Ep 107 – The Truth Agenda: Overcoming Tribalism for a Better World and the Superiority of Medicare Advantage for Value-Based Care, with George C. Halvorson

George Halvorson is a retired American healthcare executive who served as CEO of six health plans over the last 30 years.  From 2002-2013, he was the CEO of Kaiser Permanente and was listed several times on Modern Healthcare‘s “Most Influential People in Healthcare”. During his tenure at Kaiser Permanente, he led the nation’s largest nonprofit health plan and hospital system, which is also a leader in the adoption of technology to advance community health outcomes and reduce health inequities.  Under Halvorson’s leadership, Kaiser Permanente’s investment in electronic medical records and physician support systems resulted in diminished infection rates and scalable population health outcomes within partnering communities.

Since his retirement from Kaiser, George Halvorson has devoted his time to promoting the benefits of early childhood education and to addressing social difference and tensions through his own Institute. George Halvorson is currently the Chair and CEO of the Institute for InterGroup Understanding, a nonprofit organization that works on issues of racism, prejudice, discrimination and intergroup stress and conflict by facilitating a collective understanding of what children need to achieve safe and productive lives. George is someone who leads with a passion to help create intergroup Peace for our nation so that we may intellectually overcome our more negative and damaging instinctive behaviors.

In this episode, you will learn the truth about the Medicare Advantage program from one of the leading intellectuals in healthcare.  We also discuss Health IT transformation and the power of organizational culture to reshape care delivery. In the last 20 minutes of the interview, George Halvorson also discusses his mission to improve the culture of our world by helping others overcome negative and instinctive behaviors that lead to intergroup conflict.  This is a powerful discussion about the impact of tribalism in our world and how we have a collective and ethical obligation to help each child from every ethnic, economic, cultural, and racial group in America to overcome the hardwiring of societal conditioning that leads to “us versus them” intergroup conflict. “We need to steer ourselves away from the easy abyss of anger through tribalism, into a higher level of interaction. This is a just-in-time learning opportunity.”

 

Episode Bookmarks:

01:20 George Halvorson’s legacy as a healthcare executive and former CEO of Kaiser Permanente

02:20 The Institute for InterGroup Understanding, a nonprofit organization that works on issues of racism, prejudice, discrimination and intergroup stress and conflict

03:10 George’s extensive experience in international healthcare reform and his authorship of several books related to healthcare reform and intergroup peace

04:20 “The fragmented nature of care delivery and siloing of data creates an expensive plethora of uncoordinated, unlinked, economically segregated, operationally limited microsystems, each performing in ways that too often create suboptimal performance”

06:30 “We are on the cusp of the golden age of healthcare delivery, and it’s going to be made golden by information, data, and systems.”

07:15 Innovation at Kaiser Permanente led to a 40% reduction in congestive heart failure crisis events

08:15 Leveraging biometric data and predictive algorithms for disease detection and prevention

09:45 George Halvorson as a national leader in mitigating health disparities and his 2013 book, “Ending Racial, Ethnic and Cultural Disparities in American Health Care”

11:15 Medicare Advantage has become a successful social services program for millions of people (and our most important vehicle to reduce health inequities)

12:15 How Kaiser Permanente reduced prostate cancer death rates for Hispanic Americans

13:30 “I believe that we should deliver better care to every single American, and we have done a pretty miserable job for many subsets of our population.”

14:30 Linkage of uterine infection during pregnancy and childhood asthma (and how this disproportionately affects African Americans)

15:20 Dual-eligibility in Medicare Advantage and Medicaid is leading to better care outcomes and higher satisfaction scores

17:00 How fee-for-service Medicare failed COVID patients

18:00 Health plan competitive bidding, benefit design, and economics of MA leads to better care and lower costs (“a clearly superior model”)

20:00 Misinformation about health plan profitability (MA plans make 4% profit; whereas, all other American businesses make 10-20% profits)

21:00 Debate with MedPAC regarding benefit enhancements that improve patient outcomes for low-income members

22:15 Richard Gilfillan and Don Berwick’s two-part series of articles in Health Affairsexpressing their grave concerns related to Medicare Advantage (Part 1 and Part 2)

23:30 Response to Gilfillan and Berwick’s concerns related to health plan profitability and PE investment in companies driving MA care delivery innovation

26:50 Response to MA critics concerns of upcoding and how current coding limitations in the program prevent abuses in the MA program (“You can’t upcode into a system that doesn’t exist”)

29:00 Reinvestment of profit surpluses to provide better benefits for members and how MA 5-Star plans are “the best care plans anywhere in the world”

31:00 George Halvorson discusses the financial and cost savings differential between traditional fee-for-service Medicare and Medicare Advantage

32:30 MA beneficiary enrollment in urgent need counties and why spending concerns in that part of the program may be misrepresented

36:00 The importance of organizational culture in value transformation (“When the student is ready, the teacher appears.”)

37:15 “Organizational culture needs to be centered around the patient, built around transparency and data sharing, and focused on continuous improvement.”

38:45 The success story of care process redesign at Kaiser Permanente that led to reduction in death rates due to sepsis (reduced from 30% to 3%)

41:00 What culture in health care delivery do we want in our country?

42:00 George’s mission to improve the culture of our world by helping others overcome negative and instinctive behaviors that lead to intergroup conflict

43:00 “We are all creatures of instincts. Every one of us is instinctively tribal, instinctively hierarchical, instinctively territorial, instinctively emotional.”

43:40 The slippery slope of tribalism that leads to “us versus them” behaviors without values and ethical standards

45:00 The Truth Agenda – how the Institute is working on making public and political discourse honest and respectful

45:40 Epigenetic neurogenesis in children and why intergroup conflict is so harmful in early childhood brain development, i.e. hardwiring tribalism

47:30 The case for universal and affordable healthcare and how tribalism in American undermines true progress in healthcare transformation

48:20 “When people realize that an instinctive behavior is not an underlying value for the universe, you get a lot more flexibility, both in your own emotions and in your own interaction.”

49:00 George Halvorson’s books on intergroup activity that are available for free online

49:40 The Cusp of Chaos:  how tribalism leads to genocide, mass killings, intertribal bloodshed, rapes, mutilation, ethnic cleansing, and other genocidal behaviors

50:45 How tribalism relates to the current Ukrainian conflict

51:30 How George Floyd and the Me Too movement was a powerful learning experience for America

53:00 “We need to steer ourselves away from the easy abyss of anger through tribalism, into a higher level of interaction. This is a just-in-time learning opportunity.”

54:00 Predicting future and understanding history by interpreting the pattern of intergroup interaction (how George predicted the Russian atrocities in Ukraine 5 years ago)

56:00 The danger of alpha instincts —  the January 6^th insurrection and lifelong conquests of political leaders to stay in power at all costs

57:30 “We’ve got a relatively short time in this country to steer us back to a good and safe place.”

58:00 Websites of interest:  Three Key Years and the Institute for InterGroup Understanding