple languages, they truly do motivate people to seek health, to prevent disease, and to go for the resources that are available through systems like ours.”

Watch a recording of the virtual panel here.

To learn more about Dr. Davidoff, check out the Winter issue of The CEO Forum magazine. Subscription may be required.

To see a summary of The CEO Forum list, visit Becker’s Hospital Review.

The post Ramin Davidoff, MD, named among Top 10 Health Care CEOs in America appeared first on Permanente Medicine.

Writing in Harvard Business Review, Maria Ansari, MD, FACC, and Ramin Davidoff, MD, co-CEOs of The Permanente Federation, shared 7 health care innovations that employers and health care leaders should adopt to meet the distinct care needs and expectations of Gen Z and millennials.

“Young people need health care and coverage that works — with no fuss and barriers, just solutions that fit,” wrote the co-CEOs.

Not only do younger generations embrace the use of AI in their daily lives and prefer receiving care virtually more than previous generations, but they also face growing rates of chronic conditions and seek out mental health care more than older adults.

Related health care innovation story: Dr. Ansari on health care’s future amid demographic shifts

The co-CEOs detail solutions that can build a health care system young adults will trust to provide high-quality care throughout their entire lives. The strategies give employers and health care leaders several pathways to delivering care that offers real value for younger populations.

Embrace virtual health care

The co-CEOs encouraged employers and health systems to better connect with younger people by offering the same convenient, intuitive experiences they get with other app- and web-based services. For health care leaders, that means leaning into telehealth tools that better integrate vital communication about medications, results, and appointment bookings with patients’ daily lives.

An example the co-CEOs lift up is the innovative Kaiser Permanente Intelligent Navigator, a patient portal that reimagines the way members in Southern California navigate care by using AI-powered features that safely facilitate appointment bookings and provide a better overall care experience.

Related patient portal story: Transforming the patient navigation experience starts at the digital front door

Enlist AI in improving care

With young adults reporting they use AI more than other adults in tasks like searching for information, the ground is fertile for health care organizations to continue responsibly pursuing AI-based tools that improve care experience and workflows.

The co-CEOs pointed to Kaiser Permanente’s successful systemwide deployment of ambient AI scribes for notetaking during patient visits as a way to create better connections between patients and physicians while also streamlining an administrative task.

Treat mental health as an essential part of health care

Responding to demographic shifts in how mental health is discussed, the co-CEOs shared tactics to better support young adults who are increasingly seeking mental health information and care. These include preventive screenings and innovations that help health care providers reach patients at risk for depression, suicide, and other mental health concerns.

Read the full article, including all 7 of the strategies for building health care to support the next generation, here.

The post Drs. Ansari and Davidoff on meeting the health care needs of younger generations appeared first on Permanente Medicine.

In this episode of the Permanente Medicine Podcast, host Chris Grant sits down with Letitia Bridges, MD, MBA, executive vice president and chief quality officer for The Permanente Federation.

Dr. Bridges offers a compelling perspective on how systems, values, and human relationships drive high-quality care and how Kaiser Permanente’s value-based, physician-led model enables better outcomes.

Dr. Bridges also explores how the story of care quality begins with a commitment to prevention and early diagnosis, extends into cancer care, perioperative safety and chronic disease management, and continues with long-term survivorship. The conversation covers how the demographic impact of aging populations and the younger generations of Gen Z and millennials are having on health care delivery.

The episode highlights the role of emerging technology and evolving patient expectations in shaping the future of medicine—and offers personal reflections on mentorship, purpose, and the importance of relationships.

Watch the full episode on YouTube:



Connect with Chris Grant by following him on X at @cmgrant or LinkedIn.

Follow us: Subscribe to the Permanente Medicine Podcast on your favorite streaming platform.

Podcast transcript

Transcript is autogenerated. Although edited for clarity, it should not be considered an exact replication of the podcast and may also be updated as needed.

Leticia Bridges, MD, MBA: This idea of a North Star really is what is it that we’re all committed to patients, physicians, the system, all of it together. As we navigate all of the change that’s coming, we know that won’t change. But when you have a North Star, you’re able to see through all of the noise and continue to move in the right direction. And I think that’s one of the areas where we’ve really just been quite frankly brilliant, is no matter what the disruption is, we have our North Star that is excellence in care.

Chris Grant: Welcome to the Permanente Medicine Podcast. I’m your host, Chris Grant, the chief operating officer at Kaiser Permanente, the Permanente Federation. In this discussion, we will address the significance of quality care and its role in ensuring medical excellence and positive patient experiences. We are joined today by Dr. Leticia Bridges as our guest for this episode. Earlier this year, Dr. Bridges became executive vice president and chief quality officer for The Permanente Federation and co-chair of the Kaiser Permanente National Quality Committee. As chief quality officer, Dr. Bridges oversees coordination of quality care programs across Kaiser Permanente for its 12.6 million members. She also serves as regional medical director of quality and clinical analysis for the Southern California Permanente Medical Group, and I’ve had the opportunity to work alongside Dr. Bridges and see her extraordinary capabilities firsthand. Dr. Bridges, thanks for being with us today.

LB: My pleasure. Excited to join you.

CG: Alright, let’s dive in and give our listeners a bit of new insight. We’re excited about your new national leadership role and quality for the Permanente Medical Groups. First, can you tell us a little bit about your background in previous roles?

LB: My story starts like everyone else’s with the residency training. I trained here in Los Angeles in general surgery, and during the course of that training I also pursued and completed Master’s in business administration. And over the course of my training, I’ve really been struck by the operational inefficiencies in medicine. And so that really inspired me to look for a job that I would have the opportunity to both be a practicing surgeon and to think about leadership as it related to our physician practice. My initial leadership position was actually in bioethics, which was really fascinating, and I moved on to perioperative leadership to leadership in the home care space. I’ve been an assistant area medical director and obviously a medical director and chief of staff at one of our two hospital facilities. It’s one of the, I think most fascinating opportunities within the Permanente infrastructure is this ability to deliver clinical care while you’re leading and designing the systems in which you work.

CG: When Dr. Davidoff came to me and spoke with me about your new role, he said “You’re going to love Dr. Bridges because she’s a driver of innovation and a driver of change.” What goals are you most excited to focus on as you step into this position?

LB: This role is about excellence in clinical quality. My perspective is that millions of people are relying on us to deliver high quality clinical care. They’re really relying on us to communicate with empathy. They’re relying upon us to have a safe perioperative journey. They’re relying on us to capture their cancer diagnosis and to treat it. And when you think about what’s at stake within medical care, we need an infrastructure that really delivers on excellence. And that’s for every patient from cradle to grave, every single visit. And as I’m thinking about my priorities, it is very much that mindset, infusing that mindset into the work that we do every single day. And of course there are the more traditional things of thinking about what are the clinical areas of focus that deliver the greatest impact to our patients? How do we deliver on excellence in diabetes care and hypertension, again at scale, consistently at every touch point. And as you mentioned earlier, a particular passion of mine is actually building in on the systems of care. How do we start to think about where we can deliberately and intentionally design our system to deliver on all of the process and evidence basis that exists within a disease state? And so I am very excited to take on the thinking around what the perioperative journey should look like. How do we start to think about lifestyle and obesity medicine, tackling the problems of pediatric obesity? We have tremendous opportunity and tremendous need.

CG: Before we dive into the details around quality programs and outcomes, could you share something about what you enjoy doing outside of medicine with our listeners?

LB: Surgeons have many shared beliefs and practices, and one of them is that you’re born a person and that you die a surgeon. And what that means is that like motherhood, it is a lifelong commitment to who we are and to how we live our lives. And so my philosophy is very much work hard, play harder. I’m always on. I’m fortunate to have three very rambunctious teenage boys and they keep me excessively active in all of their competitive activities from choir to basketball. On vacation — I use that with air quotes — you’ll find me navigating the Chasm of Doom in Joshua Tree, exploring snake farms and being on a boat in Louisiana while feeding marshmallows to alligators. It’s a really exciting life that I lead and I think that I find myself learning and relearning how to really deeply engage both at work and at home.

How value-based care and prevention drive quality care

CG: You have one of the most complex jobs in health care to lead quality across the largest health care delivery system in America. Independent organizations, and this is one of the things I’m so proud of, such as the National Committee for Quality Assurance and U.S. News and World Report frequently recognize Kaiser Permanente for its high-quality care. Could you elaborate on how our value-based model contributes to earning these distinctions?

LB: I love this question because now we have the opportunity to brag on the power of Permanente. We have extraordinary clinicians operating in an intentionally designed, evidence-based, continually evolving system that’s supported by technology. And when we start to take a step back, that’s the underpinning of value. And our philosophy with excellence, it really starts from prevention. We think about what are we doing with the primary prevention, what are we doing in our communities to support the well-being that we know that our members deserve? And then how do we stretch that excellence from primary to secondary prevention? I think it’s very well known at this point that we lead the nation in many of our cancer outcomes. It is because members that are navigating their cancer care also get best in class cardiac care, best in class surgical care if they should need it. Everything is evidence-based, integrated and aligned.

And when we start talking about value-based care, it is doing the right thing according to the evidence, according to that individual member at the right time. The other thing that I think that is an important part of this conversation that we often leave out is that health care is not just about the journey across the disease state. It is very much about survivorship. And so we talk about early diagnosis, we talk about the rigor in the treatment processes, but what comes next is just as important. Am I surveilling you 2, 3, 4 years later? Am I able to pick up a recurrence sooner rather than later? What do I do when that recurrence? Am I following the evidence at that point? Do I offer you all of the interventions that you deserve in a step-wise kind of coordinated fashion? And so the beauty and the power of Permanente really sits in these longitudinal relationships and it also sits in our ability to reach into your family and to help you identify the support that you need so that you have not just the medical support but the social system that sits around you. And when you start to think about the work that we really do, we treat our patients just like we treat our own family members, we give them the information, we give them the longitudinal support, and we’re looking after them for the duration of their relationship, which on average with Kaiser Permanente is at least 12 years.

CG: That’s amazing. And it’s such a beautiful story that you described because it isn’t when a patient walks into a clinic or ends up with symptoms and then gets a difficult diagnosis. It starts with working with the community. It starts with understanding social determinants of health, and then it is that early intervention and it’s that lifetime support. And maybe what would’ve been a dire diagnosis a couple of decades ago now is chronic disease management in a wonderful lifestyle because of the resources that the programs that you oversee wrap around a patient and their family.

LB: And when you’re navigating these complex life moments, having the trust of your clinician is vital. So I always like to call that out because that is the core I think of a healthy clinician patient relationship.

The opportunities inside health care industry disruption

CG: Alright, I want to dive into some of our biggest challenges and our biggest opportunities to achieving quality care. What do you see as the biggest challenges that lie ahead and what are some of the bigger opportunities that you’re focused on?

LB: Patients are seeking effortless, easy, accessible care. And as we think about those three words, it seems we should be able to deliver that all the time, but there’s a lot that’s built into being able to be accessible whenever it is that the patient is demanding services. This movement into consumerism from our patients is a real challenge that they’re calling out. And so I do see a core challenge and a core opportunity for us and for every health care organization is to meet the delivering demands that are currently being expressed by our members. From the physicians standpoint, what the clinicians will universally call out is the surgeon-patient volumes. They’ll call out the level of acuity and how that is increasing, and again, they’ll point to this friction that exists between giving the patients what they want and following the evidence because we are convinced that’s what they actually need.

As we’re moving through that dynamic, this is where the trust comes in. We need to be able to have conversations that allow us to solve for what the member is solving for, but also reconciled with the evidence. Then as we’re thinking about the larger challenges for the organization, we’ve talked about workforce shortages. We’ve talked about weather as a disruptor. COVID was a disruptor and now we’re facing a governmental disruptor to the health care industry. This is particularly challenging because it is a tough time to be lifting up communities to be in education and to be in health care because the pace of change is evolving faster than a system of our size is accustomed to moving. The regulatory oversight has been drastically changed. If we think of something as foundational as the Joint Commission, for example. When I started there were 142 standards. We’re now down to 14. There were no pediatric standards for the inpatient setting. Now those exist. Within disruption. There’s always concern about change, but there’s always opportunity too. And so what I remind folks is that this is when it’s a wonderful time to be within the construct of Permanente Medicine. We have experts that allow us to navigate these challenges. We have the opportunities for alliances. We had the opportunity to look at the data independently and decide what makes sense for our members, and we have leadership that supports us in all of those endeavors.

Overcoming the demographic challenges facing health care

CG: I love the way you describe our resiliency and responsiveness to disruptions because it’s true. KP as a system responds and actually innovates in those most disruptive moments and charts, a very creative, very innovative future. Speaking of disruption, we also have demographic changes that we’re adjusting to. We know that the over-65 population will eventually grow to almost a quarter of the U.S. population in the not too distant future and more Americans are suffering with chronic conditions, oftentimes multiple chronic conditions. Also, millennials are now the largest living generation. How do you see these demographic shifts impacting the work of improving care quality?

LB: First of all, not all of the over 65 are created equal. We have some that are still out running marathons, and then we have others that are nearing the end of life. And so as we start to think about a geriatric ecosystem, because that’s what you need, it becomes teaching your clinicians and training the system on the principles of geriatric care. And so what we are doing is we’re taking the knowledge from our geriatricians. We’re teaching it to all of our clinicians from adult primary care to our surgeons. And what you’re seeing that’s happening is that we’re actually building an ecosystem to support our geriatric members in a very different way. Not only are there memory clinics, but we have emergency departments, for example, that are geriatric certified. There’s certain principles that we bring to bear in managing geriatric patients, like ensuring that their medications are appropriate, thinking about their mentation and helping to support how well they age as it relates to that.

We also spend a lot of time thinking about the multiple morbidity diagnoses that a patient might accumulate and we move into how do we prepare them for surgery differently. What I can do to a 25-year-old in preparation for surgery is very different than what I need to do in preparation with an 85-year-old. And so our system of care is evolving to accommodate the needs of the elderly and all of the spaces where they receive care. We always want to focus in on safety first, and so there is a lot of primary prevention around removing rugs in the home, encouraging them to exercise and to eat well and to do crossword puzzles and those things, but it’s also safety in all of the care environments. Now, the millennials, this is a whole different conversation and I tell you what always comes to mind when we start to think about the millennials is what is it that they want?

How do they want us to behave differently? They want to come in or not? Do they want the convenient care? The short answer is yes, they have acne at 2:00 a.m., they want to talk to a doctor about it. And so what you’re also seeing concurrent with the traditional kind of model that is Kaiser Permanente are the Get Care Now type services. Those services that allow our younger, more technologically expectant individuals to go onto a website, to navigate that website and have their needs met in that moment, whenever it might be from wherever they are in the world. Millennials are really impacting us not only as patients, but quite frankly as part of the workforce and the values that they’re bringing and the differential between the historical values of medicine, which is just work all day, every day, nights, evenings, holidays, weekends, and the values of today, which family, togetherness, well-being, all of those things I think both are necessary in medicine and our job over the next several years is to figure out how to marry both sides of that coin.

Evaluating AI through a lens of safety

CG: I love that you’re thinking about clearly the patient first, the geriatric patient, the millennial member, how they want to access care, the medium, the most convenient way, the most adaptable way for them as an individual. I’m going to take out a little crystal ball here, and you’ve already begun to touch up on new technology. I’m interested in how you see emerging technology and artificial intelligence and augmented intelligence fitting into maintaining clinical quality moving forward.

LB: What I always caution us with as health care clinicians is that our first priority is that anything that we do has to be filtered through the lens of safety. We start with safety, not with innovation. Every single tool needs to improve the safety of the care. Every single tool needs to improve the effectiveness of the care. And yes, it should improve the efficiency and the patient-centeredness and so on, but we need to step back a little bit from our excitement and say, what is the problem that we’re going to solve? How can we deliver care differently with this tool and how do we know that it’s safe? And so as the national leader of quality, I’m a little bit of the break around AI because when AI touches you and your family, I want to make sure that it’s delivering that same excellent care that we talked about earlier.

And many of the tools are not yet validated. Many of the tools are trained on data that is fee-for-service data, where many of the tools are trained on data sources that are not multicultural and cross-generational. And so as we start to think about the lens that we bring to taking care of patients, the AI is not equivalent to the human brain yet. Of course we have a quality and AI governance, but we also have the technology that comes in that we are interested in vetting and thinking about and understanding how it will evolve clinical practices. And so this is a little bit of two things are true kind of scenario, but the focus here needs to be safety, safety and safety again.

Quality as the North Star of medical excellence

CG: One of the most impressive aspects of Kaiser Permanente and why I think other health care organizations often look to us is that we’re an exceptional evaluator of emerging technology. We use evidence and data and rigor in order to identify of the multitude of technologies which offers the greatest promise of success and which does it in a way that is safe and protective to the patient. One of the things Tish I love is how you describe quality. You often talk about it as the North Star of the organization, the foundation upon which everything else is built. In today’s challenging health care environment, there’s financial pressures, there’s workforce shortages, there’s shifting patient needs. There’s many of the other industry disruptions that we talked about earlier. Why is it so important to keep quality at the center and what does it look like to lead with quality first?

LB: When you talk about purpose, it’s really been there for us from the very beginning. And so when you hear me talk about quality being our North Star, it’s our founding star, it’s our continuation star, it’s our innovation star. This idea of a North Star really is what is it that we’re all committed to: patients, physicians, the system, all of it together. And as we navigate all of the change that’s coming, we know that won’t change, but when you have a North Star, you’re able to see through all of the noise and continue to move in the right direction. And I think that’s one of the areas where we’ve really just been quite frankly brilliant, is no matter what the disruption is, we have our North star that is excellence in care. How do we get there given the current circumstances? I had a mentor from many years ago that I went to him because I had solved a problem.

I thought my solution was brilliant, right? We all think our solutions are brilliant. Two years later, I went back to it and that was completely disrupted. And so I went to my mentor and I was quite frankly whining about it a little bit. And he said to me, he said, your job as a leader is to continue to solve the same problems over and over again in a new set of circumstances. And it was a real a-ha for me because we don’t fix problems and they go away. And that shouldn’t be frustrating. It should just continue to make us aware that the world is constantly changing. And if we’re continuing to solve the problems with the same values at the core, then we’re still delivering on that ultimate purpose. And as challenging as health care is, as long as we are coming to work every day and we’re coming to work, saving lives in alignment with our purpose, it keeps us motivated, it keeps us forward facing, it keeps us feeling wonderful and amazed about the work that we’re able to do for our patients and quite frankly, for one another. And so that North Star is all about purpose.

CG: I know you’re a mentor to the next generation, and you and I have talked in the past and it’s a role that you really value. You’ve also had an extraordinary career, and personally I think the best is yet ahead of you in this new role, but you’ve led large scale operations, you’ve overseen some of the most significant care transformation, and now if you sat back down with your 25-year-old self, or as you sometimes do at KP Medical School with the newest white coated student or the recent graduate, what advice would you give?

LB: What I now know, what I’m coming to is that wherever you go, you need to hold onto your valuable relationships and whatever you commit your life to achieving, you need to do that with maximum effort, with unparalleled energy, with authentic enthusiasm, right? Life is, it’s about purpose and it’s about living with intention. And the choices that we make in our twenties really do reverberate across the next several years, and I feel extraordinarily grateful that I get come to work every single day, and I say all the time, I’m not going to work. I am going to live my life. That’s the advice. I think I would give my 25-year-old self, and I think I’ve grown into it over the years, but boy, how powerful would it be to start that at the age of 22 instead of much later on?

How organizations with physician leadership deliver higher quality care

CG: I love you’re saying, be true to yourself. Be true to who you are, and keep those relationships never let go of those relationships regardless of what geography you may be in. I want to ask you one last question, and this is big picture view. How do you see physician-led quality programs supported by technology kind of shaping the future of medicine? How does medicine change because of this laser focus on quality?

LB: So, this is a great line of questioning because I know in this country right now, we’re moving away from physician-led operating systems in the health care field. We’re only about 20% of medical oversight at this point. And what I know is this A) there’s a tremendous amount of evidence that demonstrates that physician-led organizations actually deliver higher quality care. So as the quality leader, I’d like to start with the evidence. The second piece here that is just foundationally important as we’re talking about this, we talked about how we use and deliver technology and industry. Health care is a business, but we are in the business of people. And so shifting our focus away from that efficiency into the effectiveness and into the safety domain, and of course wrapping all of that in a layer of trust, that’s where the physician training, the physician mindset comes in. We are trained to deliver care one doctor, one patient at a time.

And the reason for that is when you show up with your X, Y, or Z problem, you need me to be focused in on that, not focused on the system, but focused in on you. And physician-led partnerships tend to retain the value, the integrity, and the drive that sits beneath the trust-based relationship that we talked about earlier. The other thing that I will say, and this gets back to a little bit of the external chaos, but we’re operating in this really complex adaptive system, and when we’re thinking through something that’s complex, we need to not only recognize that it’s the system that’s complex, but the patients that are complex and the care delivery systems and the benefits, all of it just mixes in together. And you need to have someone that is willing to step through that complexity from the member’s perspective and to design a system that can actually deliver on the multidimensional challenges, I think that sit within the funding streams and the operating system. And again, as we get into these inflection points, physicians come back to the values that we all train to, and the core value is how do we keep the patient safe? How do we ensure their health and well-being long-term? And this is foundationally different than the bottom line operating margin that most companies pursue.

CG: It’s all of those connections and relationships and this focus on safety and making it the most convenient and thinking about your care maybe when you’re not even thinking about it yourself, but it’s shepherding you through in the most effective, efficient, and safest way possible. Isn’t that kind of what we all hope for our family members or our parents, our brothers and sisters? That there’s a doctor that is there truly looking out for their interest and helping them with their care, not just the care provision and delivery, but the whole kind of planning and navigation.

LB: One of the things that doctors will often say, when we’re sitting in a very complex situation and we’re trying to figure out which way to go, you will hear physicians say to one another, what would you do if it were your mother? And if you think about that standard, it really, it resonates, right? You want to bring that empathy, that trust, that commitment, that deep ownership to each person that you see. And I think as physician leaders, because we are sometimes actively still delivering the care, you remain connected to that North Star in a way that’s just deeply meaningful.

CG: That is a wonderful way to sum up our podcast time today. Dr. Bridges, I want to thank you so much for your insights. I feel exceedingly comfortable knowing that you are leading quality on behalf of Kaiser Permanente and I welcome every health care organization, institution, and hospital system in the country to watch and witness and learn from the work that you’re leading because it’s phenomenal and it’s making a difference, and it’s improving, changing, and saving lives. Thank you, Dr. Bridges, for being with us.

LB: Thank you. Have a wonderful rest of your day.

CG: Thank you. And I want to thank once again our listeners for tuning in. If you’re a new listener and you enjoyed this episode, please take a moment to subscribe or share a review. We’ll see you next time.

The opinions expressed on this podcast are those of the speakers and are not necessarily the views of Kaiser Permanente, the Permanente Medical Groups, or The Permanente Federation.

The post Podcast: Quality care in a value-based system appeared first on Permanente Medicine.

From ambient AI scribes and predictive analytics to “digital twin” technology and remote monitoring, health systems are racing to adopt new tools that promise to transform care. But which digital health and AI solutions truly add value for patients and clinicians — and which are just hype?

Hosted by Stephen Parodi, MD, executive vice president at The Permanente Federation and The Permanente Medical Group, with insights from national leaders in health care:

• Kristine Lee, MD, Associate Executive Director, Technology, Innovation, Virtual & Desktop Medicine, and the Virtual Medical Center, The Permanente Medical Group
• Caroline Pearson, Executive Director, Peterson Health Technology Institute

Together, they explore:

– How leaders decide which digital health tools to adopt

– Real-world results from ambient AI scribes and their impact on physician burnout, workflow, and recruitment

– What the evidence shows about digital tools for chronic disease management (hypertension, diabetes, virtual PT, remote monitoring)

– How to measure ROI, value, and patient experience—beyond time savings

– The role of federal policy and new models like CMS’s ACCESS initiative

– Where automation and AI can safely support clinical decision-making while keeping humans in the loop

Podcast transcript

Transcript is autogenerated. Although edited for clarity, it should not be considered an exact replication of the podcast and may also be updated as needed.

Stephen Parodi, MD: Hi everyone, and welcome to our Permanente Live webinar, Digital Health and AI: Hope, Hype and Hard Truths. I’m Steve Parodi, an infectious disease physician and executive vice president with The Permanente Federation. There is a lot of buzz around digital health and the use of AI in healthcare. Ambient scribes have become ubiquitous throughout our many practices. Generative AI solutions are enhancing our predictive analytic capabilities and talk of agentic AIs promise to automate complex tasks including diagnostics, therapeutics, and back-office functions. Given that rapid change, how do we as clinicians, leaders, patients, and families separate useful innovation from overhyped tech? Are we actually seeing true value? Those are some of the questions and more that our two esteemed guests today are going to tackle. We are joined by Caroline Pearson, executive director of the Peterson Health Technology Institute, where she leads initiatives and grantmaking to fulfill the center’s mission to create high-performing health systems that deliver better care at lower costs. We’re also joined by Dr. Kris Lee, an associate executive director with The Permanente Medical Group, where she leads technology innovation, virtual and desktop medicine, and has responsibility for the newly branded virtual medical center as well as The Permanente Medical Group’s consulting services. Thank you both for joining us today.

Kristine Lee, MD: Thank you for having us, Steve.

Caroline Pearson: Great to be here.

SP: And as we jump in, we’re going to explore these different technologies and see whether they can enhance rather than lose our basic mission to provide human-centered and design care. So before we dive in, just a little bit of housekeeping. You can join the conversation on social media by using the hashtag #PermLiveLeadership. Please submit any questions using the Q&A function on the Zoom meeting. We’re going to definitely ask some of your questions a little bit later. So let’s go ahead and dive in here. And Kris, I’m going to start with you. How can we as leaders, determine which digital health solutions to adopt? And I’d love to hear about what you’re up to here at Kaiser Permanente.

KL: No, that’s a great question. I think it really comes down to being very, very clear about the problem that you’re trying to solve. One of the things that we face all the time are vendors coming with very pointed solutions, but really for the operational leaders and us as physicians to understand what problem are we trying to solve. And when I think about our journey with AI and digital technology adoption, a couple of things really rise up to the top. One of them is physician burnout. So after sprinting through the pandemic and then having to resume the marathon, our physicians were telling us they’re very burned out. And then we all sort of faced the Great Resignation, which I think hit every industry in the states and maybe globally. So really thinking also about workforce capacity and also our workforce shortage. There is a shortage of healthcare workers in the US and we are not immune to that either.

And so really these are the big problems that we’re thinking about. How could we solve those? And then really understanding the why of the problem and coming up with different hypotheses about how might a new technology or a new tool be able to address that problem. We have really tackled physician burnout as our number one pressing problem to solve. And I will also say that there’s not, there’s no such thing as one tool that’s going to solve that problem by itself. So we’ve been taking it piece by piece and day by day and tool by tool and really doing that evaluation and measuring the ROI in terms of what impact is this making? So really having a very clear measurement strategy is also very important.

SP: Well, Kris, that sort of tees up the next sort of question here, which is that both of your organizations have put out research about ambient AI listening tools and other digital health and AI solutions. So I’d love to hear from both of you about how you evaluate the solutions, where you’re looking at ROI, commonalities, and approach design and integration. So Caroline, maybe I can turn to you for that to start.

CP: Absolutely. Well, I love what Kris said about being clear on what problem you’re trying to solve. That is one of the first questions that we ask folks when we work with ’em. So early in the year, early last year, last year, we started with about a dozen health systems that we’re in the process of piloting and rolling out ambient solutions. And so we began to just gather early data on what their experience was, how they were measuring those tools and what they were seeing in early evaluations. And I think when you ask health systems, what problem were you trying to solve? We saw an evolution throughout the implementation. So many of the systems began by saying, we’re really focused on efficiency and ROI, these are going to deliver a lot of time back to our providers. And then over the course of our work with them, we very quickly saw lots of hospitals moving from pilot phase to full implementation.

It was one of the fastest rollouts that we’ve seen, I think, in health care ever of technology. And so we said, well, what made you change? And they said, oh my gosh, the provider demand is high. And so you just saw that the user experience for clinicians was so compelling. I think that they really sort of experienced the value of the tools and to this burnout point, it made the paperwork burden feel lighter. And I think everybody believes that that may also translate into a better patient experience. We don’t have great evidence on that yet, but certainly we understand that if a provider turns around away from is able to turn away from a computer screen, look their patient in the eye and feel confident that they can listen and not just be trying to capture everything that’s going on in the room, that that’s likely to translate to a better experience.

So I think that the initial evidence is very compelling on those provider metrics across all the studies that we’ve seen. What’s a little less clear is how much time we are saving. They’re certainly saving some time, but it’s spread throughout a provider’s day, right? Small portions of time. And every note is sometimes hard to recover. And so it is likely that we’re going to see that accrue in the form of less burden on those providers, but maybe not necessarily a huge increase in the number of patients that we’re seeing per clinic or the amount that we can deliver in terms of access.

SP: So Kris, I am struck by the rollout of this AI technology in ambient in particular. And you know what it reminds me of when I first got my manual of how to do word processing and it was a big old book, and then the next time around it was a little software update and here’s a tear sheet. Can you talk a little bit about how you did ambient AI, because it was different than rolling out the EHR.

KL: Oh, very different. So the first thing we did was who are we going to include in a brief pilot? So we did a pilot, I want to say we piloted for maybe 34 or four weeks at the longest. So no “pilot-itis” happening here. And I included the most reticent folk in the pilot because that’s really the big test. Will people adopt the technology and use it? And we all kind of know who those people are on our team. So I didn’t start with just the really super technology enabled folks. I really took people who would were going to be resistant to the technology and put them in the pilot group. And the initial results were just astounding. And Caroline, to your point, we were sitting on a gold mine. And so it wasn’t like, oh, we’re going to pilot for 6 months and do a business case.

We knew it was a gold mine, especially with our first tester group. And the way we rolled it out was we pushed a little app out on everybody’s phone and we had some at-the-elbow training from our technology folks at each of our medical buildings. But really it was the word of mouth and the people that we thought might be reluctant to adopt the technology became the loudest, the biggest loudspeaker to everybody else. And I will never forget, I was in clinic on the day that we turned it on for everybody, and I literally saw doctors exiting their offices and running to their office mate’s office being like, you’ve got to see this, this is amazing. We had a one-page because who has time to read the whole manual? To your point, Steve, it was a one-page instructions on how to do this. We did have a video because we understand that people consume and learn information in different ways, but it was really that peer-to-peer spread that accelerated adoption of the tool. The results speak for themselves.

SP: So I mean, that’s an amazing story right now, Caroline, I heard a little bit of course support for that. That’s a great thing. On the other hand, it’s like, and I’ll use the dirty word, what kind of efficiency are we going to see here? What kind of ROI, and I guess it’s early days, but what do you think that looks like? And you’re interfacing with a lot of different stakeholders here, so you’re not just talking to health care leaders, you’re talking to employers, people paying for the health care. What are you hearing on that front?

CP: Well, I think the first question to ask is, ROI to whom? So in terms of thinking about the health system as the most common purchaser, there’s 2 theories on where we could see revenue gains as a result of the solution. One theory was if notetaking gets a lot faster, we if expand clinics right, can you basically get more patients into every clinic. I would say we’ve seen very little adoption of that as a solution. I think generally you’re not seeing time savings enough in sort of consolidated chunks enough that would cause folks to do that. And I think particularly to Kris’ point, given the burnout, most systems have not been focused on trying to make visits shorter and add patients to every clinic. But we do see early emerging evidence that some of the coding around those notes may be more complete.

And so providers may be incrementally increasing their billing for every patient as you’re getting better capture of the encounters in the room. And that really flows through the coding from a system point of view. That’s obviously something that as a philanthropy focused on health care costs, we want to watch, we both believe that we want every visit to be coded accurately and completely and ensure that patients are getting the care that they need. But we also don’t want that to create an escalation of billing that just increases total spending without actually materially changing the care folks are getting. So from a cost point of view, that’s the ROI to the hospital versus the system is something we need to watch.

SP: And Kris, I know that no project goes without financial consideration. So I’m curious again, where ambient is today and where do you see that or what do you see it enabling in the future?

KL: Yeah, well, the technology’s developing so quickly, very quickly. The product that we piloted here in Northern California is different than the product that we’re using today. And a lot of that is based on our experience and our influence with the vendor to say, these are the needs of these different operational areas. Could we do this? Could we add more configurability so that more people can find it more useful to what suits their practice in patients? Very different than an ambulatory setting. A mental health therapist might have a very different encounter than a primary care physician or an orthopedic surgeon. So having that flexibility with the technology has been absolutely fantastic. In terms of what you and Caroline were just talking about in ROI type of situation, what have we seen? We’ve actually seen physician voluntary turnover go down to pre-pandemic levels from an all-time high down to pre-pandemic levels. And I’m even seeing this now as a recruiting tool. So we get medical students applying for residencies and we get graduating residents applying for jobs with us in our workforce. And this is absolutely one of the questions they asked, do you have this type of technology available for me? So we’re seeing it in a lot of different areas. It’s not just necessarily the time savings, but it’s also the quality of the interactions that physicians are looking for to have with their patients.

SP: Yeah, I mean, you’re so right, Kris. I mean, I was just recently at a physician trade meeting where there were a lot of residents and fellows there. And in some ways I appreciate you saying it’s a recruitment tool. In many ways it’s turning into table stakes. Folks are saying, I’m not going to work at a place that doesn’t have this. So it is really been an interesting shift in just literally like a year. I’m going to pivot us here for a second and move us to talk a little bit about chronic disease management that holds a whole ton of promise. So Kris, maybe you could talk a little bit about what Kaiser Permanente is doing around digital health tools to better support patients with chronic conditions.

KL: Yeah, well, to understand we have millions of patients that we take care of, and an average physician might have a couple of thousand of patients that they take care of. How do you manage the chronic conditions of that? It just sounds completely overwhelming. So it’s using these digital health tools to look at aggregates, population aggregates, make that completely transparent and visible and surface up actionable items, right? Care gaps. Oh, you haven’t done your colon cancer screening or you haven’t done your cervical cancer screening in the right window. Let’s get that booked for you. So that’s one way that we’re releasing that technology of saying, okay, what is the overall population? And then having that radical transparency and not just to necessarily a primary care physician to the whole system. So we have physical therapists booking mammograms as an example, because we’re really thinking about the population as a whole, but I think it’s really with the actionable insights and really surfacing those up at the front. So a patient may come in for foot pain, but actually really I need to look at, oh, hey, what’s your A1C like over here? So I think the responsibility, especially in primary care, is that we’re holding the whole patient all the time, even though they may come in with a completely, completely different issue. So really leveraging the technology to, one, understand the population, two, deliver actionable insights to the doctor that’s taking care of that patient. That’s really been our approach here at TPMG.

SP: And Caroline, can you talk a little bit about it from the perspective of the broader industry and how they’re thinking about it? Kris is giving sort of perspective from a integrated health system, but this is permeating I think throughout the entire industry.

CP: Absolutely. We saw such a rapid adoption of new technologies following the COVID pandemic. And so you just had this boon of shift to virtual care, to digital treatments, to home monitoring, all of which was really long overdue. But then we had a lot of health plans and employers and providers saying, gosh, we’ve adopted all of these things and we don’t really know if they’re working. And particularly when we at PHDI think about what works, first and foremost is clinical outcomes. If you’re a person with type 2 diabetes engaging with a chronic disease management app, we believe that you expect that solution is going to improve your hemoglobin A1C, not just that it’s going to deliver you a nice experience. And so as these solutions have had more years of existence, we’ve started to be able to ask much more thoughtful questions about which of these things work.

And so we really try to call balls and strikes. So we’ve done now about 6 assessments of different categories of digital health solutions and really trying to say, what’s the mechanism of action? And you see a few different things. Some of these are taking established care delivery models and translating them to virtual or home-based settings that are more convenient, that enable more scale, that are often more efficient. So you can think about things like virtual PT actually is very effective and in fact works. Not only is it clinically effective, but it really makes it much easier often for older adults who may have trouble with transportation. So they can do the PT exercises, but they can’t get to PT. And we know PT is clinically effective and that not nearly enough people do it and they get a lot of unnecessary care as a result.

So how do we translate that to a virtual setting? Another example that we’ve looked at is hypertension. In any provider panel, you’ve got about half of your patients that are experiencing hypertension, and many of them may not be in blood pressure control for any number of reasons. Some of them aren’t coming in regularly, but often they’ve got other health conditions that may be a higher priority when that primary care doc is sitting in the room with them. And you’ve seen a lot of innovation around home blood pressure cuffs and virtual care teams that can really expand the capacity of a primary care physician to be able to treat more of their patients, get more folks onto hypertension meds and titrated and into blood pressure control, often in 3 or 4 months versus a year of going in and doing all the visits. So I think we’re seeing a lot of innovation around what works here in digital health, and we’re finally getting enough data to say, okay, not everything works. Technology isn’t magical pixie dust. You don’t just sprinkle some technology on health care problems and everything gets better. But when we know that there are proven care models that we can begin to translate into other delivery modes, virtual delivery modes, that’s where we see really big effect. And so that that’s some of what we’re seeing throughout all of health care.

KL: Can I piggyback on what you just said, Caroline? Because you brought to mind this example that this is a real-life experience that I had. I’m a primary care physician by training, and I still practice and see patients, and I happen to be at the consumer electronic show in Las Vegas and went to the health care section. They have all these different sections. And one of the things that I saw was, it’s unusual, but there was a commode set up on a stage and I was like, oh, this is weird. What is this? And it was, oh, we’ve developed the technology where we can do a chemical analysis of a person’s urine. And I said, okay, well what do you do with that data once it’s collected? Oh, we just send it to the primary care physician. And as a primary care physician, I was like, well, what am I going to do with that information? And then what if everybody has one? I’ll expand a little bit more too. Think about the Oura ring. A lot of people wear these rings to monitor their sleep. Could you imagine if all of that data somehow then came to me as the primary care physician? What would I do with that? And so there’s a lot of these technology solutions that are being developed that really may not have any practicality in their current state right now to the overall health of the patient.

CP: There’s 2 things about what you just said, Kris, that I think are so important. One is we can generate a lot of data with technology, but if we don’t have an action to take at the end of that data, we are not going to affect change. And this is one where we’ve seen some real differences actually. So virtual monitoring, remote monitoring for hypertension versus diabetes have varied the different clinical results. And some of that just ties back to the basics of those care plans, which is we have pretty effective medications and treatments for hypertension. If we know somebody is experiencing high blood pressure and we have the human capacity to intervene, we can get that. We can get them into blood pressure control. Diabetes is much more complicated. You have a ton of diabetes monitoring data hitting PCPs, and unfortunately all of that data does not yield lower blood sugar and better hemoglobin A1C in most cases.

So we have to really think about that. And then the second thing you said, Kris, that I loved is this integration. For a long time, digital health has just sort of floated around, not fully connected and integrated with the rest of the care delivery, and I think increasingly we’re seeing some of the best care models tightening those things. So how do you get the orthopedic surgeon or the PCP to refer to virtual PT before you send them for a cortisone shot or a back surgery versus just hoping somebody’s going to sign up for that on their own.

SP: This is such a great conversation. I just want to remind our audience that if you have any questions for Caroline or Chris, please submit them using the Q & A function. Kris, you opened the door. So I’m going to have to ask this question. So in the idea of things aren’t pixie dust, you actually have to study them, I’d be curious about you talking about the latest program, the pilot that you’re doing. I believe you’re doing it with a vendor and you are looking at data points and remote patient monitoring and baking that all in and looking at food. So I’m curious, what are you up to? Why are you doing it? Are you going to know if it works?

KL: Yeah, so we are exploring digital twin technology. So using remote wearables such as a CGM, a wrist device that monitors your activity and your sleep blood pressure cuff and a scale with the patient logging their food into an app. So collecting really over 3,000 data points per day on an individual person and seeing, really studying and learning their metabolism. So there’s an AI algorithm in the background that’s really learning. How do you respond to that cheese enchilada at 3 PM in a way that a primary care physician would never be able to really deeply understand a person and creating a digital twin of that person and then surfacing insights back to that patient that are very, very personalized, such as, oh, okay, you just logged that cheese enchilada. Can you tell, I like cheese enchiladas. But so maybe you should go walk for 15 minutes after this meal because we think your blood glucose is going to go up from this. So we want you to walk to bring that blood glucose curve down.

I’m really looking at this and thinking about this as an adjunct to our population health management programs. So we have our chronic conditions management teams that are doing a fabulous job, but maybe I only get 90% of my patients with high blood pressure under control. What about the other 10%? So could this be a way of really thinking about coming up alongside what we do traditionally in our population health management systems and really personalizing this to the patient? So far we’re about 60 days in, we’re seeing great results, we’re seeing A1Cs come down, seeing people’s weight falling also, which is great, and more to come. So we’re in the middle of this pilot right now. Very exciting, also very exciting to see the adoption from the patients. So the patients really like it so far and they seem to be hungry for it.

SP: So Caroline, we’re talking about pilot within the system. It sounds like the federal government may be getting in the mix here, so maybe you could talk a little bit about that. What are they thinking about? Why are they thinking about it, from your perspective?

CP: Absolutely. Well, I think we all adopt technology every day in our regular non-health care lives. So it is a little silly to think that we wouldn’t equally begin to integrate it in proven ways within health care. But because of the way that many of these digital health tools have come to market and get sold, in fact, they have not had any coverage in Medicare. So while you have a lot of Medicare advantage plans and then commercial plans covering digital health tools, traditional Medicare really has very few reimbursement models for that. And so there was a big new program announced last week called the access model in which CMS is really going to try to create for the first time ever a reimbursement model for some of these digital health solutions that we’ve been talking about, which is wonderful. I mean, as a provider, it’s very hard to keep track of which of your patients might have access to what.

And if you think there’s a really great tool, you certainly would want to extend that to your Medicare beneficiaries too. So I think it’s exciting and it’s likely to really help stimulate the market and the growth of more digital health tools. But what’s most exciting for me as an evaluator is the way that they’re setting up the payment structures, which it’s all going to be outcomes-based payments. So there will be Medicare payment for any digital health tool that wants to participate, but some of that payment is going to be withheld and the solutions are going to be responsible for delivering those clinical benefits that are pre-specified in order to get the full payment. And ultimately, as you’re asking Chris, how do you know what works, the very best way to do that is to tie those payments to clinical outcomes, both saying to the vendor, this is what we expect in terms of performance and then generating the data that enables you to really sort out which solutions are most effective. So I’m excited to see all of the data and all of the adoption that comes off of that program.

SP: It’s pretty interesting, right, because they’re almost flipping the fee-for-service model on its head and injecting value-based principles and using technology as a way to make that happen. It’s very interesting. Kris, you referenced earlier the patient experience, and I’m curious because it sounded positive people are liking this stuff, but how are you measuring it and do we need to measure it? And how do we need to understand that? I know that there’s a lot of concern also from other folks, regulators and others about the implementation of the technology.

KL: So we regularly survey our patients to ask them what they think. And another thing that we do is when we do these sort of different pilots of things, we make sure to include our patients in the design of these pilots. So they are a piece of how are we going to implement this? How might this lens, what should we consider? We shouldn’t assume that we know what they’re thinking. At The Permanente Medical Group, we also have a lot of discussions about consenting patients, transparency to our patients, about our use of different digital health technology. So in the ambient scribe example, every patient is consented every time. So they know that we’re using this, it’s going to help me write my notes. What we’ve seen is 95% acceptance rate with our patients. So something less than 5% of our patients actually say, oh no thank you.

And they actually think it’s pretty cool when we ask them, they’re like, wow, you guys are cutting edge. So that was our findings within the first year of using and adopting this ambient scribe technology. There are bigger conversations about, okay, well what if we’re using AI tools in an acute care setting like the hospital? How do you consent to patient who’s potentially having some life or critical event happening? How do you do that? And so there’s a lot of debate, I think also in the community about what is the level of disclosure of these things do we even disclose at all? So I think that those areas are still being tested out, but patients seem to be very willing to allow us to use AI to augment their care.

SP: We got a lot of great questions coming in. I just want to encourage people to keep submitting them. Caroline, I’m going to ask you one quick question before we switch over to the audience, which is what do you see as the biggest barriers to implementation or adoption of digital health tools like the ones we’re talking about?

CP: I think a lot of it right now is around, it’s like business stuff around how do you contract for it, how do you pay for it, how do you integrate it on provider side? How do you integrate it with the EMR? I think that’s all getting easier every year, but as Chris said at the beginning, there’s still definitely point solution fatigue. And so on the one hand why I like point solutions is actually you get really clear data about what’s best-in-class for the specific condition. But from a patient point of view, if you’ve got 3 comorbidities, you don’t want to touch 3 different solutions. And from a provider or purchaser point of view, it’s hard to manage. So I think we’ve got a ways to go in terms of making that experience better. Interestingly, I don’t think it’s resistance on the form of the patients. I mean, as Kris said, patients really trust their doctors. And so when doctors are saying, this is a tool that is helping me deliver care well to you, I think you get a lot of trust in that typically from patients.

SP: So I’m going to cut over to the audience questions, and Kris, I’m going to tee up the first one for you here. So do you think, this is kind of a trick question here. Do you think there’s going to be a time in the future where AI is going to be used in surgery or used in robotics? And maybe more broadly, to build on the question, where do you see AI not touching?

KL: Yeah, I actually think it’s going to have broad infiltration. So there’s already AI being used in different procedures. I’ll give an example, colonoscopy. So if you have a scope that’s augmented with intelligence, maybe you can be like, Hey, look at that polyp over there. That one looks like it could be a higher-risk polyp than that polyp that you just snared over there. So this is existing technology. There’s a lot of AI that’s already embedded in existing diagnostics. Imaging is probably the furthest advanced. So looking at this mammogram, oh, actually this looks like the highest risk area. This is where you should be focused on to do your biopsy or whatnot. So it’s already embedded in that technology. I absolutely could see it in surgery as well. Risk prediction, I could see it in that. Imaging during the actual live procedure, I could see it being used in that, taking the pretest probability or the presurgical probability and the postsurgical probability and saying, here’s how you can increase your postsurgical success rate for this specific patient. So I can see it being used in many ways. And I’m sorry if I forgot the second half of that question, but I do see it being broadly, potentially being broadly utilized. Will it replace the surgeon? I don’t think so.

SP: That’s really great. And Caroline going to play off of this with this next question. We were talking about this a little bit before the session, which is where is AI maybe not performing right now? And the question really focused on mental health care. And so I’m curious, just given the early days experience with chatbots and others, your thoughts on that in terms of its use in the mental health sphere?

CP: So we have looked at digital mental health tools specifically for people with mild to moderate depression and anxiety. And the first takeaway there is actually digital solutions, including AI-enabled solutions, are quite clinically effective for mild to moderate symptoms. So they really can deliver comparable benefits to live psychotherapy. So they should be part of the toolkit, but they have to be AI chatbots that are trained specifically for mental health. So the big concern right now really is unfortunately you’ve got the availability of things like ChatGPT and other general models that people are going and seeking therapeutic support from. There’s high rates of suicidal ideation being professed to those models every day, and they are not actually trained or structured to challenge negative thoughts, redirect thinking, all of the things that a psychotherapist would be trying to do in a session to help someone succeed. And so you really do want a chatbot that’s designed specifically and tested for mental health purposes. And I think the interesting question right now is how do you get those 2 different types of chatbots to work together? How do you transition someone who is needing mental health care into something that’s going to be clinically appropriate for them? And that’s really an important question that we’re grappling with right now.

SP: This is another interesting question. When you think of AI, when you really strip it down and you’re talking about large language models at the end of the day, Kris, maybe I’ll ask you first, how is language access influencing improvements in AI models? And in particular, how are we thinking about this from a non-English speaking perspective so that we make sure that we have entire swaths of our population that we’re responsible or caring for are not left behind?

KL: Yeah, I would say for me as the operator or the person that’s helping to deploy these technologies, I have to very deeply understand the data set that any tool that’s using generative AI has been trained on. Let’s say there was a hypertension tool that was trained only on native Hawaiians, and then I’m going to go and try to deploy that in a Latino population somewhere else. That tool is not going to be as successful with managing that Latino population because it was trained on a dataset of people that look completely different, that have different physiology, and different behaviors. So really looking at the data sets, and you can’t be too small of a data set, but you really need to understand what are the potential biases that may be propagated really just based on that information alone.

So I think in this area, like tools, if you’re really thinking about, oh, I really want to help this segment of this population, what is the dataset that we could train on to develop a tool specific to that population, that group where you’re trying to make an intervention? Is this happening all the time? No, because it is very specific. So if you really want to have a tool that has the highest performance, you need to have that data lake, that committed data set to really address that population. And I just don’t see that that’s necessarily happening right now. I think people are looking for the biggest data sets and trying to train tools that would be broadly applicable and that in these early stages of AI development. And I could see in the future, hey, people might want to go after this market and be like, oh, I want to be the preeminent tool to help people of, I don’t know, Afghani ancestry have great hypertension control. So just giving some examples there.

SP: So I almost feel like putting up a picture of the Terminator here, but so the question here relates to a lot of the focus has been ensuring that humans are in the loop with the decision making when it comes to an AI, and I paint that across the board right now. Do you see a feature where there are activities that get fully automated? I’ll use that term. There may be other terms to use. So Caroline, maybe I’ll turn to you so

CP: Many. I do. I hope so, and I’m a bit of an outsider. The typical rhetoric when you have AI conversations is that folks, leaders will say the AI is not going to take your job, but the person trained with the AI will take the job from the person not trained with the AI. Personally, we have a workforce shortage, a clinical workforce shortage. We have an aging population, and we have an unaffordable health care system right now that doesn’t deliver great care to everybody who needs it in the country. And so we have to embrace technology and empower it to do some things autonomously or independently, of course, with the appropriate controls and oversight and humans in the loop. And I think we’re at the start of making those decisions. But there will be facets of care that I think can be automated and would urge us to embrace that. Hypertension, we would talked a lot about hypertension today, hypertension medication titration to someone who’s taking regular home readings with their blood pressure cuff is I think a really good candidate for early adoption. Mental health care is another one where you’ve got a tremendous access problem, and we need to think really carefully about how we can be thoughtful, but empower some of those tools to allow us to use our finite workforce to the greatest and best use of their skills.

SP: So we’re almost out of time. I’m going to ask both of you a rapid fire question, Kris, and you only pick one thing. What AI use case most excites you right now?

KL: Right now, I would see this digital twin technology with the remote combining a bunch of other different technologies into a great technology ecosystem solution is the thing that excites me the most immediately. And you only allowed me to have one answer. So that’s what I’m most excited about right now.

SP: And Caroline, if I could turn to you.

CP: Automation of simple clinical decision making. Think urgent care. Think about the number of things a primary care doctor does that could be automated and would allow them to spend more time focused and talking to their patients about different issues. I think there’s a lot we should automate.

SP: So Caroline and Chris, thank you so much for joining us today. And I want to thank everyone who joined this webinar and listened in. Want to point out, look for the link to the webinar recording in your email, and don’t forget to share it with your network. And also be sure to follow Permanente Medicine on social media to learn about the future programs and check out permanente.org for our library of past videos and podcasts.

The development of new health care tools and technologies will continue at a rapid clip. As leaders, clinicians, health economists and analysts, we need to remain focused on delivery of high-quality care and not get distracted by the latest trends. Separating what offers value and defining what value means from what it doesn’t, will help us successfully integrate digital health tools and improve our patients’ outcomes, increase physician satisfaction, and decrease costs. Ensuring that humans are committed and remain in the loop will require dedication, work, innovation, and ingenuity. And that’s what has always taken us as physicians to help us fulfill our mission, to make the lives of our patients and fellow clinicians just a little bit better. Thank you all for joining us today.

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Dr. Ansari also serves as CEO and executive director of The Permanente Medical Group (TPMG), president and CEO of the Mid-Atlantic Permanente Medical Group, and CEO of Northwest Permanente. She oversees 13,000 physicians and 48,000 staff that care for nearly 6 million members.  

Fierce Healthcare’s Women of Influence list spotlights leaders whose accomplishments make health care more accessible, equitable, and patient-driven. Dr. Ansari’s achievements demonstrated a commitment to improving and transforming health care delivery by: 

• Advancing AI technology that adds real value to care. Under Dr. Ansari’s leadership, TPMG and Kaiser Permanente completed the largest rollout to date of ambient AI scribe technology. Over the last year, usage has expanded to every specialty practice and to many non-physician clinicians, including mental health therapists, at Kaiser Permanente.  
•  Promoting physician wellness. All 3 medical groups Dr. Ansari leads received high acclaim from the American Medical Association’s Joy in Medicine® initiative, with TPMG earning 2025 Gold Award distinction for making measurable progress in reducing burnout and supporting clinician well-being. 
• Driving improvements in quality. In 2025, Kaiser Permanente Northern California was recognized as one of only two health plans in the nation to earn 5 out of 5 stars for both Medicare and commercial health plans by the National Committee for Quality Assurance. 5 stars is the highest possible rating for quality and service. 
• Elevating the physician voice. Dr. Ansari ensures the concerns and clinical insights of physicians are represented in health care policy discussions through advocacy in Washington, D.C., and state capitals.  

You can read more about Dr. Ansari’s achievements in leading the delivery of high-quality health care in Fierce Healthcare’s special report on the 2025 Women of Influence winners.  

Related physician leadership story: Maria Ansari, MD, FACC, named to Modern Healthcare’s list of 50 Most Influential Clinical Executives

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The panel, “Innovation in Action: How Value-based Care is Transforming Delivery Models,” explored the current state of value-based care and how organizations are innovating in their transition away from fee-for-service models. Unlike fee-for-service systems which emphasize volume of services to generate revenue, value-based care rewards improved patient outcomes and greater affordability.

“If I have one key message, it is the importance of building trust between all the different teams that have to make this happen,” said Dr. Parodi, executive vice president, External Affairs, Communications and Brand for The Permanente Federation. “You have to have trust between the payer and the provider. You have to have trust between the physicians and the patients. And you have to have trust with the system itself.”

Related value-based care story: Exploring lessons learned from value-based care payment arrangements – Permanente Medicine

As value-based care adoption continues to grow, transforming care delivery models and spurring innovation, Dr. Parodi noted there’s more work to do. He said that even within government programs — which have led the shift to value-based care — there remains diversity in the mix of models.

“Only about 59% of Medicare Advantage plans are actually what we term HMOs,” Dr. Parodi said. Health maintenance organizations operate under a value-based care model, providing comprehensive, preventive, coordinated care services for a fixed per-member fee to improve patient outcomes and control costs.

He said the remaining Medicare Advantage plans are preferred provider organizations, or PPOs. These network-based plans work with fee-for-service models, contracting with physician organizations for reduced fees, while allowing patients to go out of network at a higher cost.

Of Medicaid recipients, he added, “about half of the beneficiaries in terms of spend are getting their care through a managed care-type organizational structure.”

How innovation aligns with value-based incentives

Health care organizations are innovating to better align with value-based care incentives. Panelists agreed that forming integrated, aligned, and incentivized teams — an approach already used by Permanente Medical Groups — lays the foundation for effective preventive care.

Dr. Parodi explained that at Kaiser Permanente, teams of clinicians and IT specialists work together to integrate protocols and algorithms and embed them in electronic health records, “that are then prompting those very teams to do preventive services screening, depression screening, cancer screening.”

Dr. Parodi also highlighted Kaiser Permanente’s innovative Cancer Expert Review Program — a virtual consultation system that gives every Permanente oncologist access to expert advice from cancer subspecialists nationwide. This approach improves patient outcomes while reducing the need to travel for second opinions.

Related value-based care podcast: What’s next for value-based care

Another innovation that has advanced value-based care is ambient AI, which transcribes patient-clinician conversations during office visits to create notes that the clinician then edits. The technology has reduced time spent typing up notes during and after clinic visits, Dr. Parodi said, “and increased face-to-face time with patients, which improves (treatment) adherence.” He said it has also standardized “a bunch of documentation, which from a data perspective, is going to be important in the future.”

Human involvement remains crucial

Dr. Parodi said artificial intelligence and data are essential tools in value-based care, but human involvement remains crucial for designing workflows, interpreting data, and decision-making across both clinical care and back-office operations.

For example, frontline clinicians helped design Advance Alert Monitor, an AI-driven predictive analytics tool used in all 21 Kaiser Permanente hospitals in Northern California. This program identifies patients at risk of clinical deterioration, enabling early intervention and preventing over 500 deaths annually.

Kaiser Permanente care teams also helped design a similar alert system that considers medical, behavioral health, and social determinants to identify patients at high risk of emergency department visits or hospitalization.

“If [the alert system] notices a social need, it alerts an assigned social worker so they can initiate an intervention,” Dr. Parodi said. Case managers are able to take care of 1,500 patients, instead of just 200, because they’re able to focus on the ones requiring intervention.

Register to watch a recording of the full virtual event here.

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During a Connected Health 2025 Virtual Summit panel, Dr. Nguyen shared that as a value-based organization, Kaiser Permanente evaluates pilot projects using a wide range of metrics, including how patients experience new digital processes, care quality enhancements, and the long-term program sustainability.

“By definition, we take care of patients end-to-end and therein begins the conversation around return on investment, or ROI, for a project,” said Dr. Nguyen. “We tend to look at it from a complete holistic view, not just from what that digital interface or the digital interaction provides for the member at that moment, but really what the final outcome may be.”

As a real-world example, Dr. Nguyen discussed the Southern California Permanente Medical Group’s Get Care Now program, which allows patients to connect with a clinician for an e-visit in less than 2 hours and also get 24/7 urgent care help.

Implementation analysis showed that patients from diverse backgrounds were able to speak to or visit a physician at different times of day, instead of visiting an emergency room. Shifting patient visits not only created initial ROI and improved the overall patient experience, it also led to positive membership growth projections.

“What we discovered is that most of these looking for convenience,” said Dr. Nguyen. “They wouldn’t have anywhere else to call and oftentimes they’d end up in the outside [of Kaiser Permanente] ER or they would end up in a place of care delivery that wasn’t appropriate.”

Related digital health pilot story: Quality assurance informs large-scale use of ambient AI clinical documentation

The building blocks of scalable health care technology

Panelists were asked about the infrastructure considerations health care organizations should remember when piloting transformative technologies. Beyond the cost of new technologies and making sure scaling a project makes financial sense, Dr. Nguyen shared 3 key factors necessary for success:

• Access to patient information and local infrastructure. Virtual care is helping more patients connect with clinicians. But without readily accessible patient information, new technologies may not operate as efficiently and effectively. Patient data includes information on local services and facilities, such as nearby community resources, pharmacies, labs, and emergency rooms. “Accessibility to that information is critically important,” said Dr. Nguyen. “Knowing what resources are available to provide that -mile care and then also to make it very accessible to that clinician in the moment so that they can quickly get to it and provide the information to the patient is also very critical.”
• Interoperability of systems. Another key factor in digital pilots is system compatibility. As health care AI tools evolve, organizations need to ensure that new software and hardware can interact with both existing and future systems. “What we’re finding is that the connection points are actually the most complicated points and the most expensive parts, at least from a digital and software perspective,” said Dr. Nguyen.
• Data security. The security and privacy of patient data shared across systems should remain a preeminent consideration when evaluating and scaling a new digital health process. “Having that data security infrastructure and having that thought in mind from the beginning is really important, not just to delivering the care, but for our patient’s information,” said Dr. Nguyen. “They are very concerned about where their information is going and who’s using it and for what benefit.”

Register to watch a recording of the full virtual event here.

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“You have to have simplicity, you have to have the impact factor, and you have to have prior authorization,” he said on the “Future-Proofing healthcare: The Path to Value-based Systems of Care” panel.

In value-based care, “impact factor” refers to the combined positive or negative effects of care models on patient outcomes, quality, and cost. This measure focuses on aspects like reduced hospital admissions, better patient outcomes, lower costs, and improved quality of care, rather than the number of services provided. The success of a value-based care program like Permanente Medicine is determined by how effectively it improves these results, often using a formula that weighs quality by total cost of patient care over time, as outlined by the American Medical Association.

Related value-based care story: Dr. Parodi on trust, innovation, and the shift to value-based care

Managing chronic conditions key for value-based care

Dr. Parodi added that focusing on cardiovascular disease measures, cancer screenings, and mental health disorders would have the greatest impact on improving outcomes across a broad spectrum of people.

“If you address those 3 things, you’re going to impact most of the large population-based issues that the nation is facing,” he said.

He added that what matters most from a patient experience perspective are care access and total cost of care. “You do a good job with all those things, and that’s what value-based care is,” Dr. Parodi said.

Related value-based care podcast: What’s next for value-based care

Optimizing team efficiency and patient outcomes

In the face of evolving health care demands — especially with a growing older adult population and a surge in chronic illnesses — value-based care organizations must also continuously improve care delivery and coordination to optimize outcomes, efficiency, and cost-effectiveness. For example, Kaiser Permanente of Northern California used an artificial intelligence algorithm to  predict and stratify risk for patients with chronic, complex medical, social and/or mental health conditions. The algorithm identified approximately 8,000 patients who were at high risk for future emergency department visits and/or hospitalization.

Each care team focused on these patients has a physician, nurse, social worker, pharmacist, and a care manager. If the algorithm flags a mental health need, the care team can make an appropriate referral. A project team was then able to pinpoint the specific reasons each patient was at risk — whether medical, pharmaceutical, social, or mental health — and alert only the relevant specialist on each team, such as a pharmacist for pharmacy-related issues.

Dr. Parodi noted that the project reduced hospitalizations and emergency visits, saving about $1.5 million per team. Previously, care teams oversaw about 200 patients each. Now, each team manages about 1,500 patients because each care team member responds only to specific issues that require their attention.

“What’s interesting is we’ve been able to increase the efficiency of the care team. And you might ask, ‘Okay are the teams upset because they’re having to look after more patients?’ And the answer is that we actually have more satisfied teams because they’re able to resolve the problem.”

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Kaiser Permanente, with the support its value-based care model, continues to lead the health care industry in providing exceptional clinical care and outcomes, as demonstrated by the 2025 Healthcare Effectiveness Data and Information Set, commonly called HEDIS.*

The 2025 report for commercial plans shows that care delivered by Permanente physicians led the United States with 71 eligible effectiveness-of-care measure — more than any other commercial health organization.

These results highlight the ongoing commitment of Permanente Medical Groups to deliver high-quality care to patients and the communities they serve.

What is HEDIS?

HEDIS is a report card from the National Committee for Quality Assurance that evaluates and rates care provided by American health systems. The kinds of care measured include preventive and specialty care, as well as management of chronic diseases.

The HEDIS report puts a spotlight on different health plans’ abilities to provide timely services, including screenings, vaccinations, follow-up care, medication adherence, and mental health services. The report also looks at how well health plans manage risk factors such as blood pressure and cholesterol levels.

Ultimately, the report is meant to help patients choose from among the best health providers in their regions and to encourage care improvements.

Important clinical achievements

The 2025 HEDIS report shows Kaiser Permanente is the highest-performing health care organization in the U.S. for 71 care measures, including:

• Prevention and screening
• Respiratory care
• Comprehensive diabetes care
• Mental health

The exceptional performance of Permanente physicians in key health areas

Some of the measures where Kaiser Permanente ranked in the top 5% of all commercial health plans illustrate the efforts of Permanente physicians and care teams to deliver the best care possible include:

• Controlling high blood pressure
• Eye exams and kidney health evaluations for members with diabetes
• Appropriate treatment for low back pain and upper respiratory infections
• Screening for unhealthy alcohol use

Kaiser Permanente also ranked in the top 10% in the nation for:

• Breast cancer screening
• Cervical cancer screening
• Colorectal cancer screening
• Avoiding use of opioids at high dosage
• Timely prenatal care

A continuing commitment to improving high-quality care

The performance of Permanente physicians and care teams in the 2025 HEDIS measures underscores a top-to-bottom commitment to provide high-quality care across a variety of critical health metrics.

By demonstrating leadership in preventive medicine, specialty care, chronic disease management, and behavioral health, it’s clear that Permanente Medical Groups continue to set the standard for health care excellence.

Kaiser Permanente remains focused on continually expanding access, delivering superior care, and improving outcomes for its members. The HEDIS results not only reflect the Permanente Medical Groups’ current achievements but also demonstrate an ongoing dedication to advancing the health and well-being of the communities they serve.

* Kaiser Permanente 2025 HEDIS^® scores. Benchmarks provided by the National Committee for Quality Assurance (NCQA) Quality Compass^® and represent all lines of business. Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality. The source for data contained in this publication is Quality Compass 2025 and is used with the permission of NCQA. Quality Compass 2025 includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass^® and HEDIS^® are registered trademarks of NCQA. CAHPS^® is a registered trademark of the Agency for Healthcare Research and Quality.

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Note: To learn more about how Kaiser Permanente is leading the way in dedicated pediatric care, check out our PermanenteDocs Chat episode featuring Dr. Eloa Adams.

Living in the San Francisco Bay Area, I know that I’m never far from the care my children might need. There’s no shortage of doctors and hospitals that specialize in pediatrics. It’s easy to take that for granted in large urban areas like my own — but it’s far from the reality many parents face.

The state of pediatric care becomes clearer to me when my family and I travel outside of our metro area. I will never forget driving to our first camping trip with my young son when it hit me: if something happened to him, we would be hours away from pediatric care. I felt incredibly vulnerable, but what choice did I have? I think that is a common realization that parents experience.

Limited access to pediatric care is not a new challenge, but it is growing. Pediatric care has been rapidly consolidating for the past decade. Many of these services simply aren’t as profitable as those for adults, and for many community hospitals, shifting pediatric care to children’s hospitals makes financial sense. While it’s true that our nation’s children’s hospitals deliver some of the highest-quality care families can find, consolidation is leaving many further away from care when they need it.

How value-based care strengthens pediatric medicine

Caring for children is not like caring for adults. Young people have physiology that demands different approaches unique to their needs. Whether it’s primary care or emergency services, it is always best for a pediatric patient to have a pediatric specialist.

Children and parents deserve access to pediatric care within their communities, and I’m proud to say that I work for an organization that prioritizes providing it. Kaiser Permanente has a long history of commitment to pediatric care: for more than half a century, we have invested in improving the services we offer, from neonatal care to our pediatric intensive care units.

What enables us to do this, ultimately, is the commitment to value-based care that is intrinsic to Permanente Medicine. Under a value-based model, we’re incentivized to improve the services we offer, including pediatrics. Similarly, being an integrated health system positions us to offer a greater breadth of services across a community via different care locations and collaborative teams that support patients on their care journeys.

What all of this translates to is better care for our younger patients. It means access to specialists when needed. It means quick and coordinated transport between care sites. And it means enabling unique initiatives to innovate our approach to medicine.

Take, for example, a group of physicians in Kaiser Permanente Northern California who are developing new strategies to reduce pediatric sepsis — an incredibly dangerous, yet preventable disease. They’re guided by a powerful motto: “More awareness equals more birthdays.” With this as their North Star, they meet regularly to discuss new ways to prevent sepsis infections in our younger patients. They’ve created new protocols and decision frameworks and are now leading national collaborations with Kaiser Permanente groups in Southern California, Hawaii, and the northwestern United States.

A path to stronger pediatric access nationwide

Value-based care has facilitated better pediatric care throughout Kaiser Permanente — and it can do the same thing in communities across the country. As our broader health care system continues moving toward this model, hospitals and other providers will have more freedom to prioritize pediatric care and prevent further spread of care deserts in their communities.

The need is definitely there. A July 2025 JAMA study found that children in the U.S. fare worse than kids in other high-income countries in key health measures. Chronic conditions like obesity, mental health issues, and developmental disorders have climbed 15 to 20% over the past decade. Infants here are nearly twice as likely to die before their first birthday, and children and teenagers ages 1 to 19 face almost double the risk of death.

There is clearly work to be done to restore and improve access to pediatric care in the communities that are left without dedicated resources like hospitals — children and families deserve that. We at Kaiser Permanente remain committed to providing that care wherever we can and advocating for the transition to value-based care broadly to support other health care systems in the same mission.

I’m proud to be a Permanente physician because we are aligned with the first priority of our members: their health. When they’re doing well, so do we.

Eloa Adams, MD, is director of Inpatient Pediatrics Quality and Operations at The Permanente Medical Group.

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During turbulent times, effective leadership is critical for maintaining the integrity and sustainability of health care systems, said Ramin Davidoff, MD, co-CEO of The Permanente Federation, during a wide-ranging on-stage interview at Reuters Events’ recent Total Health USA Conference.

“The way we deal with today’s tumultuous environment as leaders is by being visible, available, accessible, approachable, and by listening,” Dr. Davidoff said. “We especially need to listen to what physician’s challenges are, getting their input, and making sure that we incorporate their input into the delivery system as much as possible.”

Related physician leadership story: Dr. Ansari on health care’s future amid demographic shifts

Encouraging physicians to innovate

“Physicians in general are great innovators,” Dr. Davidoff said. “We do a lot of what’s called ‘small tests of change’ in Kaiser Permanente, enabling physicians to create products that they have ownership of that are focused on patient outcomes and that really helps them get through difficult and tumultuous times.”

Encouraging physicians to take initiative is especially important as their autonomy and control are increasingly limited by regulations and practice management, Dr. Davidoff said. Fortunately, he added, the Permanente Medical Groups have always been physician-led.

“We believe as physician-led entities we can focus on best outcomes for patients in the communities we serve,” he said. “We are technology-enabled, equity-driven, and team-delivered. These are guiding principles that are fantastic for any physician practicing anywhere. But in our system, they really ground us in our mission, our value system, and help us manage the difficult changes underway — with all the directives, the financial burdens people are experiencing, and the burnout and exhaustion that exists throughout health care, especially among physicians.”

Navigating funding reductions: Strategic resource allocation and investment

At a time when financial pressures require health systems to accomplish more with fewer resources, “the message to physicians is, ‘Yes, the practice of medicine is difficult, it’s not getting easier, and we’re going to support you,” Dr. Davidoff said.

Perhaps surprisingly, he said the antidote to resource constraints is strategic investment. That could mean investing in physician practice support, hiring pharmacists to help primary care physicians manage medications for patients with chronic disease, or implementing a team-based approach with nurses, physician assistants, and pharmacists all practicing at the top of their scope.

Related health care innovation podcast: Drs. Ansari and Davidoff on innovation and health care access

Another example he mentioned was the rollout in the past two years of ambient listening technology to more than 25,000 Permanente physicians across the United States, a move that has reduced the time spent on documentation, freeing physicians and clinicians to focus on patient care.

Confronting workplace violence: Safety measures and advocacy

Permanente leaders have also invested in improving safety as workplace violence remains a significant threat to the well-being of clinicians and staff.

“There is quite a lot of mistrust, a lot of frustration by the public with health care systems in general and with physicians in particular,” Dr. Davidoff said. “And the violence is not always physical. Sometimes it’s an email or a voicemail that is sent to a physician or clinician. There is quite a bit of abuse directed at all our practitionersand this is an area I believe the health care industry needs to focus on.”

Related physician leadership story: Dr. Davidoff on protecting health care workers from violence

Leaders can play a pivotal role in establishing clear policies, providing training on de-escalation techniques, and advocating for safe working environments. By prioritizing safety and supporting affected individuals, organizations demonstrate their commitment to both employee welfare and patient care.

“In an environment where people work in fear, safety and care quality diminishes,” Dr. Davidoff said. “So, we’reinvesting in systems such as screening some of the email that come through our electronic health record to make sure we properly identify and look into potentially violent patients. There also has to be advocacy at the government level because legislation can help protect our clinicians and all our practitioners. We believe this is tremendously important.”

Overcoming vaccine hesitancy: Evidence-based communication and trust-building

Another key area where Permanente leaders are working to overcome member and patient mistrust is with vaccine hesitancy, which poses a challenge to public health efforts.

Related vaccine podcast: Vaccines, variants, and trends for respiratory virus season

Permanente leaders have responded by encouraging physicians to promote evidence-based practices and foster open dialogue with patients. Effective communication strategies — grounded in empathy, transparency, and scientific rigor — can help address concerns and dispel misinformation, Dr. Davidoff said.

“What’s particularly concerning is that parents are not bringing kids in for vaccinations the way they used to, and the way they should,” he said. “We provide our research, with our clinical expertise and also consider patient values, which come into play with some preventive measures. We still believe vaccination remains one of the safest and most effective ways to protect patients against severe illnesses across all age groups.”

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On a recent episode of Becker’s Healthcare Podcast, Stephen Parodi, MD, executive vice president, External Affairs, Communications and Brand for The Permanente Federation, explored how patient outcomes will depend on supporting the physician workforce and minimizing coverage loss due to policy changes like evolving Medicaid requirements.

Dr. Parodi noted the U.S. could see an estimated shortage of up to 86,000 physicians by 2034, according to data from the Association of American Medical Colleges. In response, Kaiser Permanente is working to enable practicing doctors with digital support tools like artificial intelligence to help meet growing demands while at the same time easing burnout.

“Even if we are able to expand the workforce through some policy decisions, we’re going to have a very large, aged population,” said Dr. Parodi. “If you want to be able to expand the reach of our existing workforce, it’s going to need to be supported by AI.”

One such innovation that is creating real value, according to Dr. Parodi, is an early-warning tool that uses predictive analytics to identify patients at risk of clinical deterioration and in need of more immediate services, including acute care. The AI-driven Advance Alert Monitor, used in all 21 Kaiser Permanente hospitals in Northern California, detects patients who may be heading toward clinical decline, enabling early intervention. So far it has prevented more than 500 deaths annually.

Other innovations include:

• Launching AI-powered ambient scribe technology, a game changer in reducing time spent on administrative tasks. Both patients and physicians have reported improved interactions when using the tool.
• Creating flexibility in clinical schedules and more opportunities in virtual patient visits, including “virtual list positions” which allow moving to a virtual-only practice.
• ​Employing team-based care to streamline workflows and improve service and access by enabling all team members — including physicians — to practice at the top of their license.
• Prioritizing physician wellness efforts at the organizational level, as recognized by the American Medical Association’s Joy in Medicine® program. The AMA recognized 5 Permanente Medical Groups in 2025.

Turning to the impact of the new HR-1 law — which creates eligibility requirements that will complicate access to care for current Medicaid patients — Dr. Parodi reaffirmed the importance of preserving access to high-quality care for those currently enrolled in the program.

That will mean working with partners on the state level to think through ways to minimize coverage loss over the 10-year implementation period of HR-1, said Dr. Parodi. Plus, exploring the services and support patients may need to complete paperwork involved in redetermining coverage eligibility.

“If there’s anything we’ve seen with health care policy over the last 15, 20 years is that when you do provide more coverage, you actually get better outcomes when it comes to preventive services, cardiovascular disease outcomes, and cancer screening outcomes,” said Dr. Parodi.

Related health care policy story: Dr. Parodi on how recent policy changes impact Medicaid

Listen to the full podcast here.

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In this PermanenteDocs Chat, host Alex McDonald, MD, speaks with Hemali Sudhalkar, MD, MPH, SFHM, hospitalist, inpatient palliative care physician, and National Medical Director of Strategy for Kaiser Permanente Care at Home, about how Advanced Care at Home delivers hospital-level care in patients’ homes.

Dr. Sudhalkar explains why this shift is essential as the U.S. population ages and capacity strains grow, and how Kaiser Permanente’s integrated model enables safe, coordinated care beyond the hospital. She shares early results from Northern California, where nearly 4,000 patients have received care since 2020, with average length of stay reduced from 5.5 to 3.5 days, hospital readmissions 3% lower, and likelihood-to-recommend scores 10 points higher than inpatient care.

The conversation covers clinician training, virtual nursing, and home visits — plus the policy steps needed to expand and sustain this model nationwide.

Guest

Hemali Sudhalkar, MD, MPH, SFHM

Hospitalist, inpatient palliative care physician, and National Medical Director of Strategy for Kaiser Permanente Care at Home

Podcast transcript

Alex McDonald, MD: Welcome everyone to today’s PermanenteDocs Chat. I’m your host, Alex McDonald as always, and today I’m joined by Dr. Hemali Sudhalkar and we are talking about what I like to refer to as the ultimate in patient-centered care: advanced care at home and Kaiser Permanente’s innovative approach. So Dr. Sudhalkar, welcome so much. Thank you for being on the program.

Hemali Sudhalkar, MD, MPH, SFHM: Oh, I’m glad to be here and thank you for taking the time.

AM: Wonderful. Well, let’s start by my first tried and true question. Tell the audience who you are and what you do.

HS: Yes, I’m Hemali Sudhalkar. I am a hospitalist and an inpatient palliative care physician at one of the 21 hospitals in Northern California, Kaiser Permanente. I work in the San Jose Medical Center. Actually, including my training, I’ve been with Kaiser Permanente for over 24 years and this is the best that has been for my career. Over the years I’ve had leadership roles and for the past 6 1/2 years I’ve been the regional medical director for what we call TPMG, The Permanente Medical Group. Currently my portfolio is hospital strategic initiatives; basically those are the programs that don’t fit into the 4 walls of the hospital, but it’s connected, so it’s like continuity of care before and after hospitalization. And I also have a national role, I’m the national medical director of strategy for Kaiser Permanente Care at Home.

AM: Wonderful, thanks so much. So you have a lot of both clinical and administrative and operational experience to speak to this and I’ve read some of your prior work and some of your articles and things you’ve put out before. And you’ve really talked about imagining a future where hospitals are primarily just for emergencies and surgeries and critical care and everything else can be managed outside the 4 walls of the hospital. Can you talk about the trends and the factors across the health care landscape that you see driving us in that direction?

HS: Yeah, sure. But before that, I also want to say that I was reading your bio and I love that you believe in lifestyle medicine and exercise, and one of the things I read about was holistic approach to care. And I believe in that specifically for all the programs that we’ll be talking about today, specifically at care at home, it’s geared towards what our patients and our members are telling us what they would like and what matters most to them. So felt like I had to mention that before we continue our conversation.

AM: And as I said, this is the ultimate in patient-centered care. It’s the care comes to the patient as opposed to making the patient come to us, but we could go on about that all day.

The vision of truly patient-centered care at home

HS: Exactly. So I think, this is again a prediction, from what you have seen how medicine has evolved. I know that I’m aging myself here, but when I started as an attending physician — what that means for people outside of medicine is that you finish your training and you become your own independent doctor — when patients used to come into the hospital to get total joint replacement, that is either knee or hip replacement, they would stay in the hospital for 4 to 5 days.

You may ask me what happens now. More than 80% of the patients, as you know, in all of Kaiser Permanente markets, which we have 8 of them, they go home the same day. We call it the home recovery program. So they come into the post-acute care recovery and from there they go home. That is an example of care at home. My prediction is that in the next several years or maybe a decade or two, what will hospitals look like is just emergency departments, operating rooms, some complex, we call it MCH — which is the delivery and ICUs for adults and kids — and complex procedures. The rest of the care could be at alternate settings.

AM: I think that’s such a great vision. I practice both hospital medicine as well as outpatient family medicine, and I have a lot of times patients who are just getting IV antibiotics for a couple days and they’re like, can I go home? And a lot of times they can’t without that infrastructure and that ability to do that care. Also, I think the same thing when I was in medical school, maternity care after deliveries, patients were in the hospital for much longer periods of time where we realized when we can get them physical therapy at home, we can get them social work and nursing visits and wound care at home. That’s just a win for everybody. We know patients recover and do better at home or there’s gaps in care between the hospital and primary care and home care. And so I think it’s great. I love this vision. I love this idea both as a physician and as just someone who’s really interested in health policy overall. So with that in mind, how are health care organizations responding to create these home care programs or make sure there isn’t a gap in continuity between surgery and recovery? Can you describe example of how this operates outside of the Kaiser Permanente system and then also what’s unique about the care at home within Kaiser Permanente?

AM: Yeah, I just want to take a step back and tell you why is it an imperative for us to think about this. The largest growing demographic in our country is older adults, 65 and above. In 2020 it was 56 million people, and about in 2050 it is going to be 82 million.

Now, we learned during COVID-19 that we are not able to take care of all our patients in the hospital setting. So it is an imperative for us to increase the capacity and the capabilities of taking care of our patients with high-quality and safe care. Care at home is relatively a new concept coming out of COVID. I was just at the hospital at home World Congress in Vienna this year, in March. A lot of European countries and other countries, France, UK, Germany, Singapore, Australia, Israel have been doing this for decades. So there is a lot for us to learn from them. And what we are realizing is, as you said, there are unintended consequences of patients being in the hospital with deconditioning, hospital-acquired infections. We can actually prevent them. And we also learn from patients that they would like to be home as much as possible. So there are a lot of programs out there in the country with big organizations as well as small organizations. It’s a national movement in our country. So you have Mass General, Brigham, Mayo Clinic, Cleveland Clinic, Kaiser Permanente, we are all looking at how can we innovate to make sure that we are taking care of our patients at home when possible.

Taking care of patients at home: what it looks like outside of and within Kaiser Permanente

AM: Yeah, that makes perfect sense. Well, help me understand more about how that looks outside of Kaiser Permanente and then also how it’s different within Kaiser Permanente because I do think there’s some nuances there.

HS: What I want to say is that a lot of the organizations outside of Kaiser Permanente that I know of, they’re in different stages. First of all, this is really important that organizations are able to invest, and this is where we need, from what you mentioned earlier, the advocacy to make sure that this is part of the care that we provide and it is embedded into the government agencies that help us create these models. Because when you start this, it’s almost like a startup. So there is an upfront investment and it’s really hard for a lot of smaller organizations to do this without knowing that they have future in this. So right now a lot of advocacy is going on with the Centers for Medicare and Medicaid Services (CMS) and others to make sure that we continue this. And good news is that there is bipartisan support for this work because everybody understands that this is really important for our patients. So there are programs out there which has hospital at home, urgent care at home, observation status at home, and looking at a lot of other programs like remote patient monitoring, emergency care at home. There are some programs that also do chemotherapy at home. So there is a lot of programs out there.

AM: I think with the advent of technology and especially the COVID pandemic, I feel like it’s sort of forced our hand a little bit here. We started doing more of this work out of necessity and then we realized, wait, we can do this. We can do this safely, especially with remote monitoring and home visits. I also appreciate the irony of the fact that 200 years ago, doctors used to make house calls and then we are like, wait, it’s more efficient maybe if we put all the patients in one building and have the doctors work in the building. And now here we are shifting back towards that truly patient-centered home care. So I have to point out the irony of this situation, but what’s old is new again, or something along those lines, right?

HS: We recently had a patient who used to live in France and he actually got the opportunity to be part of the Advanced Care at Home program, and he was saying that, oh, this is what I’d experienced in my country, and now you have two, which is great. So it was good to have that validation, but I can also mention what’s happening within Kaiser Permanente. We have 8 regions, Northern California, Southern California, Hawaii, Oregon, state of Washington, Colorado, Georgia, and Mid-Atlantic States, which includes parts of Washington, D.C., Virginia, and Maryland. And at Kaiser Permanente, we call our program Advanced Care at Home where patients get high quality, safe care in the comfort of their own home. And this is with the guiding principle of the care being as safe or safer than brick and mortar.

The Advanced Care at Home program is live in 7 out of 8 regions, with Hawaii going live either at the end of the year or next year. And as you know at Kaiser Permanente we serve over 12 million members. Giving you an example, we started Northern California and Northwest, which is Oregon, 5 years ago, early 2020 during the pandemic. And in Northern California alone, we have taken care of almost 4,000 patients. Currently we have average daily census, which is how many patients do we have in the program on a daily basis, into the mid thirties with touchpoint of about 50 patients. And we are also almost mimicking some of the efficiencies we have elsewhere. So we started out with the length of stay of about 5.2 days, but we have improved significantly where our patients stay about 3 1/2 days in the program. And because of the beauty of our integrated system, they get readily back to their primary care physicians if they need any other home health services or anything else. And what we have seen is that the readmission rate to the hospital is 3% lower than the hospital, and the likelihood to recommend score for care experience is about 10 points higher.

AM: I was going to point to that exact piece, if we can improve the quality, if we can improve the resource utilization and we can improve patient satisfaction, it’s really the quadruple aim. It’s a win-win for everybody. I’ve been able to discharge some patients from the hospital, get them home sooner, more safely, more efficiently. With that help, it’s like an off-ramp to the highway, kind of a transition period. Instead of going from the highway straight to slamming on the brakes at the traffic light, it’s an off ramp where you can smooth that transition. So it’s really much more efficient and effective. And I’ve had patients love it. Some of my colleagues do this work and they love it. It’s really quite beneficial from multiple angles. But again, I always think about the patient-centric piece. You talked about this a little bit earlier about the scalability of some of these models also, and initially this requires a lot of investment upfront. Can you talk about what has made this successful for Kaiser Permanente specifically as you scaled this model up?

HS: Yeah, I think the most important is that it has to fit into the organizational priorities, which for Kaiser Permanente is specifically because it is what our patients want and this is good for the patient care. And one of my colleagues mentioned this is the most innovative care transformation that she has seen in her career. A lot of physicians feel that way. So that is why it’s part of it and making sure that executive sponsors from top to the medical centers, everybody’s in alignment. And I think having that has really helped us move this forward.

Because again, we didn’t start out by as many patients when we started. We would have one or two patients on a daily basis. This is also care transformation for physicians. We are used to doing things in a certain way. As you said, I’m a hospitalist myself and I’m used to doing certain things. And also as doctors, we are very protective of our patients. And even though it’s the same physicians, the hospitalist physicians from my group taking care of patients in the home setting, I need to know. That’s why it’s important for us to talk about patient testimonials, the stories, the outcomes. How do I know that even though I know you Alex, that you’re going to do well in the setting that’s different from what you’re practiced in?

How care at home is evolving the physician’s role

AM: That’s a great point about how does a physician role evolve and change. When I’m routing in the hospital, the workflow in my brain is, okay, does this patient need to stay in the hospital or can they potentially go home from a medical point of view? What are the barriers to getting them home, be it social or medical, and what pieces need to be in place before that? Here I need to almost shift my thinking a little bit and being like what medical care has to be done in the hospital and what medical care potentially could be done at home, and it’s taken me a while. Again, practicing here in San Bernardino County in Southern California, we’re one of the first and one of the largest areas in Southern California to do this work. We’ve been doing it for a couple of years and it’s taken a while. Can you talk more about how the physician role is going to change or evolve when we’re taking care of these patients in settings other than the hospital?

HS: It’s a great question. First of all, I just want to say that as you’re transitioning patients from the 4 walls into the home, you are thinking of what is that level, advanced level of care that I can provide. So we are able to provide video visits with the physician in the home setting twice a day, nursing visits, or more if needed. We also have 24/7 virtual nursing in certain parts of the program that’s available. So just for your awareness, hospital medicine has reached about 25 years and a little more since its birth. It’s relatively a new field where you’re taking care of hospitalized patients and you don’t have a clinic where you’re seeing your patients. And coming out of pandemic with a lot of burnout, with the work we had done, this also provides a little bit of a different area where you can practice.

It’s bringing other kind of rewarding work for you to do. Having said that, it’s also a different way of practicing. So when I’m practicing as a hospitalist in my facility, if I’m having either a bad day or if I have a question, I just run down the hall and talk to my colleague, just go to my office and sit down and talk to someone. It’s not that because you are in a virtual setting, so it is different. We are actually creating that kind of training for our physicians. We are also trying to create a community of practice of physicians who are practicing this. IV antibiotics have you order in the inpatient electronic medical record; it’s different when you do it on a virtual setting because the workflows are different. So we are creating training programs. We are also doing virtual meetings for the physicians to update them. And again, having said that, this is all still in evolution. So we are learning. One of the things that we are really excited about is we participate in national meetings. So for example, next week, a lot of us are going to go to the American Academy of Home Care Medicine where a lot of these things are discussed and one of our physician leaders is going to talk about how we train physicians for this work.

AM: That’s a great point. It’s really interesting and it really takes so many different pieces, people working collaboratively together, and those workflows and developing new patterns. To that point about the diversity of practice, I’m a family physician. I work inpatient, outpatient, I do some sports medicine, I do a bunch of procedures. Variety is the spice of life for me and my own wellness. And I think that’s really key, especially for some of my hospital colleagues who just do hospital medicine who are very burnt out, being able to do some virtual care and home care helps them diversify their practice and helps keep them happier and more well as physicians,

HS: And remember when you’re doing virtual visits, you have the home care nurse going at the time, you have virtual nursing, so you have to collaborate with everyone. It’s not just that you are rounding on patients on your own. So it’s really key. We also try to do in-person monthly get togethers for whoever can come in. So you are kind of connecting. For me, it’s very important that I connect with people in person or in a group, see them, which I’ve missed some of it. So yeah, a lot of variety of work going on to improve.

Behind the metrics: Patient satisfaction, fall rates, infection rates

AM: The personal connection is perfect. So you touched already on some of the benefits here. We’ve learned a lot from these experiences, lower readmission rates, higher patient satisfaction. What are some of the most surprising outcomes that you’ve seen from the medical care at home program?

HS: Let me start out by also letting you know what other quality metrics we are measuring. Definitely we’re doing the regular quality metrics that we do in the hospital setting. Looking at infection rates like you have a IV line, is there an infection there? Are you looking at hospital-acquired pneumonia, is that happening in the home setting or not? So some of those conditions that we measure, we compare it to the hospital. One of the things we learned is that not everything is that right. For example, falls. As a family medicine physician, you may know that rate of falls in the home settings are higher than the hospital.

A lot of elderly people at home fall because of lot of reasons. Actually, there was an review on NPR just last year about it. What we realized is that for falls, we were excluding a lot of the patients that could come home and the patients who could actually receive care at home. So we had to change how we measure the risk of falls, and we had to educate patients and families. And the good news is we have nursing going into the home setting to evaluate. We may even have advanced practice providers going there. What we realized is that we have to compare falls for the home health fall rates.

We now actually serve more patients with high risk of falls, but much less falls because of the education we have done. So that was an interesting finding. And what that taught us is that along our journey of taking care of patients in the home, we have to be vigilant and we have to be ready to evolve and pivot. So we are going to be presenting our data on falls next week at the conference that we have done really well. And that’s pretty rewarding that you are bringing patients home and you’re reducing the risk of other conditions that can happen in the hospital setting.

AM: One of my least favorite things is when I come on service and I realize this patient’s been here for 5 days and they have not gotten out of bed and they just get more deconditioned and weaker and then we’re just make a bad problem worse. Getting patients moving and getting them moving safely and at home, I feel like that’s a win-win for everybody.

HS: That is my pet peeve. I walk my own patients in the hospital and one of the things we call it is mobility medicine. It’s really important for them to get up and move and improve their conditioning. But going back to your question, I want to say that one of the most interesting things that we have discovered is how much the patients love this program. And we can’t underscore that or underestimate. What I say is that if I’m ever in the emergency room and I am qualified, I would always want to go home.

AM: I’ve actually had a patient who requested to do the advanced care at home program, done it before or their family member had done it before, and they were so happy with it. It’s really the ultimate in patient-centered care, which again, is a win for everybody. This has been a great conversation. My last question here, because we try to keep these pretty brief and high yield for our listeners. I want you to look into your crystal ball and look out five years from now, what do you think the role of care at home in the United States and the U.S. health care system is going to look like, and what are the policy or the advocacy steps which are going to make it possible to get there?

HS: First of all, I want to say that CMS published this year the 5-year outcome study of the hospital-at-home waiver that was given during the pandemic. And the most important thing would be for it to be extended for another 5 years or more, or made permanent because the results have shown that we provide better care or as good care as brick and mortar. And as we talked about, the quality outcomes that are much better. So I think it’s really important for the government agencies to implement this so that all the organizations can provide benefit for this to our patients in the country. I think that’s the key. Absolutely it’s important for us to scale it. If we don’t scale, I’ve heard this from a lot of leaders in this space, if we don’t scale, we’ll fail.

Defining care at home

AM: Medical care at home can mean a lot of things to a lot of different people. Can you tell us what your definition of this program is?

HS: For sure, and I’m speaking for myself here, when I think about care at home, what I think of any medical care that we can provide to our members or patients that is outside of the 4 walls of the hospital and institution. And what that mean by is nursing facility. So pretty much how can we take the care to the members where they call it home?

And that is very key to all the work we do. Can that be our North Star as we are providing care to our patients because that’s what they tell us. Most of them would like to be in the home setting to get the care. And I can give you my own example. My mother-in-law, she was 85, was in the emergency room, and she was there with diverticulitis, which is an infection in your large intestine. And she refused to be admitted to the hospital. And I’m talking about 8 years ago. She had the advantage of me as a physician being home. We brought her home, she went back to the clinic the next day to get some hydration, and she recovered so well in the next 3 or 4 days at home. And that is what I talk about care at home, including what we talked about for surgical patients that come home the same day.

AM: And we know patients often will do better at home in their own environment, in their own bed. This is something we’ve known for years.

HS: Their own pets and their own pillows and whatever, they love music. They also enjoy just the comfort. And as providers, when we get chance to go into their home, we can look at what are they eating? This is where it goes to lifestyle medicine, what medications are they taking? Are they taking what they’re not supposed to and how can we improve that?

AM: And as I said before, this is the ultimate in patient-centered care. We really bring the skills and the advanced care to them as opposed to make them come to us in the hospital.

My last question is, what makes you most proud to be a Permanente physician?

HS: I don’t even know where to begin. I just love being a Permanente physician because I don’t have to worry about somebody dictating the care I give my patients. Having said that, I also get to learn the latest evidence-based medicine and what I need to be providing to my patients. At the same time, I get time to listen to my patients. I get time to provide them the best care they need. And most of all, I also get to be a leader in various spaces that I would want to continue the work. So Alex, you are a Permanente physician, so you know this, but we are the leaders. We as physicians, we are the leader shaping health care for all our members. And I’m most proud of that.

AM: Wonderful. I really appreciate that sentiment. I could not agree more. Well, thank you so much for taking time. I think it’s just really wonderful to understand how patients and physicians alike can really gain from this transformation in care delivery and doctors’ responsibilities may shift a little bit from the hospital to more acute and emergency needs in the hospital space, and then also the infrastructure in the policy. We need to really make this sustainable and spread. So Dr. Sudhalkar, thank you so much for your time and your energy and we appreciate you very much.

HS: Thank you very much. And what I would say is to the listeners here, that if you’re listening to this and you are a Kaiser Permanente member, and if you’re ever in the emergency department or hospital, ask your physicians for advanced care at home program.

The post The future of care at home appeared first on Permanente Medicine.

Not even a government shutdown could stop the Permanente executive medical directors and physician leaders from traveling to Washington, D.C., to speak with members of Congress about improving America’s health care system. It is moments of division and controversy that give us an opportunity to show how the practice of Permanente Medicine transcends our differences by focusing on what really matters in health care: caring for people.

This shutdown is about many things, but at its roots are concerns over the affordability of health care, both to individuals and to the country. Now more than ever, physicians are obligated to inform leaders in Washington that there are so many productive ways to make health care more accessible, affordable, while striving for ever higher quality.

It is daunting to talk with legislators about an issue that caused the government to shut down. But when I thought about it, I realized it’s not so different from the daily work of a physician and where we help our patients navigate their everyday realities and sometimes urgent needs. Seeing our patients in both difficult and sometimes the most meaningful times of their lives is at the core of a physician’s vocation. No matter the circumstances, we always show up. Once we were on Capitol Hill, I knew we were in the right place, at the perfect time.

On a mission to make health care better, smarter, and more accessible

To change America’s health care system from one based on volume of services to value of care takes a massive commitment from all of us. Here are three topics we discussed: 

• Value-based, integrated care delivery. Kaiser Permanente is paid through a value-based system with the quality of the care it provides as its North Star. Physicians and clinicians are incentivized to provide patients with preventive care that keeps them well and, when they do get sick, with the right treatment that helps them recover with the minimal amount of medical intervention possible. Most providers in this country are paid fee-for-service, based on the amount of care and services they provide. This can incentivize unnecessary tests and treatments. At Kaiser Permanente, we hold ourselves to high standards, ensuring our care decisions reflect what is best for our patients’ health and the responsible use of their resources.

• Responsible AI, physician-led health care innovation. Kaiser Permanente pursues responsible and equitable innovation like artificial intelligence in health care and prioritizes physician leadership in designing, testing and deploying innovations to ensure tools support — not replace — clinical decision-making.  We are using AI tools in both the hospital and clinic, making sure it augments our clinical practice and improves outcomes. We believe AI will assist the health system to respond to the growing health care demand in the U.S.

• Maintaining coverage. Keeping enhanced premium tax credits and Medicaid coverage in place helps millions of people stay insured, lowers their health care costs, and access the medical care they need. Without these supports, many could lose coverage and skip needed treatments, risking poor health and financial strain.

As Permanente physician leaders, we are responsible for shaping the future of health care whenever we have the opportunity. We enjoyed meeting with Congresspeople and their staffs, sharing our experiences and those of our patients, and listening to lawmakers’ concerns and questions. Though the setting may be different from our day-to-day jobs, our goal is to show up, as always, and do whatever it takes, no matter the circumstances, to make a difference on behalf of the patients and communities we serve and beyond.

We hope you’ll add your voice to help advocate for improving the health care delivery system to policymakers.

Stephen Parodi, MD, is executive vice president, External Affairs, Communications and Brand for The Permanente Federation.

The post Our visit to Washington: A reminder of why advocacy matters appeared first on Permanente Medicine.

If you needed surgery and could choose between getting discharged a few hours after your procedure to recover with medical help in your own home, or spending three days in a double-occupancy hospital room receiving traditional post-surgical care, which would you choose? 

With Kaiser Permanente’s care at home programs and advances in home care medicine, this is not a hypothetical question for many people. When medically appropriate, an increasing number of patients are choosing to receive advanced level care in the comfort of their home. 

As it becomes more available, I predict so many patients will choose to receive their care at home that the hospital of the future will look very different, with a focus on emergency, surgical, and intensive care departments, amongst others. 

While this may sound outlandish to people who only have experience with the U.S. health care system, medical professionals around the world have been delivering care in patient homes for decades. When I attended the World Hospital at Home Congress in Vienna earlier this year, experts from the United Kingdom, France, Australia, Singapore, Israel, Germany, and others shared insights that we can learn from as we continue to migrate care into the home. 

Why health care at home is transforming the patient experience 

Data shows why home-based care is emerging as a patient-centered alternative to traditional hospitalization. In addition to higher patient satisfaction scores and better health outcomes, risk-adjusted readmission rates (observed over expected) in our Northern California Advanced Care at Home Program were lower when compared to brick-and-mortar hospitals (0.79 versus 0.87), according to internal data.

Hospitals can be risky places for some patients, especially those with weakened immune systems and/or multiple comorbidities. Hospital-acquired infections are sometimes antibiotic resistant and can quickly become a more urgent concern than the original problem that led to admission in the first place. Providing care in the home reduces the chance of exposure to harmful pathogens. 

In-home care also gives physicians and clinicians a deeper understanding of their patients’ real-world circumstances. They can double-check medication lists for accuracy, assess cleanliness and safety, check for adequate nutrition, and identify social and environmental factors that strongly impact health — insights that they would not know if they were delivering care in a traditional setting.  

That’s not to say care at home is without challenges, but we are proactively discovering issues and putting solutions in place. For example, we began educating patients and caregivers about how to reduce the risk of falls, and we trained physicians and clinicians to identify and remedy potential hazards in the home. As a result, we’re now seeing fewer falls among patients at high risk. 

Integrating home and hospital expertise 

The success of our Advanced Care at Home program relies on the same principles as the rest of Kaiser Permanente. It’s part of our highly integrated system in which primary care plays a critical role in prevention, care coordination, and patient-centered decision-making. When a patient is discharged, they are seamlessly routed back to their primary care physician for any post-acute care needs, like physical or occupational therapy. 

The shift of care from the hospital to the home is not just transformative for patients; it’s also a game changer for physicians. Delivering care at a hospital bedside is different from delivering care virtually. To support this transition, we are creating a community of doctors who provide home care, creating a space where physicians can ask their peers questions, easily arrange consultations, and get the same level of support from their colleagues as other physicians. Convenings of groups like the American Academy of Home Care Medicine helps me learn from other physicians who provide care in the home. 

Between the outcomes and satisfaction data, there is high demand to continue expanding the availability of advanced care at home in the United States. The next step will be for other health care delivery systems to develop and build these programs at scale. While it takes significant investment and commitment from leadership, our experience illustrates that the results are well worth the effort.  If policy incentives and financial feasibility continue to align with the evidence, advanced care at home could offer a safer, more efficient and truly patient-centered option for care. 

Hemali Sudhalkar, MD, MPH, SFHM, is the national medical director of Strategy for Kaiser Permanente Care at Home. 

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