Will COVID-19 Permanently Transform Health Care?

Welcome, everyone. You're watching "Coronavirus in Context." I'm Dr. John Whyte, Chief Medical Officer at WebMD. It's a new year, we're starting to have some hope with the vaccine thinking, what does health care look like in the future? So to help provide some insight, I've asked back my friend, Dr. Richard Isaacs, the CEO and Executive Director of the Permanente Medical Group in Northern California, as well as the Executive Director and CEO of the Mid-Atlantic Medical Group in the Maryland, Virginia, Washington D.C. area. Dr. Isaacs, thanks for joining me.

Thank you so much, John. It's a pleasure to be with you. And Happy New Year.

Thank you. Well, let's start off with, how is vaccination going in California?

RICHARD ISAACS: So the vaccination is going exceedingly well. The team has done an exceptional job distributing the vaccine as soon as we get it. So I think we are nation leading in the distribution. Pretty much as soon as we get the vaccine, we're vaccinating our folks. We have very high percentage of vaccine utilization is happening. It is a ray of hope. I had the opportunity to walk through our medical centers during the time between Christmas and New Year's.

Just the fact that people are having this immunity, this vaccine, this hope for the future, it's very inspiring. We're also facing a third and significant surge as you know here in California. But our teams are rallying. They're doing amazing work.

You and I wrote this editorial at the end of last year, where we gave a few predictions of how health care is really permanently changed as a result of the COVID pandemic, and in a good way. So now I wanted to go over them with you. We titled it, "Advancing Health Care During the Pandemic and Beyond." And the first was we talked about this accelerating in wide adoption of technology and digital tools, more than just telemedicine. So talk our audience through, what do you see are some of the changes that are going to continue to be adopted?

Well, what we saw on both coasts is when we had shelter in place, patients were not coming in for their routine care. But they really depended on information that they were getting from their personal physician. So we were able to expand with a video care first strategy, which personalized the care, which provide convenient access with a trusting expert who you know. That was key. And this past year, I think we broke records.

We did 3.5 million video visits by the end of the year here in northern California, and a record number in the mid-Atlantic as well. And the feedback that we're getting from our patients is they really enjoy this and the physicians really enjoy it as well.

At one point you said 80% of visits, when we talked early on in the pandemic, were virtual.

That's correct.

Where do you think that number is going to pan out six months from now? Will it be 60%? 30%? Still 80%? What do you think?

I think it's going to depend on the problem reason, why is the patient reaching out to us? So we're currently evaluating every possible problem reason code that a patient would be reaching out to their physician. And we're looking to see, where does the video add value and where is a face to face going to be really important? Because what I want to ensure is that the video doesn't become an added layer for what the patient ultimately needs.

So we're looking at, does the video solve the patient's problem, or does it start the treatment, or was it unnecessary at all? So that's where we are now. I would say in the next five years, it'll shake out. It'll probably be somewhere between 30% to 50% in the telehealth venue.

The other big area you and I've been talking about is equitable care. How do we reduce disparity? So it's great we can improve access through telehealth. But we need to make sure that that care is equitable across different ethnic and racial groups, across gender, socioeconomic groups. Tell us what you all have been doing to address issues of disparity, to address issues of the inequity that has persisted in the health care system, really since the beginning.

So this is an area that Kaiser Permanente has been laser focused on for many years. And I believe that the COVID-19 pandemic just accelerated the exposure. So now the social determinants of care are front and center. And Kaiser Permanente has been working diligently for many years to focus in on creating equitable care, equitable access. It's really about creating a product that allows people to have access to care.

It's about understanding the determinants, the social determinants in the community. Actually partnering with resources internally and externally to help do the best job that we can. Because it's all about prevention, as you know, John. It's really about access to care and preventing disease.

But what does that look like? People will say it's issues of food insecurity, it's issues of housing, it's issues of education. That's not my role as a doctor. That's not my role as an insurer. How do we bring people on board to recognize those connections?

So it's really about the cultural understanding. There are social inequities that we have to invest and create more equality. Folks who have difficulty getting the appropriate food. I mean, we're going to need to partner with governmental agencies to ensure that there is programs in schools, programs in communities that allow people to get the basic needs of daily living. There's huge housing insecurity across this nation as well. And Kaiser Permanente, as you know, has been very involved in partnering with other agencies to bring shelters and other types of venues for folks, which is, as you know, key to providing health.

And then how are you addressing this DIY approach? This do it yourself approach in health care? A lot of people are waiting, long visits for dermatology, some other appointments. And they're going online. They're downloading apps. They're uploading images. They're researching on their own. And they're not necessarily talking to their doctor about it.

And sometimes, there can be good outcomes. And sometimes, there can be bad outcomes. So how do we address this do it yourself approach in health care, that people are taking it upon themselves and figuring that they can look online and figure out their illness?

So Kaiser Permanente, with the advent of Health Connect, which is the epic product, we turned on in 2005 the Email your Doctor function, which I believe creates access to the most trusted name that you have in health care, is your physician. So if you have an issue, the expectation is your physician will help you solve that. If you need the expertise of a dermatologist, we want to ensure that you have access to that dermatologist in a very timely fashion as well. So we've been leveraging our integration through the technology to allow today's work today to be done.

So it's today's work today and care without delay. So if a patient here in Northern California or in the mid-Atlantic states comes in to see their primary care physician, and they have a skin lesion, we can image the lesion in real time and then loop in the expert who can evaluate that with the primary care physician and the patient, and start the treatment regimen right then and there, or recommend a visit in the dermatologist, which we would like to be seen in a very timely fashion. So we've been focusing in on this level of access.

So for me, if it's a subspecialist, and it's a referral from a doctor to a subspecialist, I would like that to be seen in a very timely fashion. Today, tomorrow, next day, the majority of time, keeping the patient's schedule in mind, or by the end of the week or whenever the patient would like to be seen.

And, Rich, I want to ask you, how has COVID changed patients' expectations? And the example I'll use is retail. And we can take grocery shopping. We don't have to go to the grocery store anymore. You can order it all online. You can go for curbside pickup. You could have it delivered to your home.

Expectations are very different now in terms of what consumers need, when they want it, and the way that they want it delivered. How is that going to change the way that health care is delivered? You and I talked a little bit about, people want more things in their home. Telemedicine is just one aspect of bringing care into the home, but people want clinical trials in home, want chemotherapy in home.

Why should I have to drive to the doctor's office or take public transportation, wait 30 minutes? I've lost half my day. So how are expectations different now because of COVID?

Well, banking, retail, and travel, and other industries are way ahead of health care. I watched my 20-year-old daughter navigate the internet. And it's easy to get the things that you need through various vendors that have a digital front door. So here in Kaiser Permanente, we have developed a digital front door, which gives you access to the health care system. And we're going to be rolling that out in 2021, harvesting a lot of the learnings from telehealth in 2020 to create that consumerism, the convenience.

We want our patients coming to us if they have an issue or if they have a question about a medication or any other family member illness. We'd like them to get the information directly from us. So we've created a platform that is very similar to these other industry platforms that just gives you the ease of access to your health care system.

What are you going to miss least in terms of changes that have occurred because of COVID-19?

So I think I'm going to miss least the uncertainty. I think the uncertainty has really challenged health care delivery in this nation and across the globe. Just the unknown. And then when you look back to the big epidemics in human history, there's always a phase of uncertainty, where you're learning, you're trying to understand. How do I protect myself? How do I protect my family?

How do I get into the therapeutics that help resolve this issue? So I think it was really just the flow, and the rapid flow of information. The rapid changing, do we wear a mask? Do we not wear a mask? Is at an N95? Is it a surgical mask? And do we need to wear these outside? If you look back over the last 10 months, I think the uncertainty really created challenges for the way that we approached COVID in this country.

I started off with asking you about the vaccine and how things are going in California. I want to end with a question on the vaccine as well, and ask you about, how concerned are you about vaccine confidence? In getting the public, getting members of minority groups, confident that the vaccine is safe, it is effective, and it's in their best interest to get vaccinated. How do we do that?

So it's going to require a very robust public service communication strategy, where we have culturally competent messages to the communities that actually need them. Perhaps, we use experts that are culturally aligned. Wouldn't it be wonderful if we could have Barack Obama, Michelle Obama, Oprah Winfrey, speak to the virtues of getting a vaccine? We also believe that the mothers of families will have the maximum influence on whether a family gets the vaccine or not.

So I think we are very fortunate that we have this "miracle on ice," is what I recently heard it being described as. And it happened quickly-- in the same year. And it's because of the messenger RNA strategies that we were able to develop a laser focused vaccine that is 95% efficacious. It's an amazing time to have this science merging with this really challenging disease.

And finally, what keeps you up at night?

Well, I worry the most about our patients who've had delays in care, because of the limited access. People who haven't had their routine screenings, mammography, colorectal cancer screening. Because I know that if we don't provide that access in a timely fashion, disease will present in a more advanced stage. And I'd like to have that disease present when it's curable. That's why we do screening in the first place.

So we basically have almost a year of delay in screening. And I worry about the impact that that's going to have on individuals.

And certainly, we need to encourage folks to come back into the health care system. We can do a lot virtually, the things like mammography, screening, patients are going to have to come in. Hopefully, we'll get back to a sense of normal with vaccination of the population.

Dr. Isaacs, I want to thank you for taking the time today to share your insights about the future of health care as well as how we deal with the pandemic on a continuing basis.

Thank you so much, John. Pleasure. Any time.

And if you have questions about COVID, drop us a line. You can email them to us at [email protected], as well as post them on Twitter, Instagram, Facebook, and Pinterest. Thanks for watching.