Dr. Edward Ellison, Executive Medical Director, Permamente Medical Group

Dr, Ed Ellison

Mark Masselli: This is Conversations on Healthcare , I’m Mark Masselli.

Margaret Flinter: And I’m Margaret Flinter.

Mark Masselli: Well Margaret we have seen a spade of public health concerns
dominate the news of la ke , the water crisis in Flint, Michigan is still unfolding.

Margaret Flinter: Well that’s right Mark and there is still a state of emergency in Flint,
Michigan . They had switched the source for Flint’s water supply in a move to save
money but the result – the river’s much more toxic water was fed through antiquated
pipes into homes and businesses in the region during the trigger period and that caused
Lead to leach into the area’s tap water and that has created a major health crisis.

Mark Masselli: The damage may have been done, even small amounts of Lead can
cause permanent brain damage in children.

Margaret Flinter: Well the truth is Mark that we may not know for years just how much
damage has been done. Many children who are exposed to toxic lev els of Lead don’t
show immediate symptoms but serious problems can emerge later as they get older
and much will need to be done to mitigate those health and perhaps developmental
issues as well as re - earn the public’s trust. So in the meantime most of the residents ,
they are living and bathing with bottled water.

Mark Masselli: And mosquito borne zika virus has been cutting a wide path through
South and Central America as well as the Caribbean sparking health warnings from the
CDC, now the World Health Or ganization and the National Institute of Allergy and
Infectious Diseases .

Margaret Flinter: The World Health Organization is warning women of child bearing
years to avoid these regions or if they must go, to take extra precautions.

Mark Masselli: It pose s a very real threat to pregnant women and their offspring, and
it's something for health clinicians here to keep an eye on Margaret.

Margaret Flinter: Speaking of health clinicians the way they will train in work to meet
21st century health needs is chan ging and that is something that our guest today is very
well versed in. Dr. Edward Ellison is leading a team from the Kaiser Permanente Health
System in creating a new medical school and a new kind of medical school.

Mark Masselli: Focusing on team care, patient centered care, value - based care and
better outcomes for the entire population.

Margaret Flinter: We will also have a visit from Lori Robertson, the Managing Editor of
FactCheck.org , always on the hunt for misstatements spoken about health policy in the
public domain.

Dr, Ed Ellison

Mark Masselli: And as always if you have comments , please find us on Facebook or
Twitter ; we love hearing from you.

Margaret Flinter: We will get to our interview with Dr. Ed Ellison in just a moment.

Mark Masselli: But first here is our producer Marianne O'Hare with this week's headline
news.

(Music)

Marianne O'Hare: I'm Marianne O'Hare with these healthcare headlines. The third
open - enrollment under the Affordable Care Act has come to a close without much
fanfare. The administration had been hoping to entice more Hispanics to sign up for
coverage during this third go - around , across the country 20.9% of Hispanics a re
uninsured in the US compared to 12.7% of Blacks and 9.1% of Whites. Meanwhile, the
national uninsured rate is at an all time low.

Meanwhile a Kaiser Foundation poll shows in spite of public rhetoric against the
healthcare law, most people are satisfied with the healthcare they are receiving. The
Kaiser Family Foundation poll revealed 71% of insured adults younger than 65
considered the healthcare services they received to be either excellent or good values
given its cost , and even though many insurance plans limit networks of hospitals and
doctors as well as procedures that are covered.

The World Health Organization is urging women of child bearing age to avoid much of
South and Central America in the wake of the zika virus outbreak. WHO officials
dete rmined there is still much that’s not known about the virus and whether it's directly
linked to serious spikes in microcephaly , babies being born with smaller heads and
brains. Officials are cautioning if women of child bearing years must travel to the
re gion, they should take extra precautions.

And teens are smoking less but feeling more anxious than their predecessors according
to a recent study by the Substance Abuse and Mental Health Services Administration .
The annual survey of teen behavioral health issues show the percentage of adolescents
who smoked or binged drank in 2014 actually dropped while pot use went up about a
few tens of a percent. The 2015 Behavioral Health Barometer did show a jump in the
number of teen suffering from depression. Howe ver, the report noting 11.4% of
adolescents 12 - 17 had at least one major depressive episode, about an estimated 2.8
million adolescents. The report noting the need for better screening of depression and
better treatment options for teens as well. I am Ma rianne O'Hare with these healthcare
headlines.

(Music)

Dr, Ed Ellison

Mark Masselli: We are speaking today with Dr. Edward Ellison, Executive Medical
Director and Chairman of the b oard for the Southern California Perm a nente Medical
Group. Dr. Ellison is also the national sponsor of recently announced Kaiser
Perma nent e School of Medicine. Dr Ellison is a Family Medicine Physician who has
served in various roles at Kaiser since 1984. He earned his undergraduate degree at
Duke, his medical degree at the University of Virginia. Dr. Ellison , welcome to
Conversations on Healthcare.

Dr. Edward Ellison: Thank you so much for having me, it's a pleasure.

Mark Masselli: Yeah. Kaiser I think was a national leader in the devel opment of
integrated health systems driven by coordinated care , c an you tell our listeners about
Kaiser’s evolution from a young upstart health organization to this national model of the
value - based care delivery?

Dr. Edward Ellison: Back in the great dep ression , really the first Permanente physician
was Dr. Sidney Garfield prior to deliver care to the workers who were building the
California aqueduct . So he was trying to think about how can I staff my clinic and how
the supplies I need and he took on the idea of pre - payment , he went to the workers and
said, for a modest fee each week if you pay me I will provide all the care that you need
and I thought that was a great idea and with that he was able to assemble a clinic , a
staff to take care of the worker s . And then as he was walking across the work site one
day, he saw there were nails on the ground so the idea of prevention was born . And
when World War II came along and Henry Kaiser was asked to build battleship for the
very rapid pace, then he asked his good friend Sidney Garfield to come and provide
care for the workers at the shipyards.

And so that marriage of Permanente physician and Henry Kaiser and his resources
brought about this care delivery model that was based on prevention and prepaid care.
The entity is developed so that we had a nonprofit hospital health plan , a system which
is the Kaiser side of the houses , and then what makes our system a nd our model really
special I believe is that we do have the separation so the Hospital/Health Plan is a
nonprofit which means the revenues go back into caring for the members and then
independent autonomous self - governing medical groups so the physicians are in charge
of making the care delivery decisions, the quality decisions . It's that alignment of vision
and values that allows us to succeed in a different, that the care is physician led and yet
the physicians are very much part of a team and the team is integral to caring for that
patient, that our care is technology enabled connected by this electronic health record,
that we are also focused on the communities that we serve, respecting the care across
the continuum helps us to ensure the best outcome from everything, put all those things
together it provides the care model that I believe answers a lot of the questions that are

Dr, Ed Ellison

asked today about how can healthcare evolve to better serve our country and the
people of our country.

Margaret Flinter: Well Dr. Ellison now you have got another kind of template for the
organization . Your CEO, Bernard Tyson has announced the formation of a new medical
school one that’s based entirely on the Kaiser Permanente model of care saying the
time has come to rethink th e way we prepare medical students for a value - based care
system. So talk to us ab out what you and your colleagues in the organization identified
as really missing from the current way that medical training is happening in this country
and why you felt an entirely new approach wa s called for?

Dr. Edward Ellison: Well I think we all rec ognize d that we are going to probably the
most seismically significant change in healthcare in our country’s history . And the
answer for that change is not about running faster on a wheel , p hysicians are struggling ,
burnout is at an epidemic proportion pr opositions and so it's really about transforming
care. And we need to prepare physicians for this new world , for this ability to practice in
the environment that I was describing a few minutes ago, one that does understand the
physician’s role as both lea der and team member, one that does utilize technology and
yet also understands elements of culture responsive care and social determinants of
care. So it's a situation where we are working together to help [ Inaudible 00:08:51]
understand how we can both t ransform medical education and the training of physicians
to meet this need for the future.

We have brought together to the last number of years , recognized medical educators
from across the country some of whom are from some of the most prestigious medica l
schools in the country to help advise us and help us think about how we might do this
because we did feel we had a lot to bring to the table in this regard and they were very
encouraging to us. They said, look we are all in this together and we all need to think
about how we can transform and we can do it from where we stand, and you as part of
this coordinated integrated model of care delivery bring a unique perspective so that’s
really how we came about thinking in the first place that we had a lot to bring to
physician education it was the time was ripe and again those elements of being patient
centered, evidence based, physician lead as well as part of a team, being culture
responsive and using technology and understanding the social determinants of c are and
how we implement those elements into how we serve a diverse population, how do we
create increased diversity among medical schools to better reflect the populations that
we serve so all of those elements t ogether seem to fit well with our learnings and our
model something that we could contribute on the national stage to ongoing medical
education.

Mark Masselli: You know we have a lot of nice hand in global relationship and as you
just mentioned you have r eally gone out and brought some of the best and brightest

Dr, Ed Ellison

people in the country together as you have been thinking about medical education and
certainly in the area of quality improvement . We had Dr. Christine Cassel , a guest on
our show recently and she left her leadership post at the National Quality Forum to
become the planning dean of the Kaiser Permanente School of Medicine and could you
tell our listeners why Dr. Cassel was such a good fit for the post?

Dr. Edward Ellison: Well as we all know it is about quality. It's about making launch
better and improving quality. So Dr. Cassel has great perspectives not only as her
leadership role formerly in the National Quality Forum but as you know with the
American Board of Internal Medicine, American Colle ge of Physicians and she is also
formerly the dean of the School of Medicine and vice president for medical affairs at
Oregon Health and Science University so she has that background. On a more
personal level, we know Chris from her role as a former board member for Kaiser
Foundation Health Plan Hospitals. And so she understands, she knows the
organization so she brings that national perspective as well as an understanding
connectivity to Kaiser Permanente. We have a poor planning team for the School of
Medicine that also has representations from Permanente , multiple Permanente
physician leaders who are very engaged in medical education and so Chris is joining
that team and it's a great evidence of collaboration that is what our organization is
about.

Mar garet Flinter: Dr. Ellison so concept of team work, team based care, team vitality
these evolve certainly entered the lexicon of 21st century healthcare and maybe even
medical education, tell us what you are going to do, what the Kaiser School of Medicine
approach is going to be to really embed this concept of team work, and with team work
comes certainly inter - professional collaboration.

Dr. Edward Ellison: At Kaiser Permanente we absolutely view medicine as a team
based sport , all voices matter in carin g for patients, we all have something that we can
do to help elevate the care of the member. So for example, we have systems in place
such as the Proactive Office Encounter where at every touch point that a patient comes
into our system , we have to identify if they have care gaps that need to be closed
perhaps, they are overdue for mammography or the colonoscopy and so we are able to
engage the entire healthcare team and helping to advise the member of t h is need and
to arrange for that care to be del ivered.

One of my favorite stories about that is a patient name, Mary Gonzalez [PH] who came
into see her Allergist and the receptionist noted that Mary was overdue for her
mammogram. So Mary was, well I will get to it, I will get to it. The receptionist was
insistent said, no we are going to schedule that mammogram for you now, and so they
found an early cancer and fortunate ly because of that Mary was cured. And so we have
many many examples of how the team all comes together using this information that

Dr, Ed Ellison

allows us to understand where each patient is in their own journey . And in primary care
and specialty care we know that utilizing advance practice providers and n urse
practi tioners and PAs using RNs, medical assistants, social workers, physical therapist,
pharmacists that we all have a role to play.

It's also a great way to distribute the care appropriately across the continuum so we
maximize all of our talents in a coordinated way it improves the outcomes and it also
helps us to leverage everyone’s skills and talents , especially in a day and age when we
know that there are shortages particularly for physicians and particular primary care
physicians.

Mark Masselli: We are speaking today with Dr. Edward Ellison, Executive Medical
Director and Chairman of the board for the Southern California Permanente Medical
Group . He is also national sponsor of the recently announced Kaiser Permanente
School of Medicine. Dr. Ell ison talk about something that will surely be primary tool for
care delivery for healthcare providers in the future and that technology and you know
this is a new generation of people communicating in different ways, tell our listeners
about how training s tudents to navigate health information technology are going to play
a role in the curriculum and the cultivation of the next generation of primary care
providers?

Dr. Edward Ellison: You are right. The millennial s, the generation coming out today is
so savvy with all aspects of technology and our members, our patients are also very
savvy and increasingly looking for what they want, when they want, how they want it,
right. So when you can apply systems of care and electronic health records so that
every touch point allows you to know that patient’s history, what their needs are in that
current moment , to bring all that together it's very powerful. Putting these tools in the
hands of physicians who understand how t o apply them and systems with care and as
part of a team magnifies the ability to use that data in a really powerful way.

But what's also exciting is what it means to the patient. So as a Kaiser Permanente
member for example we have an online system calle d kp.org where you can book
appointments and you could look up your lab results, you can email your doctor. And
so it begins to put more powers and opportunity in the hands of the patients. I am a
member also, right so I had had my labs done and when I a m in my way home from the
lab, I get an email that says , your lab results are ready and I can go online and check it
without even having to contact the doctor’s office and so that’s pretty powerful. We can
connect specialist to primary care physician and take care of the patient’s need without
having to refer to the specialist for the right condition so it's more convenient for the
member, better use of everyone’s time.

Dr, Ed Ellison

But I also want us to think about innovation in a different way. We know that the most
powerful change is behavior change and if you can understand how better to meet the
patient from where they stand, those are ways in which we can help to impact the
patient for the better in the way that they manage their health. Those are places that we
can begin to impact understand your needs and help to engage you in ways that will
improve your health and engage those around you in supporting you.

Margaret Flinter: Well Dr. Ellison so as I think about your medical school I can't help but
wonder what else are you thinking about in terms of education and training for the other
people on your team , are you envisioning developing schools of nursing, social work,
what are the kinds of education training are you thinking about as part of building this
team of people?

Dr. Edward Ellison: So we have residency programs already within our system of care.
We graduate more than 600 residents of our own . We have thousands more who come
into affiliate programs. We have a number of our physicians who are clinical faculty at
medical schools in our communities across the country. We have nursing students ,
nurse practitioner students who rotate with us. That whole focus on education and
resource is very much part of who we are.

Mark Masselli: How are you focused i n on making sure that you have diverse primary
ca r e practitioners who represent the various populations that you serve?

Dr. Edward Ellison: It's one of our fundamental values and that sets a tone and sets a
culture and culture is everything. So Hippocrat es Circle goes to middle school and high
school students, particularly those from underserved communities and under -
represented communities who have an interest in medicine and we link them with
mentors . So the missing piece in this art for us was the medical school. We are very
focused on closing gaps and disparity and we have been able to, we are not there yet
but more successfully than most in the country been able to begin to close care gaps in
hypertens ion control for example in the African American population and how does that
connect also just to wellness and resilience. So it's all connected. How we pick the
best care of our members so it's the medical schools and natural extension of that work.
We intend for our medical students to go in the communities to visit their patient ’s
homes, we have programs like the promoter’s programs where medical students and
residents go into the community, go into their patient’s homes to understand how they
can bes t meet that patient’s need and to learn more about the community that they
serve.

We have a national diversity inclusion council that helps us to understand how we can
promote diversity inclusion across the organization, how that impacts positively, how it
brings in, as we talked before the social determinants of care and by vice versa it would

Dr, Ed Ellison

be almost like a virtual cycle, I beli e ve. We are also considering scholarships for
students from under - represented and underserved communities so that we can
advan ce the inclusion of students who might otherwise not have that opportunity to
attend medical school.

Margaret Flinter: We have been speaking today with Dr. Edward Ellison, Executive
Medical Director and Chairman of the board for the Southern California Ka iser
Permanente Medical Group and national sponsor of the recentl y announced Kaiser
Permanente School of Medicine . You can learn more about their work by going to the
website kp.org/share or follow them on Twitter @KPShare. Dr. Ellison, thank you so
much for joining us on Conversations on Healthcare today.

Dr. Edward Ellison: Thank you ver y much, my pleasure.

(Music)

Mark Masselli: At Conversations on Healthcare , we want our audience to be truly in the
know when it comes to the facts about healthcare re form and policy. Lori Robertson is
an award - winning journalist and managing editor of FactCheck.org , a nonpartisan,
nonprofit consumer advocate for voters that aim to reduce the level of deception in US
politics. Lori what have you got for us this week?

Lori Robertson: Well another open - enrollment period for the marketplace plans of the
Affordable Care Act comes to a close at the end of January. So let's take a look at the
projection s for how many would sign up, how many actually have signed up and the
overall numbers on the reduction and the uninsured under President Obama.

As of June 2015 9.9 million people had secured their own insurance for the state and
federal insurance marketpla ces. Last October, the Secretary of Health and Human
Services predicted that number would increase only a little in 2016 moving up to 10
million people. The Congressional Budget Office’s projection are higher than that, it
said in January that it estimat ed a 13 million people would have exchange or
marketplace coverage per month on average in 2016. The vast majority of those , 11
million would receive subsidies CBO said, but those numbers are lower than what CBO
had said in the past. It had previously pr ojected that 21 million would have exchange
plans in 2016. In its recent report CBO said that most of the unsubsidized folks whom it
may no longer expect to buy exchange plans would instead buy insurance directly from
an insurer. Medicaid coverage meanwh ile has exceeded CBO’s previous estimates.
By 2025 CBO now expects about 14.5 million people to be on the Medicaid role due to
the ACA that’s 3 million more than what CBO had estimated just last august.

Looking at the overall numbers under President Obama , we turn to the National Health
Interview Survey conducted by the Centers for Disease Control and Prevention during

Dr, Ed Ellison

the first six months of 2015 the most recent data available, about 28.5 million people of
all ages said they were uninsured at the time of being interviewed, that’s down from
43.8 million for all of 2008. It's a decrease in the number of uninsured of 15.3 million
people since Obama first took office. The number of uninsured for 2010, the year the
ACA was signed into law was actually higher than in 2008, 48.6 million people making
the drop in the uninsured with the ACA higher than the reduction over Obama’s entire
time in office, and that’s my fact check for this week. I am Lori Robertson Managing
Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact, that you would like checked, email us at
www.chcradio.com . We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Healthcare.

(Music)

Mark Masselli: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Currently about 2 million people
around the world are suffering from End Stage Renal Disease or Acute Kidney Failure.
There are basically two options for these patients; kidney transplants which are costly
and severely lacking in available donor kidneys or dialysis, also costly as well as time
consuming , r equiring patients to undergo blood filtering treatments at medical facilitates,
lasting up to five hours per treatment, costing about $90,000 per year.

A Montreal teen science project just may pave the way for another solution. Anya
Pogharian , developed a portable home dialysis kit that cost about $500 to produce far
less than the $30,000 dialysis machines currently in use. Her idea inspired by her high
school internship working at a Dialysis Center in Montreal.

Anya Pogharian : When you have to make it a way to the hospital which is a problem for
a lot of patients, it's not necessarily easy to go three times a week to the hospital
especially because maybe limited mobility.

Mark Masselli: Pogharian says hundreds of hours of research led her to build a
pro totype of the dialysis machine which is about the size of a typical game board but
pumps and purifies blood just as large scale dialysis machines do. Her invention has
earned her numerous awards and scholarships and the attention of one of Canada’s
key he matology labs now supporting her continued research. She hopes this device
can be developed throughout the world, especially third world countries where
significant percentage of the population doesn’t have access to either transplant surgery
or dialysis leading to early deaths of those patients.

Dr, Ed Ellison
Anya Pogharian: 10% of patients living in India and Pakistan who need the treatment
cannot afford it or can't have it and anyway it's not accessible so that’s really what
motivated me to continue.
Mark Masselli: A relatively cheap, portable, easily assembled dialysis machine that
could alleviate the cost and treatment hurdles of ongoing dialysis, keeping patients
healthier longer, allowing them to be treated at home, now that’s a bright idea.
(Music)
Margaret Fli nter: This is Conversations on Healthcare, I am Margaret Flinter.
Mark Masselli: And I am Mark Masselli, peace and health.
Conversations on Healthcare, broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
Health Center.