Expert Opinion: Christine Paige, PhD, Senior Vice President Marketing & Digital Services, Kaiser Permanente
If you ask people what Kaiser Permanente is, chances are they will say, “I’ve heard it’s one of the very best health insurance providers in the United States.”
That is correct, because Kaiser is deeply committed to delivering top-notch plans and service to its members. But Kaiser is much more than that. It is, in fact, a unique nonprofit organization that offers not just health insurance, but a network of top-quality clinics and hospitals that are staffed by Kaiser-affiliated physicians and caregivers. Kaiser, which was founded in 1945 by industrialist Henry J. Kaiser, has grown to be the largest managed-care provider in the United States. Kaiser currently has more than 12 million health plan members, more than 22,000 physicians, and more than 55,000 nurses who provide services in more than 40 medical centers and about 700 Kaiser medical facilities. Kaiser Permanente is, in fact, a completely unique organization that brings unique excellence to everything it provides.
Christine oversees advertising and brand management, marketing content and communications, direct and digital marketing, consumer and customer insights, customer value reporting, and proposal development. Paige is also responsible for leading Kaiser Permanente’s consumer strategy, focused on building excellent consumer experiences. She has also led the development of e-commerce capabilities and web and mobile clinical features for Kaiser Permanente members.
In these capacities, Christine has been at the forefront in establishing Kaiser Permanente as an international leader in the use of personal health records and informatics to enhance and expand affordable, high-quality care and service. She was instrumental in developing the landmark “Thrive” brand advertising campaign, now in its fifteenth year. The award-winning campaign embodies Kaiser Permanente’s commitment to total health, through an integrated health care delivery system, focusing on preventative care and the empowerment of members to maximize their total health — mind, body and spirit.
After joining Kaiser Permanente in 1988, Christine has served in a variety of roles, and has led the organization’s marketing functions nationally since 1999. She is a frequent speaker on the topics of technology, consumer engagement, and marketing.
Prior to joining Kaiser Permanente, Christine was a political science professor at the University of Notre Dame and Southern Methodist University, specializing in comparative political development, and Italian politics.
Christine received a Bachelor of Arts degree from the University of Southern California and master’s and doctoral degrees in political science from the University of California, Berkeley.
Christine Paige On Kaiser’s Incentives and Orientation
We stay focused on the health outcomes and satisfaction of our members, rather than on factors like our transaction volume. And to me, that orientation is the key to everything. It keeps our people focused on what matters, rather than on simply what is doable. And it makes it easier to focus on the patient care experience, because considerations like transactional activity and financial data fade completely into the background and become invisible to the people who are in the system.
That orientation was easier for us, because we were an early believer in maintaining electronic records for our patients. Because we were an early mover, it was easier for us to make the patient experience central to what we do. We understood that the benefits of investing in patient data would accrue back to us.
And globally, we got that right as an organization. Whereas for the rest of the industry, the barriers to early investment were often about who was going to put up the dollars to invest in technology, and what the benefits would be. As a result, for those companies there were all kinds of aspects of the care experience that never became integrated.
On How Technology Relates to Different Populations
I think there are several different dimensions to thinking about how technology relates to populations and their health management. With the right technology enabled, screening for preventative health became a bedrock of our operations. It is how we are able to catch cancer early, prevent heart attacks, and make very significant improvements in people’s lives.
It depends on making sure patients are screened, making sure we know what their risk factors are, so we can intervene earlier with them. We have a digital backbone to our operations.
We have numerous stories of people coming in to get their eyes checked, for example, but the receptionist reviews their records and says, “Did you know you are really overdue for your mammogram?” And the patient will say, “yes I know, I will get to it.” But and the receptionist says “Well, can we make that appointment, I’ll pull it up right now . . .”
We save lives that way. That’s the importance of having disciplined execution tied to data and preventive care. We can cover an entire population in a way in which digital tools help the provider, and help everyone in the system execute on that. So that’s a very important point.
On Patient Engagement
In The Digital Health Revolution, you point out that in years past, it was difficult to engage people to become involved in managing their data and their health. Yet there are some segments of the population that are active in self-management. We call them health-seekers or information-seekers. They will read everything, and they will research everything. right? And you know, that is 20% maybe 30% of the population. But the rest of folks also want their care experience to be simple and easy.
In the early days when we were simply offering information online, we learned that it was difficult to engage with people. Then we began to offer transactions, time-saving opportunities. People could manage their prescriptions online, make appointments and message with their physicians. As a result, we have grown to the point where 73% of our members are registered online with us, which leads the industry by a very big margin.
Measuring the Results of Online Engagement
We are a very evidence-based, research-oriented organization. One thing we investigated early on was the question of whether patients who are engaged online actually become healthier.
In one study, we investigated whether our members who are online have diabetes have better blood sugar control than members do who are not online. When we investigated, our data showed very clearly that patients who are engaged online have much better blood sugar control than patients who are not online.
Why would that be? It is because they are more likely to make appointments with their physicians, more likely to keep up with their medications, and more likely to engage in a whole range of healthier behaviors. So we certainly see clinical benefits as well as higher satisfaction levels for people who are engaged online.
Another thing our research has found is a business benefit, because the people who are engaged online are more loyal to Kaiser. We have higher retention among those members then we do with people who don’t engage.
On Developing Technology In-House vs. Outsourcing
One example of sharing technology is that we use Epic 4’s services for electronic medical record-keeping. That company provides the underlying functionality that is part of what’s on our member portal. Our digital health monitoring modules come from Johnson & Johnson. Some of our health content comes from Healthwise, and we have a long-running relationship with American Specialty Health. We have worked cooperatively with Omada Health to provide some of their diabetes options for our members.
How do we decide what to bring in from the outside and what to develop ourselves? We go through a technology evaluation process that is essentially like our pharmaceutical and therapeutic evaluation process.
On How Potential Partners Come to Kaiser’s Attention
When companies contact us with an interesting technology that might be good for us, we engage in what is essentially a process of gap analysis. In other words, does what they are offering help us better meet a specific need of our members?
We know, for example, that some of our members could use help with transportation they need to get to their appointments. So when someone comes to us with an Uber-like app that could potentially be incorporated in plans, we might consider that from the perspective of whether it improves our capabilities, or introduces a new option that would be meaningful to our membership.
On Social Determinants
Social determinants have been a major area of focus for us for seven or eight years now. Because we are a not-for-profit organization, we have a mission around community health and a long history of making investments in programs that promote health, through nutrition, community health clinics, a wide range of things.
In the last few years, we have focused on a wider range of activities like making sure that our lower income members are signing up for programs that will benefit them. We have just announced a $200 Million investment in addressing homelessness through impact investing. So it is fair to say that we want to improve health at both the individual and the community levels.
I am sure you have seen studies that show that people who live in specific Zip Codes often suffer from the same conditions. We look at patterns like that and see that addiction or other factors within a specific area could be improved with the right kind of initiatives from us.
For more than a decade, we have seen opportunities that we have been able to take advantage of because we have been part of the digital world.
On Results in Fighting Smoking
Our members have among the lowest smoking rates of any health organization.
A big reason is that it is virtually impossible for members to get through any interaction with us without being asked whether they are still smoking. It is a question we focus on as part of our basic intake procedures, but it something we ask in virtually all points of patient contact. We ask about alcohol use. We ask about exercise, which we call a “vital sign.”
And incidentally, thanks to our data, we have among the lowest rates of opioid abuse among our members. Our patient records are critical there. We can look at patients’ prescription records to evaluate whether patients have been overusing painkillers. And our data assures that our members cannot get their prescriptions filled at multiple pharmacies, or visit several different physicians to get refills.
Many people and organizations have data that is really robust. But the issue is really how you use it, right? And how you turn it toward solving problems.
On How Kaiser Will Be Using Data in Five or 10 Years
There are thousands of apps out there that are meant to do the right kind of tracking, issue reminders and do more, and they will continue to grow in number and scope. We’ve done some work with telephonic health coaching around nutrition, stress, and so forth. But for us, the major focus with data has always been the individual health of our members. And I think we are going to continue to innovate around that. I envision that even more powerful opportunities will emerge from that focus.
What we are working on around digital innovations is the question of how we can continue to make the user’s experience just that much better. We already have an organization where our members, from the moment they open their phones, can make a face-to-face or a telephonic appointment, or can get real-time advice.
We’re moving into a world that is much more preference-sensitive, where our members can shape their own experience, and where there are more modalities to choose from. Overall, the experiences that our members can have, either in a physical environment or on their phones, are merging.
When you arrive at a physician’s office, a clinic, or a hospital, you will be able to register on your phone instead of at a desk. You will use your phone to connect to the pharmacy, to pay, and to take advantage of all the benefits of connectivity, period. And that’s the sort of future state we are working on now,. We have high digital engagement rates now and are really, verifiably improving the health of our members.
But in the future, I believe the experience of healthcare we are moving toward will be one that is highly personalized and utterly convenient.