Sidney Garfield, MD, and industrialist Henry Kaiser first met in the 1930s while providing support to workers building the Colorado aqueduct in Southern California. The two developed a prepaid system to help see patients no matter their race, ethnicity or insurance status.
In 1945, they launched The Permanente Health Plan with the same premise—among other things, hospitals were not to be segregated. Eight years later, the name evolved into Kaiser Permanente, and 71 years after that, the same principles of equitable care remain.
“As a health care delivery organization, we need to be focusing on what our members want and what our members need," said Leong Koh, MD, president and CEO of Northwest Permanente. “We have to be willing to train ourselves and be able to take care of our patients in this culturally responsive way that they are telling us they want.”
One way that Northwest Permanente does that is by screening all patients for social drivers of health. Community health workers connect with anyone who is identified for a need and create a customized action plan to provide necessary resources. More than 5,000 people have benefited from the program since its launch in 2020.
Since the program's inception, Northwest Permanente has seen a triple-digit reduction in hospital days per 1,000 members, Dr. Koh said. He talked about that statistic along with Northwest Permanente's approach to culturally competent care in a recent episode of “AMA Update.”
Northwest Permanente is the largest independent interspecialty medical group in Oregon and Southwest Washington, with more than 1,500 physicians and other clinicians. The group is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Initiatives lead the way
Northwest Permanente has several major initiatives that support its efforts to advance equitable care.
One initiative is Northwest Permanente's “Salud en Español” model of culturally and linguistically inclusive care for Spanish-speaking patients. Physicians, medical assistants and nurses who all speak fluent Spanish provide care to much of the medical group's Hispanic and Latino populations.
For this population, “we've done some very innovative approaches. For example, group visits for our patients with diabetes," Dr. Koh said. "Our physicians are really improving that care experience for our patients, and we've seen some fantastic outcomes in A1c control and also nutritional status.”
The latest initiative is the medical group's leadership in the newly launched Center for Black Health and Wellness. The primary care center is designed to improve the health of Black members, elevate their care experience, and adopt culturally responsive care. The center is led by a team well versed in providing culturally competent care to Black patients and their families.
“Data has shown that when a clinician looks like you and understands your culture and history, it really does have a significant impact not only on lifespan but also adopting that proactive care that we're all seeking here,” Dr. Koh said. “This will have emphasis on screening and prevention with the goal of care not only for our patients, but we want to spread the best practices throughout the entire community as well.”
Advancing equitable care is an iterative process, and it's one that always needs refinement. For example, Northwest Permanente has made great strides in closing the gap in high blood-pressure rates between Black and white patients.
“We've been able to close that gap by over 50%,” Dr. Koh said, “but a gap still exists, so we still have a lot of work to do.”
Advice for health systems
Dr. Koh had two suggestions for other health systems looking to improve their cultural care: Know your data and examine your patients’ experience.
“You've got to know your data. You've got to take a look at it and have honest conversations about what you see there in terms of health equity,” he said. “You also have to look at the experience. That care experience, I believe, is equally important as those quality measures.
“How we actually care for our patients and how they experience the care is what embodies that trust between the care team, health care clinician, and the patient,” Dr. Koh added.
Evaluating data and talking with patients is critical to developing a more culturally competent health care system, but knowing what is needed is only part of the process, he said. You also need to have the courage—and the leadership—to try something new.
“Health care and the way we deliver care cannot be static,” Dr. Koh said. “We need to adjust our current practices and establish new ones. This is part of the equation of building trust with our members."
“AMA Update” is your source for physician-focused news. Hear from physicians and other experts on trending public health concerns, practice issues and more—because who’s doing the talking matters. Catch every episode by subscribing to the AMA’s YouTube channel or listen to all AMA podcasts at ama-assn.org/podcasts.
