This episode is brought to you by r one RCM, a leading provider of technology driven solutions that transform the financial performance of hospitals, health systems, and medical groups. R one delivers proven, scalable operating models that power sustainable improvements to net patient revenue while reducing operating costs. To learn how you can transform your revenue cycle performance, visit us at www.r1rcm.com/beckers. Hello, and welcome to the Becker's Healthcare podcast. My name is Will Riley from r one RCM. With me on the podcast today is doctor Rameen Davidoff. Doctor Davidoff is the co CEO of the Permanente Federation. Welcome to the podcast. Thank you, Will. Pleasure to meet you. And you. Doctor Davidoff, please, would you start by telling us a little bit about yourself, your professional background, and tell us about the Permanente Federation? Absolutely. I'd be delighted to. I'm a urologist, and I work in the Southern California Permanente Medical Group where I've been for the last twenty six years, twenty two years as a clinical, faculty, and the last four years as the executive medical director for the Southern California Permanente Medical Group. And I'm also the, co CEO of the Permanente Federation, which is a national organization consulting and leadership that oversees all of the Permanente medical groups all the way from Hawaii to the Mid Atlantic states of Virginia and Maryland and Washington DC. And in our role, we oversee 25,000 physicians across the nation. Excellent. Thank you for that context. On the podcast, we're exploring some of the big, issues, opportunities facing health care providers as we transition into 2025. So I'm looking forward to hearing your perspective on those from you the vantage point that you have. The first thing I'd like to talk about is, cybersecurity. That's been a big issue that has really risen to prominence, through 2024 with some of the events that we've seen, like the change health care outage, for example. I'm just curious from your perspective, how do you look at and think about cybersecurity, in the position groups that you oversee? You bet. And it's becoming more and more important. Of course, protecting patient information and the trust that we have with our patients and their safety as it relates to their information and electronic health records is absolutely foundational. Without that trust and security of protecting that information, we lose our trust with our patients. And so, we do look at cybersecurity as a very important aspect of what we do, and we make very heavy investments in cybersecurity to protect that information. And it comes in the form of multiple different ways of looking at things. We have advanced encryption methodology that we use, for our records. We also have multifactor authentication for entry points into the electronic health records and our other data systems. We also do very regular audits and assessments of our programs, and we proactively make changes as as we need to to assure continued, security as it relates to the health information. And we also have a very robust training program for all of our physicians and employees, which is mandatory. It's not optional around issues around cybersecurity and protecting the health information. So it is a heavy investment, and we prioritize it with other investments that we have to make, including in patient care and research and other infrastructure investments that we have to make. But it is a priority for us. It's a very important thing. Has the reality of cybersecurity attacks made you think differently about business continuity efforts? Should you be the victim of an attack at some point? Absolutely. So we very proactively evaluate that, and we anticipate potential attacks because it's not a matter of if. It's a matter of when they will happen. And so we have drills, and we have many ways that we prepare for that eventuality. And we have downtime procedures, etcetera. We do all kinds of, simulations as it relates to cyberattacks, and we have other backup systems in case that happens. We read about, for example, younger physicians, being unable to read, charts and things that are captured in more manual and traditional ways, not using modern technologies. I I can imagine that the problems that you have to think through in that kind of continuity planning are are really broad. Yes. Yeah. Yeah. Absolutely. That's why the training because so becomes so important and doing those drills, becomes critical because you're right. You have all kinds of physicians and staff in different stages of their careers, and not all of them wanna see paper anymore. Right. In fact, very few people do. Know what to do when they do. Oh, that's right. Yeah. Yeah. Exactly. Yeah. Absolutely. Excellent. Thank you. Let's talk a bit little bit about artificial intelligence, if we can switch to that. Another obviously big topic area in health care right now and an area that seems to be showing real promise both for physicians and how they how they're using the technology, but also on the administrative side of health care. Can you talk a little bit about how you're using, artificial intelligence? It's super exciting, and it's gonna revolutionize the way health care is provided with our question, both in direct clinical patient care and other administrative and, protocol types of issues as you mentioned. And so we're very excited about this one technology, which is ambient listening technology, which is absolutely phenomenal. It's something we rolled out to the entire organization, and, all of our physicians, all 25,000 are eligible to use this technology. Essentially, it's machine learning where, this technology listens to the conversation between the physician and the patient, whether it's a face to face in office visit in the exam room or a virtual visit, video or audio visit, telephone visit, the technology is able to listen in to the conversation and to create an actual document, a note, which is wonderful. It's incredible technology. It's been a game changer for our physicians. Of course, the physicians then have to go back and read the note and make sure it's accurate, and it's becoming more and more accurate. And it allows for the patients to also be heard when they have the full attention of the physician in the conversation, and the physician is not preoccupied with typing notes on a keyboard. They're able to pay full attention to the patient, and so patients feel heard. Yeah. And it also removes the administrative burden of documentation, and there's cognitive burden that it relates to documentation. That's pretty heavy, and it adds up every day, dozens of times for the number of patients that we see. And so it's a real win win game changer, and that's something we are super excited about. And, we're evaluating right now. We're deploying it to all of our, physicians, twenty five thousand strong. Our adoption rates are pretty high. And it, anecdotally, as well as in some of the studies that we've done, physicians absolutely love it. We've had many physicians who were on the verge of retiring towards the end of their careers. But because this technology has been introduced, they tell me directly, I'm gonna stay because this has helped me so much throughout my day. So the ambient listening is a very exciting thing that I think is gonna be very helpful to sustain many other practices that we have in our organization. We're also looking at using AI in different ways. For example, the burden of the messages that come into a electronic health record from patients to our physicians is overwhelming, and it's the type of work that ends up being actual care that needs to be provided. It's just not in the form of a visit. It's email or some sort of a message that comes in. And we're looking at exciting ways to use AI to triage these messages so that they could be sent to the proper venue of care. Whether it's a physician or a pharmacist or a nurse, it's gonna be a game changer also because using this technology, we'll be able to better take care of our patients with the right venue at the right time using the right personnel. And so really, really exciting ways that AI is gonna come in and transform the care. And, of course, on the administrative side, there are so many opportunities to use AI, whether it's to look at data and information, related to the business of our work. All of those opportunities are being looked into. Yes. Are there any areas of, risk or concern around the adoption of AI? Hallucinations that, inherently these new technologies have. But as we bring on more and more people, physicians, and other staff, onto the use of this, and as the machine continues to learn, we are able to reduce the chance of these biases and hallucinations. So the more data that comes in, the more we will be able to perfect it and make it more safe. But, initially, I have to tell you that there were things that, occurred as a result of the use of this technology that, the physicians had to go back and correct. For example, a recommendation for a different, diagnostic procedure was made, and it had nothing to do with what the patient came in for. And we see that with those types of biases and hallucinations. At least initially, it's very important for the physician to go back and review and assure accurate documentation of what actually was discussed in the exam room. Over time, those will be less and less. Yeah. Yeah. Okay. Excellent. You touched briefly on the administrative side of health care and some of the opportunities there. I'd like to switch gears and talk about the payer relationship and the payer dynamic. So you're in a a unique situation at at Kaiser, but how perhaps is are you using technology to help facilitate the integration of the different sides of the Permanente organization to smooth that administrative process for physicians and and your patients. Yeah. Thank you for acknowledging, Will, that we are in a unique environment because we are as, the Permanente's, we are aligned with our hospital and health plan colleagues. It's all one big organization that has aligned incentives. And in a integrated value based model, we get together, and we talk about the different types of technologies that can be brought in. And we have alignment and agreement on what to bring in, what not to bring in. And so from a payer status, we're in a very we're very fortunate to be able to work in a system that's fully integrated. It's value based. So we bring in technologies that actually help us with our aim, which is the quintuple aim, of being able to provide high quality care that is affordable. And it also assures that safety is and, patient perception and, service experience is good for all involved, including patients and physicians. And also equity of care is also addressed as we bring in these new technologies. And so in our system, it's it's, I think we're very fortunate and blessed to have that, alignment with our hospital helpline colleagues. So we make decisions together. Mhmm. And so there are really no issues related to our payer, and what technologies to bring in. And we use that technology on so many aspects of what we do, as I mentioned, in patient care. We're looking at other clinical applications of what to bring in, for example, areas such as retinal scans, that can be read and look for signs of diabetic retinopathy or, evaluation of mammograms for breast masses or tumors. And all of these medical groups are aligned, and we work closely with our hospital health plan colleagues to bring these these technologies in. So it works very well in our system. I suppose, when I when we meet, leaders from health systems who aren't in that kind of, arrangement, they are struggling with the payer dynamic. They're not quite sure what to do about it. Many of them, though, are hopeful that increased use of data and analytics and some of the principles of value based care, I suppose, will help them improve that relationship. Yes. Do you are there learnings from the kinds of dialogues that you're able to have within your system that you think other leaders who aren't in that situation could apply perhaps? Yeah. There are. And I'd be happy to share with you that I think if the focus in a health system is on creating value to the patient population and the communities as well as to the business, then things fall into place. So the learnings for us have been that bring in technologies, not just for the sake of technology and, making massive investments that will not have a return on that investment just for the sake of doing it, but that will actually create value in care of the patient. And then aligning the types of incentives that are required and important for all entities involved, including the hospital side, the insurance side, the health plan, as well as the physicians because, ultimately, when you adopt telehealth technology, it has to make sense for all of these entities. And if one is disadvantaged over the other, the adoption rates are just not gonna be there. So the learnings for us is to sit together, work together, and figure out what will bring a win win situation for the insurance side, the hospital side, the physicians, and, frankly, the most important is the patients. Yeah. And, so if we are able to create those incentives for everyone where they see the why of why we should adopt this particular technology and then measure the return on that investment and see and pivot if we need to, then, those are the learnings for us. And so we've pivoted very, comfortably towards telehealth and use of virtual video visits, telephone visits, even though in most health systems, that probably is not incentivizing on the physician side. But I will tell you that we figure out a way to make it a win win for all involved. Excellent. Thank you. Let's end with a with a look at 2025. I'm curious about what are some of the key initiatives that you're pursuing, and what what outcomes are you looking for from those initiatives? Excellent. The the key things that we're looking at in '25 are in the area of patient experience, and the experience and their perception of receiving excellent service. That's number one. The second, major initiative that we're working on is to improve access to care. Mhmm. And access is very challenged in multiple specialties across the country. But, certainly, our geographies are also have been impacted by access to care and assuring equity so that certain geographies are not disadvantaged over others. And the third area that we are looking at is technology and adoption of the new methods that we're bringing in, such as the AmbientScribe technology or adoption of the, for example, the retinal scan screenings that, look for diabetic retinopathy and pick up the signs early and adoption of telehealth, technology. And so these are the three areas that we're specifically looking at very strongly and with the aim of assuring high quality affordability, good service for our patients, excellent access to care, and also equity so that no particular geography is disadvantaged over the others. And we have specific metrics to look at all this. We look at member perception scores, member satisfaction scores of experience and service. We also have very robust access data systems, that, again, we use technology and AI to track and data analytics to evaluate it over time. We also look for the cost and the return on the investment. And so as I mentioned earlier, it's very important for they are not just to be a, investment for the sake of investment to say we adopt a technology. There has to be a return on that investment and improvement of outcomes as well as, improving perception of, experience, etcetera. And the last thing is to evaluate, adoption rates for the different technologies because if we bring in technology that very few people are adopting, then it's not really achieving what we want to. So we have very specific metrics that we track to look at our three, major strategic areas of focus for '25. Excellent. Thank you very much for that summary, and it's been lovely to talk to you today. Absolute pleasure. David. Thank you. Thank you. Thank you so much. Thank you.