In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of George Halvorson.
This profile was published in the December, 2013 issue of HealthLeaders magazine.
"I told the board that what I've been doing in healthcare, and for the past 30 years, has been a warm-up for what I need to do next."
George Halvorson says he's been preparing for this for 30 years: the next chapter of his life after his role as chairman and CEO of Kaiser Permanente.
He left his post as CEO on July 1, and steps down as chairman on Dec. 31 as head of a $55 billion annual revenue health plan and provider network with 9 million enrollees, 190,000 employees, which includes 16,000 physicians, and more than 600 medical facilities in eight states plus the District of Columbia. He will be 67 in January and, after 11 years with Kaiser Permanente, he says it's time.
"But I'm definitely not going into retirement mode," he says.
He's chairing the First 5 California commission, which uses state tobacco tax money to give children a better educational start. He says that children with low reading levels by the third grade are 80% more likely to end up in jail at age 18, 40% more likely to get pregnant, and 60% more likely to drop out of school than children with better literacy skills.
And he's starting and self-funding the Institute for InterGroup Understanding, to work on resolving the roots of intergroup ethnic conflict and racial bias in our communities and improve diversity within the workplace, global corporations, and their C-suite leaders. He sees increasing divisiveness—illustrated this year by the national animosity between those on either side of the Trayvon Martin incident—with "the kind of energy building in various places that have the potential to go to a very bad place."
Halvorson says that at Kaiser Permanente, he created a workforce that is 59% minority that managed to lead the way in healthcare. "No other major health plan in America has the staff and team anywhere near as heavily minority as ours, and we've turned that status into synergy rather than division," proving, he says, "that you can bring people together by creating common sets of values, agendas, and identity. The country needs to learn how to do that."
He's also doing more coaching for administrators, especially those who are women and minorities, on how they command authority in senior leadership positions so they are less likely to be sabotaged and fail to meet goals.
These pursuits, to which he's long wanted to devote more time, prompted him to make his decision.
"I told the board that what I've been doing in healthcare, and for the past 30 years, has been a warm-up for what I need to do next."
Looking back at his influence on healthcare, Halvorson says he doesn't "feel I need to provide more steerage there." He's paved the way.
He lists at the top of his accomplishments his push to create Kaiser's electronic health record, a $4 billion investment that now links all health information with laboratory tests and images, pharmacy, and physicians' notes, all in one place that any provider can access instantly in any Kaiser setting.
"That was a path we weren't on when I got to KP, although we were building pieces of it. We weren't looking at our opportunity to build an interconnected system, and people didn't believe it could be done, that the idea we should be completely internally paperless and interconnected was impossible because no one had ever done it. We were used to all those systems being in unrelated silos."
For example, each imaging center only had information about the images it created for just those patients who received imaging services at that center, and those images often required manual transport to be reviewed.
"Now, we connect the imaging system into the overall medical record, the whole thing is electronic, and so we can electronically flow a digital x-ray directly to the room a doctor is in, to any specialist in our system, or wherever the patient ends up."
All Kaiser providers can also pull patient medical records up on their smartphones, "wherever they are in the world," and Kaiser experts comb through medical journals for best practices to make decision tools available electronically as well.
"We're way ahead. Most doctors in the world would kill for this system."
Now the federal government is trying to follow Kaiser's lead with the creation of the meaningful use incentive program to promote electronic health records throughout the country's healthcare delivery systems, Halvorson says.
Halvorson says that massive amount of data has given Kaiser a way to understand the quality of care, enabling it to create a culture of continuous improvement. By learning where problems occur, the system makes changes.
"You don't ever get to a point and declare victory," he says.
"We dropped the death rate for sepsis to 20%, and then 15%, then 10% and it's now less than 10%. The rest of the country averages more than 5% of patients getting pressure ulcers—painful, disfiguring, and sometimes fatal—but we got ours to 1% across three dozen hospitals. And we have the lowest stroke rates and lowest HIV death rates in the country, half the national average."
Most of Kaiser enrollees use the electronic system, doing so more than 100 million times per year to schedule appointments, get lab results, exchange e-mail with their doctors. That, too, Halvorson says, was a project that others in Kaiser said "we probably shouldn't be putting resources into."
A third accomplishment about which he takes pride is the way in which KP has shared what it knows with others outside the organization. "We didn't just make a success, but we told others what we had done, creating an expectation that it can be done."
With all of this accomplished, Halvorson has been busy recording it in a collection of books, which he says "help educate people outside KP about healthcare reform issues. One explores the three "B" reasons for healthcare disparities, which he explains are biology, behavior, and bias.
"African Americans are half as likely to get an intervention quickly; that's not biology or behavior, it's just bias and needs to be fixed. But African American women are more likely to get multiple sclerosis. That's biology."
Another book is on healthcare costs, which he calls "a recipe for the next stage of healthcare improvement," in which payers begin paying for care "by the package instead of by the piece."
Halvorson also plans to spend more time fly fishing and on boats—power and sail—that he keeps at his waterfront homes in Minnesota and Sausalito, Calif.