Kaiser's 'professional business athlete'

Bernard Tyson, Kaiser Permanente’s new CEO and chairman, came to his new roles at the start of what most say will be a challenging year as healthcare reform gears up.

But, he comes prepared, with nearly 30 years of experience at the organization, including holding the positions of president and chief operating officer.

He spoke with Healthcare Finance News about revenue cycle challenges, his view of leadership and the issues facing Kaiser Permanente as it pursues further organizational change.

Q. What are some issues that you expect Kaiser Permanente will be wrestling with in 2014 in California and nationwide as the health insurance exchanges and newly insured populations are established?

A. There is so much change going on in the industry that we have to get a little comfortable with the dynamics of change. We have more members coming in through Covered California; we have the transition of members who received cancellation notices who are re-signing up for Kaiser Permanente; … we may have people who have signed up, and we don’t have all the paperwork, and so we’re trusting them; and then, the flow of money to follow.

Q. Kaiser is a leader in testing new models of care delivery and payments and other reforms. What has Kaiser found that works in the trenches to improve health outcomes while at the same time reducing costs?

A. We have learned that when a person joins Kaiser Permanente, it is best to reach out to them immediately to do the work ups, get them into the program, check their health status, understand what medicines they are on, making sure that they have been caring for themselves and being cared for. We have learned over time that you are more efficient in the quality of care by understanding holistically what’s going on with the person – it’s mental health, physical health and community health. We look at everything – how much they are exercising, sleeping, and preventive care. 

Q. How does Kaiser champion the culture of transformation with its physicians and other healthcare professionals, administrators and patients?

A. They are directly engaged in making the transformation happen. The most effective process that I’ve been a part of is when the very people who are providing the care are at the table having to make the changes. For one, it’s a learning process for everyone.

Two, we have incredible data that’s coming through our electronic medical records and health information system that give us what’s going on in the care processes and the registries that we have people in. So change is happening as result of sharing facts and expertise, not just the theory of transformation. …

We have a lot of internal publications that we share information in for physician groups. (So), as protocols change, those protocols can be placed inside the health system, so it is transported electronically across the organization to providers.

Thirdly, we bring groups together from across the country in seminars, summits and sessions to work through how change occurs throughout the program. We also have the Care Management Institute that works across the program and operations to implement the latest changes.

Q. How do you anticipate the continued implementation of the Affordable Care Act impacting Kaiser’s revenue cycle?

A. We fully expect that we will continue to have turbulence just with the implementation alone. We anticipate over time, especially as we all work towards greater affordability in this country, that we, like everyone else, will be looking for ways to be more efficient to help to drive down the cost of care. I think that that is one of the most important agendas in the ACA – to make sure that more people are covered, that they get access to the front door of the healthcare system and that the healthcare industry works toward greater affordability.

Q. How is implementation and testing for ICD-10 going? We hear a lot about providers pushing back on ICD-10. Because you play such a large role in healthcare, is there more pressure for you to be ready?

A. We always have a challenge when we implement major system changes (when) we have legacy systems. We’re very different from the rest of the industry because we cover and care. So, when we modify a system, add or change a system, it is a complex surgery for us because there are so many parts that it has to connect to. I’m very pleased that with all the complexity that we are on time and on schedule. … We’d rather just slog through it and get it done as opposed to just keep delaying it. I use the analogy a lot – the plane is in the air. I don’t want to keep flying around the airport when we could work our way through to a good landing. 

Q. You’ve worked in many parts of the Kaiser organization. What does your view of leadership look like having come up through different layers of the organization? 

A. I believe in the people here. I have been a part of many changes, and I’ve seen what our people can and are willing to do when they are aligned around the vision and the outcome that we’re trying to achieve. That is not to minimize how difficult change leadership is – but to have everyone aligned with the direction and then the challenges around how far and how fast and how deep – that is a very different change agenda than trying to get people aligned around a vision in which there is a lot of disagreement.

I view myself as being a professional business athlete. I practice my skills, and I practice every day. I’m shooting for a thousand, a perfect score, even though I know I will not make that every day. The people in the organization should know that they have a professional business athlete leading the company as big and complex as Kaiser Permanente – not a rookie, not a leader in training – but a leader continuously learning and honing his skills.