A vision for health care Better integration that yields higher quality, less waste

Dr. Robert Pearl envisions an American health care system that works, where high-quality care is available to individuals and families regardless of their place on the economic spectrum, and where the tools of preventive care and electronic health records are deployed to make efficient use of precious health care resources.​And he’s no stranger to that type of big-picture thinking.

Pearl heads the Council of Accountable Physician Practices, or CAPP, whose 30 members are large, integrated health care systems in the vanguard of the U.S. health care reform movement — institutions such as the Mayo Clinic, the Cleveland Clinic and Kaiser Permanente. And he’s the executive director and CEO of Kaiser affiliate Permanente Medical Group, the largest medical group in the nation with 7,000 physicians and 25,000 staff, operating 19 medical centers in northern California.

It’s why NJBIZ spoke to him recently about patient-centered health care, the growth of physician-led practices and growing coordination in the industry — all trends that are increasingly finding their way into the New Jersey health care landscape.

CAPP’s philosophy is that physician leadership is critical to forging a health care system that delivers, and Pearl is a perfect reflection of those ideals, as he is physician and a CEO.

“I sometime talk about (the) American health care system as a sort of a 19^th century cottage industry,” said Pearl. “It is fragmented, it’s fee for service, which is really piecemeal, it’s paper-based and it’s really unled.”

And he said all those dysfunctional aspects of the system “need to change in order for us to achieve what’s possible in health care in terms of quality, service and affordability.”

 “I believe people have come to recognize that, with the complexity of disease today and the advances that are being made, health care has got to be integrated, which means all the pieces working together as one,” Pearl said.

He said the old model is typified by the hospital patient getting care from several different specialists: “They all come and wrote notes but there is no real collaboration, no real coordination. These are really parallel processes happening to the same person.”

While there are no New Jersey practices that belong to CAPP, there are a number of large and growing physician-led practices in the state, including the multispecialty groups such as Summit Medical Group and Advocare, and the large oncology practice, Regional Cancer Care Associates.

New Jersey has a growing roster of patient-centered practices, focused on delivering coordinated primary care. And more than a dozen Medicare Accountable Care Organizations across the state are bringing doctors and hospitals together to improve the quality of care, reduce hospital readmissions and share in financial savings that result when medicine is practiced more efficiently.

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“If you’re looking at the issue of cost, the solution is not to pay people just for doing more,” Pearl said. “You want to pay them for doing the right thing, the first time, in the best way possible.”

As head of Permanente Medical Group, Pearl oversees health care for more than 3 million Kaiser Permanente members. He also serves as chief executive and president of the MidAtlantic Permanente Medical Group, whose 1,000 physicians care for 500,000 Kaiser Permanente members in Maryland, Virginia and Washington, D.C.

He said patients have a tendency to put off medical care until a minor problem gets worse. Kaiser Permanente is in the forefront of telemedicine: Patients can take digital photos of their symptoms, or email or call their doctor to describe their condition, then get a diagnosis and prescription.

Telemedicine has arrived in New Jersey in the last couple of years and is being offered by a number of health insurers including Health Republic Insurance of New Jersey, Oscar Insurance and Horizon Blue Cross Blue Shield of New Jersey.

Pearl believes that health care organizations like Kaiser, which provide both health plan coverage and medical care, is a viable destination for health care.

“Can every (health care system) get there in a year or two? Absolutely not. But over time moving in that direction we can really change the experience that patients have. That’s why we formed the organization,” he said.

He said the CAPP members came together “to help us continue to get better. We can learn from each and figure out how to expand into areas where this is no history of integrated, technology-enabled, prepaid health care.”

He said CAPP “gets calls continually from physicians across the U.S. saying ‘we’d like to become like you — help us to get there.’ ”

Health care needs to be patient-driven, Pearl said.

“I think when the patient starts demanding the same excellence from health care as they already demand in travel or demand in retail, I think change is going to start to happen. I think patients have yet to understand what is possible.”

When they understand what kind of patient experience is possible, “that’s the first step in the process.”

Health care organizations need physician leaders working as equals alongside the nonclinical leadership, he said. And this is a culture change that in many places around the country has been slow to evolve. 

“One of the challenges is that hospital leadership has got to be to be willing to share decision-making (with doctors) in a deeper way,” Pearl said. “To see the physician CEO as truly an equal will allow the right things to happen to the patients — and allows the outpatient care to be as important as the inpatient care” delivered in a hospital room.”

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