Robert Pearl MD

Dr. Pearl begins this talk by having the audience think back a decade about healthcare. And then gets them to consider/tell him what is different today than in the past. Unless the audience obtained coverage through Medicaid or the individual exchange (rarely the people in the audience) the answer is "nothing".

Dr. Pearl then discusses disruption and the threats that exist and recommends alternatives:

1. The first is to close half of the hospitals in the United States and convert some of them to 24-hour ERs. We are in a vicious cycle where low volume hospitals and services drive up costs and produce unnecessary utilization. In this part, Dr. Pearl talks about all of the operational efficiencies possible and the success that his team achieved in Kaiser Permanente when he was a CEO at lowering utilization to half of the national average while making Kaiser Permanente the leader in quality based on the NCQA evaluations.

2. Ask an organization like Leapfrog to define the volumes per procedure a surgeon must do and not pay doctors who fail to meet them. Not only does low volume lower quality, but it raises costs since physicians who "dabble" rarely take the time to improve performance. The example Dr. Pearl uses is total joints in which we went from a 3-day average length of stay to 60% of the procedures being done as an outpatient.

3. Eliminate the 30% of procedures that add no value through a rigorous set of second opinions and centers of excellence.

4. Provide "concierge" primary care to every patient. The mathematics is hard to explain in one line, but by investing about 1% of the total health care spend in primary care expansion, there is a 10% reduction in hospital, drug and specialty costs. Dr. Pearl uses various primary care groups with whom he has worked with as examples.

5. Use technology including video, AI and smartphone embedded algorithms to help every patient get the same level of excellence in care regardless of where they live. Dr. Pearl uses specific example of what he has done to bring in consultative and specialist expertise from hundreds of miles away, to allow continuous patient monitoring when they are at home and identify patients on medical/surgical units who today seem fine but tomorrow will deteriorate and require ICU admission. By addressing their problems before they happen, mortality and cost are decreased by 75%.

Depending on the group, Dr. Pearl closes with a call to action – either specific to a medical group, insurance organization, purchaser or lay audience. For health care professions, the point is change now or regret it later. For patients, it recognizes all that you are failing to receive and begin to demand it. For each point, there are stories and interesting research that engage the listener and cause them to leave with enthusiasm about what is possible.

Healthcare speaker and former CEO of The Permanente Medical Group, Dr. Robert Pearl offers a fascinating transparent look at the American healthcare system as he reveals why we receive surprisingly little value for the tremendous amount of money we spend as a nation and patients. He gets to the heart of what truly needs to change in healthcare – the way we perceive it and the way it is delivered. Motivated by the death of his own father which was caused by miscommunication among physicians, Dr. Pearl presents a hopeful and viable proposal that includes restructuring our health care system and introducing technologies that will give us better clinical outcomes while reducing errors and costs.

Dr. Pearl speaks frequently on the intersection of American healthcare, business and policy. Popular themes include:

• Americans spend the most money on healthcare, yet our quality outcomes lag most industrialized nations: Why?

• How does the context of American healthcare distort the perception and alter the behavior of doctors and patients?

• What are the four pillars that will transform the future of our healthcare system?