This is a preview of the November 20 edition of Access Health-Tap here to get this newsletter delivered straight to your inbox. Here in Chicago, we have a Restaurant Week each year has released a study discrediting “pediatric sex rejecting procedures” for the treatment of gender dysphoria in children and teens. The study found “significant, long-term, and too often ignored or inadequately tracked” health effects from gender affirming treatments given to pediatric patients, according to a Wednesday news release from HHS, led by Health Secretary Robert F. Kennedy, Jr. The report’s authors included physicians from Duke University, University of South Florida and Baylor College of Medicine. The American Psychiatric Association participated in the review, but the American Academy of Pediatrics and the Endocrine Society refused HHS’ invitation to partake, according to the report. Health systems around the country are caught in the medical and political crossfires. As of August, at least 21 hospitals had discontinued some or all of their gender-affirming care services for transgender patients amidst increased pressure from President Donald Trump’s administration, NBC reported. The American Academy of Pediatrics and the American Medical Association released a joint statement on Wednesday, saying, “We reject selective or politically motivated interpretations of data that ignore the totality of research and clinical outcomes.” Click here for the full statement. You can view HHS’ report here. UMass Memorial Health Care She’s also the primary CEO of three of the eight medical groups in the Federation: the Mid-Atlantic Permanente Medical Group, the Permanente Medical Group in Northern California and the Northwest Permanente Medical Group in Oregon and part of Washington. Ansari oversees about 12, 000 physicians caring for a combined 6 million patients. We discussed how she’s preparing to support them into the future-especially as the Baby Boomer population ages, placing additional strain on an already-taxed health care system. Below, find some of her insights on how new care models and AI can lighten providers’ load. Editor’s Note: Responses have been lightly edited for length and clarity. How is The Permanente Federation planning to care for an aging population? We’re using a lot of different care models to look at this population, because [our plan] depends on the state. As an example, in Oregon, the birth rate is really low, and so the growth is in the Medicare line of business. What’s true across [all of our] markets is that we’re aging faster than we’re growing [the workforce], and so we have to really invest in caring for this older population. We know that for people over 65, close to 90 percent of them have at least one chronic medical condition, and 60 percent have at least two chronic medical conditions. People are living longer and they are carrying more disease burden. And so what we’re looking at from a population perspective is, how do we keep them living their best lives? How do we keep them healthy? How do we support them in this? Because they all look different, right? If you’ve seen one 80-year-old, you’ve seen one 80-year-old, because one might be playing tennis, another might be bedridden, and there’s everything in between. We have a few different pilots going on, but the general approach is moving care more and more upstream so that they don’t get the late-stage manifestation of their disease. If they have hypertension, [we want to ensure] that it’s under tight control, or if they have diabetes, that we’re controlling it so well that they don’t get hospitalized, because nobody wants to be in the emergency department. Frictionless, convenient access to care and care management systems help keep them healthy at home. That’s a mainstay throughout The Permanente Federation and all of our medical groups: care managers for chronic conditions. What we are doing differently right now is using AI to [identify patients that are at] the highest risk to be admitted, to have a fall, to have a heart attack, and really put wraparound services around them. We’re calling that Care Plus. We’ve been using that in Northern California, and we’re trying to spread it to some of the other markets. But the Care Plus model is basically a care team that includes a nurse, a pharmacist, a physician, a social worker and a care navigator. There are multiple [of those] groups of five that care for a population of patients that are at risk for getting sicker, and the AI alerts us to get involved, and they direct the right type of person on the team to address it. So if it’s a transport issue or a food insecurity issue, it might be the social worker. If it’s they’re running out of meds, it might be the pharmacist. Did Kaiser Permanente develop that AI tool internally, or are you working with a vendor? We do work with vendors on some of our AI tools. This particular AI tool is our own in-house AI tool [that] we use our electronic medical record for. We actually have 12. 6 million members across our entire enterprise, and use a predictive analytics model to determine who is most likely to get re-hospitalized, who’s more likely to deteriorate, and then alert the care team on what the gap is in terms of the need so that we can match them to the right member of the care team. It’s almost like AI is part of the care team-so we have a team-based approach, and AI is just one that is trying to match the patient to the right care team member. For most of their lives, patients over the age of 65 have been receiving care face-to-face, without much technological intervention. Are you concerned about integrating more digital tools into their care journey? Personally, I am not worried about it. They are not a monolithic group, and many of them are wearing wearables and are very tech savvy. They want real-time feedback. They want to have what we consider asynchronous interactions with their care team, where they can just [ask], “What do you think of this mole?” We piloted a [dermatology] app and had people send in pictures of their moles, and the AI algorithm helped tell them [if they were] going to have to see a doctor or if this could be managed with over-the-counter treatment. We had just as many older patients engaged in that as younger. In fact, the older patients are more likely to have some lesions that they’re more concerned about. So I’m very optimistic about our seniors embracing AI. We use AI in most of our clinic visits because we use Abridge and supplementing by looking for the metaphorical sunshine. Health care professionals are confronted with a lot of problems in their day-to-day: ill patients, declining reimbursement rates, staffing shortages. Naturally, a lot of our conversations focus on these issues; you have to examine them closely to find the solutions. But lately, I’ve really enjoyed hearing what industry leaders are excited about-what they feel is going right. This week, I saw some of those bright spots in my conversation with Dr. Alexa Kimball, president and CEO of Harvard Medical Faculty Physicians. Kimball told me that she sees progress when reflecting on her time in medicine, and that helps her keep a positive outlook. Here’s what she said: Editor’s Note: Responses have been lightly edited for length and clarity. “It’s been an incredible journey of watching the progress that medicine has made over the past 25 years, and an amazing privilege to be able to have been a part of it. “There are diseases that were so common and so problematic years ago, and today, this next generation of physicians has never even really seen the disease because it almost doesn’t exist anymore. “It’s been extraordinary to watch that, so I am very optimistic about the care that we bring to patients. We have to figure out how we support the physician enterprise effectively to bring the best care to patients, and AI has also made me optimistic about reducing some of doctors’ burdens to make them more effective. But we’re all in this together at the end of the day, and we’re not going to optimize the health care system unless all parts of it are really pulling the same direction, which, at the end of the day, should be about the care of the patients.” CEO Circle Insights from health care thought leaders around the world “A quiet paradox is unfolding in health care,” according to Dr. Lawrence Rosenberg, president and CEO of the Integrated Health & Social Sciences University Network for West-Central Montreal, and a member of Newsweek’s CEO Circle. Governments are focused on centralizing their health systems-but Rosenberg argues that they could become vulnerable to “intelligence bottlenecks” in the age of AI. Click here to read his thoughts.
https://www.newsweek.com/should-nursing-contracts-be-more-like-prix-fixe-menus-access-health-11084548