Patrick T. Courneya, MD is the Executive Vice President and Chief Medical Officer of National Health Plan and Hospitals Quality at Kaiser Permanente. Get to know Dr. Courneya through his Q&A on workforce shortages and the role technology plays in bringing care to homes across California.
Q: How are you, as a major healthcare provider in California, seeing workforce shortages manifest and what immediate steps is Kaiser Permanente taking in places like the Central Valley or Inland Empire where the number of primary care doctors, for instance, falls well below recommendations?
A: A robust healthcare workforce is critical to Kaiser Permanente accomplishing and expanding its mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. A well-trained workforce that meets the needs of all who call California home, whether they be KP members or not, is important to ensuring we meet the care needs of the population.
California’s population is growing, aging, and becoming increasingly diverse — trends that place an untenable burden on the state’s health workforce. The pipeline of caregivers, including physicians, nurses, behavioral health therapists, and elder care specialists, has not kept pace with demand, particularly in underserved, rural, and ethnically and linguistically diverse communities.
One strategy that Kaiser Permanente uses to address heath workforce shortages, particularly related to primary care physicians, is investing in training. Kaiser Permanente’s university-affiliated residency, intern, and Graduate Medical Education programs are among the largest training programs in the country, offering training in almost two dozen specialties. The purpose of Graduate Medical Education is to provide an organized educational program with guidance and supervision of the resident (includes interns, residents, and fellows), facilitating the resident’s professional and personal development while ensuring safe and appropriate care for patients.
In addition to the above programs, Kaiser Permanente Community Benefit significantly invests in workforce development throughout the state, particularly in areas where there are shortages such as the Central Valley and the Inland Empire. For example, Kaiser Permanente Community Benefit recently made a contribution to the residency program at Valley Health Team Family Medicine, a federally qualified health center that has clinics in communities throughout Fresno County. The residents will be placed in clinical settings serving primarily underserved populations.
Kaiser Permanente will also directly contribute to the academic development of a new generation of physicians through the Kaiser Permanente School of Medicine, which is scheduled to open in the fall of 2019. The Kaiser Permanente School of Medicine will be embedded in Kaiser Permanente’s health care system and will move beyond traditional health care settings, acknowledging the importance of team-based care, promoting a focus on diversity and inclusion and caring for patients in underserved communities.
Kaiser Permanente is actively focused and committed to the training and education of the workforce of the future, and the programs noted above are a few of the examples of the ways in which we aim to ensure we meet the evolving health care needs of the diverse population of California and beyond.
Q: Kaiser Permanente is on the forefront of electronic records and using technology to improve efficiencies, patient experience and coordination between healthcare professionals. Do you see technology playing an important role in bringing care to those who are home bound, located in rural areas or facing language barriers?
A: The answer to this questions is a resounding “yes” to the important role that technology plays bringing care to the home. And while technology certainly addresses geographic, rural and language access issues, it goes far beyond this as care shifts out of the hospital. Patients have indicated that they want to be cared for closer to home in their community, want greater access and around the clock coverage, and, on-demand tech-capable services and information. Keeping this in mind, it is important to emphasize that Kaiser Permanente’s objective is more of a “high-tech, high touch” approach; that technology – virtual visits, remote monitoring, in-home self-care devices, robotics, etc. – is not intended to replace the hands-on, human provider touch. Instead, telehealth capabilities augment and supplement, as well as expand the in-home visit by the physician, nurse, etc.
Kaiser Permanente has a number of pilot projects that are exploring the use of technology. Current pilots in San Diego include video visits, remote monitoring of vitals for palliative patients, and digital image capture of wound care patients. Primary care is exploring the use of Alexa in the home for medication reminders as well as tablet technology which can assess patients for basic clinical and social, non-medical needs. Of course, this is just a handful of countless technology product services being tested. The success of any of these technologies rely on a highly-skilled and coordinated continuum of care professionals that are connected by centralized digital platforms. This allows for efficient dispatch of staff and durable medical equipment, real-time sharing of extensive clinical diagnostic data, and reminders/health education for patients. Near future use of artificial intelligence and machine learning will also significantly augment Kaiser Permanente care teams’ ability to design detailed personalized care plans for patients.