Kaiser Permanente in Southern California has been working to address some health equity issues with its in-home cardiac rehabilitation program. Tad Funahashi, M.D., chief innovation and transformation officer for Kaiser Permanente in Southern California, recently described that program and the organization’s overall approach to innovation.
During a March 16 PermanenteDocs Chat with family physician Alex McDonald, M.D., Funahashi began by noting that there has not been a shortage of innovation in healthcare in pharma, genomics, and medical devices. “But if you think about innovations or creativity in the way we deliver care, there has been remarkably little. If you think about the experience that patients have or the experience we have as clinicians, it's pretty much looked the same for decades, if not longer. There are some substantial opportunities to leverage new developments, including technology, to substantively improve that experience for both parties, and that's the main area that we're focused on.”
He said one of the things that happens in an organization like Kaiser Permanente that has been so successful is that people begin to think that it has got everything figured out, and if you continue to do just what you've been doing, that you'll continue to be successful.
You have to remember that the environment changes, stressed Funahashi, who also is a clinical professor of orthopedic surgery at UC Irvine. The environment in healthcare has dramatically morphed over the course of the last few years, with developments like Amazon Health and CVS, he added. “One of the key things in our role as the innovation studio team is to be looking at the developments outside of Kaiser Permanente that are eroding our competitive advantage,” he explained. “We want to make sure that our core capabilities are used to an advantage in the competitive marketplace.”
For example, he said, millennials and Gen Z prefer online care and virtual care. Amazon and others have stepped in and offered online virtual and convenient access, but that can oftentimes lead to disaggregation of care. “Whereas in our system, we can offer all of that,” he said. “We control every touchpoint. If you think about it, we're probably one of the few organizations in healthcare from the insurance side and administrative side to the clinical side to the support — every point of contact is under our control. We can provide complete integrated care in a holistic manner in a way that really very few institutions can. We need to leverage that and provide the convenience that others are beginning to sell as their primary competency.”
In speaking about the in-home cardiac rehab initiative, Funahashi first gave credit to the champion of the program, Columbus Batiste II, M.D., the regional chief of cardiology. “He saw a problem not only in Kaiser Permanente, but across the United States,” he said. Once people have a heart attack, the likelihood of having a secondary event is significant. An intervention like cardiac rehab can dramatically reduce that likelihood by 34 percent. But you have to be enrolled and you have to complete the program. The enrollment rates were less than 20 percent for most people and less than 10 percent for certain ethnicities such as Black people, he explained. Moreover, the completion rate was in the low 40 percent range. If you have few people participating in it, the effectiveness of cardiac rehab, which is a life-saving intervention, is quite limited. Batiste asked why is it that more people are not enrolling and found that there are geographic distance issues, scheduling issues and trust issues.
They built a solution that seeks to mitigate some of the reasons why people can't participate. They collaborated with a technology company to develop an app for a customized smartwatch. Now clinicians can review data, including step counts and heart rate to check exertion, through a dashboard in the EHR. “It's quite rewarding to see that the enrollment rate, which was 20 percent in our system, increase to 60 percent, which is quite a landmark accomplishment,” he said. “But Dr. Batiste isn't satisfied with that. He wants to get that up to 80 or 90 percent, so we're working on methodologies to improve that. But the completion rate is well over 80 percent, so it's more than doubled from what it used to be.”
Initially, his innovation team was trying to help solve problems in local medical centers as well as problems that stretch across the whole system. “But currently our strategy is to really look at scalable, enterprise-level problems. Scalability isn't a matter of taking a hammer and saying everybody shall do it this way. It's actually a matter of knowing that the problem exists ubiquitously across the enterprise. If you create a great solution for a problem that exists already, you don't need to tell people they have to do it. They're asking for it. In the case of the home-based cardiac rehab program, the problem was not trying to convince people that they should do it, but rather asking them to wait until it was ready to be expanded.”
Funahashi’s innovation team is looking for solutions that have a meaningful impact — that save lives, reduce admissions, improve the quality of care, and are feasible. “Not every problem has a feasible solution to it,” he said. “If it meets the criteria of scalability, meaningfulness, impact, and feasibility, then we as a department will typically take that on to try to solve the problem for the enterprise.”