In Lessons Blog

The Permanente Medical Group (TPMG), the nation’s largest medical group, turns 70 this year. Since 1948, it has earned a reputation for cutting-edge innovation and superior quality outcomes.

It was therefore a privilege and an honor to keynote the quarterly luncheon of the TPMG Retired Physicians’ Association on Saturday, Feb. 10.

The purpose of my invitation was to discuss my recently published book Mistreated: Why We Think We’re Getting Good Healthcare – And Why We’re Usually Wrong, and to offer my current perspectives on ways to improve the American healthcare system.

There were many familiar faces in the crowd of more than 300, and I thanked them all for the contributions they made across their careers. Combined, the association members account for more than 10,000 years of medical excellence in clinical practice.

I began with the solution, a roadmap for solving the challenges facing American healthcare, based on the success of The Permanente Medical Group, with its 9,000 physicians and 36,000 staff. I highlighted the excellent outcomes achieved through the medical group’s efforts on behalf of 5 million Kaiser Permanente members on the east and west coasts. I described how implementing the “four pillars of transformation” – (1) integration, (2) prepayment, (3) advanced information technology and (4) physician leadership – would allow health systems to save hundreds of thousands more lives each year, while offering patients access and convenience beyond what’s available almost anywhere else in the United States today.

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Further, I stressed the importance of primary care and how, through their passion for preventive medicine, TPMG physicians have significantly reduced the risks of patients dying from heart disease and cancer. I highlighted the excellence of its specialists, and how the medical group had achieved remarkable clinical outcomes for patients by creating centers of excellence with high volumes in areas like cardiovascular surgery, neurosurgery and cancer care.

When the Q&A session began, dozens of hands shot up in the air, and one of the first questions pertained to the new healthcare venture forged by Amazon, JPMorgan Chase and Berkshire Hathaway. As I explained in my recent article, the trio has the clout, cash and connections to disrupt American medicine, with serious implications for Kaiser Permanente and all of the healthcare industry.

Another question pertained to the retirees’ concerns over Medicare and its future. I explained that the economic challenges facing American healthcare are, indeed, cause for concern. Recent Congressional legislation to reduce taxes and increase federal spending will add to the deficit and could lead to further reductions in Medicare funding. Depending on which party controls the U.S. House and Senate following the 2018 midterm elections, we could see a shift toward a different system, one that either makes Medicare available to a broader demographic or one that shifts funding from the government to the individual through vehicles like Health Savings Accounts (HSAs). Either way, the pressures on healthcare will continue to increase, requiring doctors and hospitals to provide higher quality medical care at lower costs.

Finally, I was asked my opinion on the next big breakthrough in healthcare. Technology, I replied, particularly video and Artificial Intelligence (AI). Both will have a tremendous influence on the future of medicine. Telemedicine can improve quality and patient convenience while reducing office visits by 30%. Meanwhile, AI serves to increase quality and drive down costs. Ultimately, the combination could help all doctors match the outcomes of today’s best physicians.

I closed by expressing my gratitude for the remarkable contributions the physicians in the room have made over the past half century. I congratulated them on helping the nation to see what is possible through integration, capitation, advanced information technology and physician leadership. Finally, I assured them that the current generation of TPMG physicians are outstanding, hardworking, mission-driven and exceedingly well-trained. They won’t let the successes of the past diminish.

I would like to offer my special thanks to the luncheon coordinator Ron Bachman, along with the current RPA officers, including: Fred Barnes, President; John Igo, Vice President; Art Levit, Secretary; and Kris Steensma, Treasurer. There is nothing more important for organizations like Kaiser Permanente and all of American healthcare than to embrace and celebrate the values and vision that began with our medical group founder Dr. Sidney Garfield more than seven decades ago.


Dr. Robert Pearl is the former CEO of The Permanente Medical Group, the nation’s largest physician group. He’s the bestselling author of “Mistreated: Why We Think We’re Getting Good Health Care–And Why We’re Usually Wrong” and a Stanford University professor. Follow him on Twitter @RobertPearlMD.

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