Coronavirus in Context: How Healthcare Systems Are Handling the Surge and Physician Burnout

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You're watching "Coronavirus in Context." I'm Dr. John Whyte, chief medical officer at WebMD. I'm delighted to be joined today by one of our most popular guests, Dr. Richard Isaacs. He's the president and CEO of Permanente Medicine. Dr. Isaacs, thanks for joining us again. Nice to see you.

Great to see you, too, John. Thanks for inviting me.

We talked a couple of months ago, in the height of the pandemic, about what Kaiser and the health care community, uh, was doing to address the pandemic. Can you fill us in what's been happening, uh, since we last talked?

Well, thank you, John. And, uh, as you know, when we last spoke, we were doing the victory lap here in Northern California. And we were preparing for a surge, uh, in-- on the East Coast.

Yep.

And we were celebrating how well California had done at flattening curve. And we-- we-- you know, we did an amazing job. But we're now seeing, uh, the inevitable. And we're seeing COVID-19 play out across the entire state.

Uh, we did very well in Northern California initially. We had a couple of surge medical centers in the southern Santa Clara County, our San Jose Medical Center, and our Santa Clara Medical Center. The team really rose to the occasion and did exceptional work. And now those two medical centers are doing very well. We're starting to see resurgence of COVID-19 through the Central Valley heading north.

Do you think it's because we're seeing a greater incidence of cases in a younger population who may not be following guidelines? Is it, uh, not just more testing, but improved sensitivity of testing?

Well, it's interesting that you say that because we're-- actually, the majority of patients that we're seeing now are below the age of 49, the 18- to 49-year-old age range. And they're behaving differently even in the community.

So we have far fewer, um, critical care admissions. We're watching these patients very closely, the ones that are more critical. But they're being managed without intubation. And they're turning around much faster. I think that that relates to the lower age range. Actually, watching the news media, it seems that the 18- to 49-year-old age group, or particularly the 20s and 30s, don't really believe that there is a problem, perhaps. And that may be contributing to spread alo-- among that community.

So Dr. Isaacs, how do we educate folks about-- that we know these public health measures work, but, for whatever reason, people either don't believe it or they're not doing-- in that?

Well, I think they need to trust their health care provider. We've been doing, uh, outreach to all of the membership at Kaiser Permanente nationwide. And we're-- we're sending regular communications, um, via secure messaging to all of our members, uh, giving them education about how to protect themselves, how to protect their families, and how to really eliminate the spread of the disease through their communities.

We talked last, um, about the percentage of visits that were telehealth. And you had said it was roughly 80%. Are you still seeing 80% or has that changed a little bit in terms of telehealth visits?

So we're still seeing a fair amount of televideo visits. So we've learned a tremendous amount. The-- there's huge satisfaction, uh, on both sides, uh, for the video visit. But we-- we've actually created the opportunity for the patients that need to be seen to be seen face-to-face. And we're still sitting in the high 70% range, uh, for total video visits right now.

So I think people are still concerned about coming in. We've done a great job of keeping all of our medical centers, uh, sterilized and clean. We have a regular process with, uh, regular social distancing. And-- and I like to say it's a lot safer to be in one of the Kaiser Permanente facilities than pretty much anywhere else in the community.

I feel like we're not getting that message across. Uh, you're right-- safer. You check everybody's temperature.

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There's different entrances. You have infection control. But we know people aren't coming back, you know, nationally because we see a decrease in immunization rates. We see decrease in, you know, screening for cancer. How-- how do we convince them?

There's still a pandemic of fear. People-- uh, at this point, people know somebody who's been infected by the virus. I was talking with my sister-in-law over the weekend. She's very concerned. Uh, she's watching what's happening on the news. And she's worried about her family and her kids.

So I think there is a-- remember, we talked about the two pandemics, the pandemic of the disease itself and the pandemic of fear. I still think there's a fair amount of fear. And it's changing behavior. And it's probably going to be with us for a while. And these behaviors will probably be with us for a long time.

Can you talk how Permanente Medicine has been addressing those social determinants, especially now in the light of the George Floyd, um, you know, killing and-- and the protests that resulted from that?

It's clear, and we've known this for a long time, that health disparities are directly related to, uh, access to care, and also, um, the-- the wealth disparity. Those who have more wealth, more job security tend to have more access to health insurance.

So what we're doing at Permanente Medicine nationwide is reaching out with community partners to actually address the health disparities that exist in our countries. As you know, Kaiser Permanente is committed to improving the health of not only the population that we care for, but the communities in which they live. And we've got a lot of innovative projects that we're using to network and reach out to those folks.

You know, one of the communities that you're responsible for is the community of physicians and other health care professionals. We talked, you know, several months ago about stress and burnout. And there was an issue of burnout pre-COVID. What are employers doing to help address employee stress?

So I can talk to you about, uh, the folks who-- who work directly with me and the focus that we have. I think it's a model for other employers to follow. We focus on morale, physician wellness, and physician safety. It's top of mind for me. Uh, since I became the president and CEO, it's been a priority, uh, as much as quality and safety of our patients.

So we've created, uh, a new infrastructure where we're empowering physicians to help me help them by identifying where are those pebbles in the shoes, the challenges that people have on a day-to-day basis, what are the things that we can do as an organization to help support our workforce.

You know, within the physician community, there has been a lot of talk about mental wellness and in-- in terms of how they ask for help. And as-- as you and I know as physicians, historically, physicians were not ones who asked for help. What do you find are the barriers for physicians and other health professionals-- nurses, pharmacists-- um, to seek help, especially when it relates to-- to their mental health and wellness?

So I think it's really about creating an environment, a culture of psychological safety. It's really important to me that there is a breakdown of the barriers between the people that are, uh, doing the work and their leadership. So I've been working to transform the culture for now three years, where-- and we've done some surveys. And I've identified what are the biggest challenges that people face that are closest to the work. And then we've initiated programs to break down the barriers to helping folks get the-- the desired support that they need.

Do you have an example of things that have been successful as you've done that?

When you're in, uh, internal medicine, as you are, John, if you're seeing a patient and you need a s-- particular supply that's not in the exam room, that's not satisfying. So we have a process that replenishes those supplies-- very simple things that I heard from a-- from our physicians. It's-- so this is a challenge. So we immediately created a-- a project that creates constant flow of supplies into the rooms.

I always ask you to make predictions when I talk to you. So I-- I want to hear what you think the short- and long-term impact will be of a potential recession, even the fact that when we've talked to other health systems, they're talking about losing billions of dollars a month, some of them. What's the short-term and long-term economic impact on the structure of the health care system?

So I think we're going to be all pressured to provide high-quality care with contracting revenue. We're already seeing it play out as people are losing their jobs. And they're transitioning from commercial insurance to the individual exchange and-- and-- and Medicaid in-- in many states as well.

So as a health care delivery system, how do you survive in an environment where, hey, the expectation is the highest quality, the best convenience, but we're going to be seeing contracted revenue? And that's going to drive integration of technology into our practice and new ways of doing things.

So I'm trying to inspire our physicians to think about what's possible with a video approach. How do we transition patients from the inpatient to the outpatient setting and from the outpatient setting to the home setting?

So I would anticipate over the next five years-- going to see an incredible, transformative approach to care delivery in this country. And it's going to be forced by these external factors.

What are you hopeful about?

I'm hopeful that this model of practice that I'm describing could actually transform the way that we deliver care. Consistent excellence across the nation using the resources in the most effective ways is really creating operational excellence across all 50 states and creating just this exceptional care that's-- that's ultimately going to benefit the entire nation.

Does anything keep you up at night?

Well, we've got the trifecta of uncertainty that I think a lot about. How long is COVID going to be with us? How quickly will we have some type of herd immunity versus a vaccine? And then what's the impact that that's going to have on the economy and people's livelihoods?

And I used to think, very optimistically, that we would have a V-shaped recovery. The jobs were diminished. And they would bounce right back. It's now looking more kind of like a Nike swoosh. Those are the things that-- that keep me up at night.

The other trifecta piece is the, uh, health inequities and the social injustice that has been uncovered by this process and really systemic challenges that we've had for, uh, several generations.

Well, before we leave, I want to congratulate you being selected as one of the most 50 influential people in clinical medicine. So congratulations, an honor--

Thank you. I credit my entire team. I've got an exceptional team here on both coasts. And, uh, they share this with me.

Well, again, thank you for taking the time to share your insights.

Thank you so much, John-- hope to see you soon.

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