Reimagining Health Care Delivery: Kaiser Permanente’s Jodie Lesh

Given that at Kaiser Permanente you lead their Office of Transformation, let’s begin with a quote from Kaiser’s former CEO, Bernard Tyson, on the future of healthcare, who said last year: “The entire health care industry was built on the idea of people coming to our space for care ...For the future, what we have to do is push care out to where the patient or member is. That’s our reimagined idea—care anywhere. What we’re trying to do now—what we will do—is turn this industry upside down.”  

With COVID-19 upending many industries, comment on the prophetic nature of this vision and what responsibilities fall on your shoulders to realize that reimagined idea as the organization navigates this unprecedented moment in public health?

I do think it was prophetic, but that was Bernard; he had incredible vision. Bernard saw things in the future that other people couldn't see. We thought that the industry might turn upside-down, but I'm not sure even he realized the whole world would turn upside-down—which is exactly what happened. In doing so, it's shed light on some of the deficiencies in the healthcare system but also some of the great opportunities to address them. I think that's what Bernard meant, that consumer expectations will change, are changing, and have changed—and that will change our industry. I can't think of an event that affected people's perception about what is safe, how they should receive care, or how they should live their lives more than COVID-19.

As an example, we had been steadily increasing our use of virtual care over many years leading up to this. But now, in the last five weeks, our use of telehealth has increased about 70 to 80 percent. What we thought might not be possible— or something that might take many years to achieve—we literally did in a matter of weeks. Because that was the right thing to do and that was the expectation people had—that we would meet them where they are. In this case, where they were was in their homes. So, I think it was very prophetic. The industry will never be the same again—on a number of fronts—but particularly around how care is delivered. We'll see huge change and that presents an incredible opportunity for the industry. 

Elaborate on your role leading Kaiser Permanente’s Office of Transformation.

Let me start by saying that no one owns innovation and transformation. No one owns it anywhere; no one owns it at Kaiser Permanente. I certainly don't own it. But a year and a half ago, when Bernard created this position, what he wanted me to do was think ahead and reimagine what was possible for our system. It's interesting that he used ‘reimagine’ in that quote, because that is a word that he and I used a lot with each other. What could be? He put me in this role to help the organization think about what might be possible and then try to move the organization along those lines.

There are many incredibly innovative people at Kaiser Permanente, and the entire history of the organization and model is innovative. But I think he put me in the role so that innovation and transformation would be somebody's day job—not something that people would do on the side—but that we would actually put real resources, focus, and funding towards thinking about what might be possible in the future and then accelerate that movement.

Bernard also acknowledged that the industry, even before all this, was under incredible pressure. He spoke a lot about a single-payer system and how it was not something he felt was a good idea or necessary; but, he did recognize that significant change needed to occur to make healthcare more affordable and accessible.

 One of the things that Bernard championed—and something he told me when I came into this job—was that healthcare was unaffordable and that we needed to look at affordability not in terms of relative affordability—not whether we were less expensive than our competitors—but absolute affordability. Could people actually afford to receive the care? That was his mission: to make care truly accessible and affordable. He talked about making the “front door of healthcare” accessible to all so that people, especially people in poverty, people of color, weren’t forced to use the ‘back door’— the emergency room— as the front door to care. I was put in this role to be a thought partner with him about the possibilities for the industry.

How was your position was created.

It was a very sad day for me when Bernard passed away, because we were in the process of putting a transformation capability together that not only designed the future state, but also executed on that vision. Innovation groups within organizations sometimes suffer from a failure to execute on great ideas. I have some good execution experience with large-scale transformation, and we continue to fine tune these skills and capabilities. With this in mind, our group is a combination of people who have design backgrounds— industrial design, human-centered design—and people who have experience in strategy and operations, including people with clinical backgrounds. The Office is designed to deliver tangible results and in our first couple of years, we have been quite successful in this regard. 

Has the onset of COVID-19 accelerated your office’s transformational mission? If so, how?

The first week in March, when everything really started to break loose, I met with the leaders of my group and we talked about two possible paths to pursue. One point of view was that we should continue to focus on the future, as there were many people focused on the here and now. The other was that we could and should contribute to addressing the unprecedented challenges presented by the pandemic. And, in focusing on the latter, we should have an eye towards the future and use the current situation as an opportunity to accelerate innovation and showcase the group's potential. So, we did a little bit of both.

For example, we were working on a project to bring care, at scale, into the home. That has been given a huge jolt, because when we start reopening, some of our patients will be best suited to receive care in their home, including hospital at home. So COVID-19 accelerated an effort that was well underway and sharpened our outstanding of capabilities needed at scale across the enterprise.

We’ve also started new work focused on COVID-19 that has demonstrated our ability to pivot our innovation capabilities to meet real time needs. An example is the unprecedented disruption to the supply chain that needed some creative solutions. So, while our procurement folks were valiantly trying to move product through our traditional supply chain, Greg Adams, who's our current CEO, asked my group to stand up an alternative, auxiliary PPE supply chain leveraging the talent and the capacity of the Los Angeles garment district. Within just a few weeks, we created patterns, tested and sourced materials and set up production lines to produce products such as isolation gowns and face masks.

 We encountered many challenges, such as raw material shortages, the need to vet alternative materials, and a workforce dispersed as a result of the pandemic. Now, we're in production with over two and a half million units and putting hundreds of grassroots seamstresses back to work. We are sharing our PPE Playbook with others using an open-source approach which we think is important at a time when the needs are so pressing. This effort has allowed the Office of Transformation to showcase both our creativity and our bias toward action.

We're also doing some work now on the next phase of the pandemic, which is called suppression. We're working on developing a physical and digital toolkit for households to help curtail family transmission. That project brings some of our industrial design skills into play as well as our strategic planning expertise and, now, our supply chain management skills. My message to my group is ‘be flexible.’ Meet the organization and the world where it is, and this is where we find ourselves. It’s an important and challenging time, and I believe we are contributing in meaningful ways.

Turning to some of the technological innovations you've referenced, how are technologies like machine-learning, the internet of things, and the digitalization of our economy impacting the transition you're involved with and what you see is the future of medicine?

It's impacted the industry slowly, very slowly. The healthcare industry has tended to treat people as one-size-fits-all, whereas other industries—like consumer products and retail —have been able to deeply understand people's needs and uniquely meet them. The healthcare industry has not been able to do that. It's been largely our way or the highway.  That is beginning to change in meaningful ways.

We've been working with a consulting firm recently on something called the ‘digital twin.’ This methodology and tool allows us to bring a diverse and large data set together which wouldn't have been possible at another time, and garner insights about people – their behaviors, motivations, lifestyles, and disease states, to name a few -- that go well beyond the insights of the past.

We can understand not just who people are, but how people make decisions, how people respond to change, and how behavior modification can occur. This ultimately will be the future of care: to understand how people make healthcare decisions, what people need to be effective at that, and how can we design solutions that are personalized. How can we get to an ‘n of 1?’ This goes well beyond the notion of ‘mass customization.’ It’s more about consumer insights that are data-informed, future forward, and applied at an individual level.

It's also about being able to address people's needs based on their unique circumstances. As an example, if you look at the CDC guidelines around curtailing family transmission of COVID-19, it tells you to isolate from other family members within your home. Well, if you live in a 750 square foot apartment with four people, self-isolation can be exceedingly challenging. And so even in this work, we're looking at how we can customize solutions to address real barriers to suppressing the spread of disease to other family members. That's where AI, machine learning and data science will change how we offer care to people in the future, and it will be much more effective. But we, as an industry, have been slow to change. 

What are the likely long-term implications of Kaiser Permanente’s changes in procurement and supply-chain in response to the immediate health needs of your members?  Will the just-in-time delivery model that KP has relied upon to date change?

It's hard to say what the long-term effect will be. Certainly, we were living with a ‘just-in-time’ delivery model that I think will have to change. We've been confronted with the fact that the supply chain is not as secure and stable as we might have once thought.

We also don't know what the next phase of this pandemic is, or if there'll be another surge. Whether or not some of these alternative supply chain models will remain, I don't know.

Something we’re doing right now is putting a playbook together so that other organizations—such as a smaller hospital that perhaps doesn’t have the same access to the supply chain as a large organization like Kaiser Permanente does—can quickly activate an alternative supply chain effort.

And then lastly, I've been leading some work for several years at Kaiser Permanente looking at economic stability as a healthcare indicator. I've done a lot of work with Michael Porter's group out of Boston, called the Initiative for a Competitive Inner City, helping small businesses get access to capital and essential business education. We're trying to figure out how we can create longer-term opportunities for these small businesses. I really want to leave these businesses in a good position to grow and be resilient during these turbulent times. I don't know if I can do that, but I'm very focused on trying to figure out what we can leave behind here for these businesses.

To continue to better understand your current responsibilities within the Office of Transformation, share what your prior roles at Kaiser Permanente have been.

For my first 14 years-or-so years at Kaiser Permanente, I lead Delivery System Strategy & Planning in Southern California which was responsible for the planning, design and funding for construction of our clinics, hospitals and administrative facilities. It was a significant responsibility, as we were spending over a billion dollars a year in new construction and renovation. Around 2017, I took on this responsibility nationally for Kaiser Permanente, and also began to focus on building an innovation capability. When I was in Southern California, we started looking at what the future of ambulatory care could be. I led a project called Re-Imagining Ambulatory Design, which looked at how ambulatory care would be delivered in the future. A lot of that's coming to fruition now.

 Project RAD reimagined the medical office building of the future and this design has become our standard. They're very different; they have different waiting room models and very different technology that allows people to check-in from home and be ‘untethered’ from the waiting room. It’s designed to support a future where telehealth is a significant part of our model. A piece of this work looked at how we could explore the intersection between what is good for business and what is good for our communities. This resulted in strategies to design buildings that provide needed services for the community such as free wi-fi and walking paths, and provide job opportunities through local hiring practices. Project RAD also laid the foundation for our care-in-the-home strategy. 

If you were burned-out by this challenge in the near future, and a prestigious School of Public Health came to you and said, ‘We want you to be our dean’ and to reorganize our School of Public Health’ – how, if you accepted, would you approach this opportunity? 

It's funny that you asked, I really would like to teach and actually do teach at the School of Public Health at UCLA as a guest lecturer. When I first came to Kaiser Permanente, our Community Benefit focus was largely on grant-making, Medicaid, and charity care. Over time, our strategy has evolved and now encompasses the overall health of our communities. It’s been an important and impactful pivot for Kaiser Permanente. We now grapple with how to address issues such as homelessness, food insecurity, and poverty.  We have an important role to play and we are making a meaningful difference.

I think I would bring a very different lens to how broad the spectrum of ‘public and community health’ is and what it means to be focused on taking action rather than taking a more academic view of the issues. We're living these challenges right now and solutions cannot wait. You see it with the death rates among disadvantaged communities. Health disparities need to be addressed now, and COVID-19 has only amplified the need. So, I think I would have a broader view of what's under the purview of a public health school.

And similarly, if a position as state or county public health director were offered, how would your imagination likewise be activated? 

I don’t think I would make the best public official, to be honest. I am a firm believer, however, in public-private partnerships, such as the work we did with the City of Los Angeles – LA Protects – to leverage the garment industry in producing PPE.  I believe I can add more value in the private sector, so I think I’ll keep my day job.

Something that we practice in my group is what we call human-centered design. Our projects start with deep ethnographic research so we can uncover unmet needs, barriers and failure points. I think there’s sometimes a lack of true understanding of the issues and people, including those at the state and federal level, assume they know what the problems are but don't. The result is often solutions that don’t fix real problems, and worse yet, sometimes ‘solutions’, while well intentioned, actually make problems worse. 

Given what you've just shared, there likely are thousands of talented people who want to apply to work with and for you. What talents are prized? And, are you even able, in this cratering economy, to afford hiring anybody?

The latter is the million-dollar question. With so many unknowns, I think hiring will be put on hold for a time. But in terms of who we look for, I have no prescribed background and that is by design.  We put people through a very rigorous case-based interviewing process. We interview in groups, because we like to see how people interact with each other. Creativity is a team sport – there are no individual contributors. We like to see how people think and form ideas. We look for courageous and creative thinkers. We have people from all backgrounds—nursing, home health, industrial designers, architects, somebody who used to work for the UN. It really doesn't matter to me, as long as you can think creatively and work with other people and aren’t afraid to take risks.

If we were to check back with you at the end of the year, or next January at VerdeXchange 2021, how far along will healthcare’s  transition – per Kaiser Permanente’s mission – be?

The economy is going to be hit hard and no one will be spared. In this respect, our progress may be impacted. I think we've underestimated the impact on the American psyche. Human instinct is to keep ourselves safe.  I worry that even as restaurants, gyms, salons and everyone try to come back, we will feel the effects of the indelible mark on the American psyche this pandemic has made. Having said this, I do think what will come is great innovation across industries at a level never before seen. That is the American way and the American spirit. Then I think we'll come back stronger, but I think it's going to be a little bit of a bumpy road.