Underriner enjoyed a 35-year career at Providence Health & Services that culminated in him leading the network of eight acute care hospitals and 90 clinics in Oregon.
He took over Kaiser Hawaii in May and is eyeing how to bolster Kaiser’s local market share, expand its physical and virtual presence and enhance the overall experience for its 255,000 members – in fact, for everyone in Hawaii.
Q: What prompted you to make such a drastic career switch?
Underriner: We were respected competitors. I used to get up wondering how we would compete because of Kaiser’s model. Providence Health & Services is a fairly integrated system, not as much as Kaiser, but we were moving in that direction. This is where health care needs to evolve. A lot of companies are working hard to get there, but it’s really hard without the right mechanisms.
I liked that Kaiser is very mission driven: providing high quality, affordable care and servicing communities. It’s a not-for-profit system and that was important.
Q: Is it a steep learning curve given Kaiser’s unique model?
Underriner: It’s a steep learning curve if you really want to understand the health system and the community you are servicing. It takes awhile.
You need to talk to lots of people to understand not only how Kaiser works in Hawaii but also as an entire national system. What are the benefits of being part of a national system? How does that affect how we operate locally?
It is also about understanding the broader community, but that is where listening, learning, being involved and asking questions comes in.
Q: Why is it difficult for many health care organizations to integrate?
Underriner: Having lived it, the challenge is getting everybody aligned in a common direction. There are group models versus staff models. In the staff model, an organization has both employed physicians and private practice physicians.
How do you align the diverse physician populations into a coordinated way of delivering care? You have to figure out a coordinated mechanism and then incentivize the right behaviors.
Going from fee-for-service to fee-for-value is a huge change, but it is the right journey. But you have to redesign your systems and approaches. And that is hard to do when you have invested in a certain infrastructure. If you are Kaiser, that has been in your DNA for 60 years.
“Integration allows you to focus on evidence-based medicine as opposed to what’s going to generate revenue.” – Dave Underriner, President
Q: How can integration help tame the cost of health care?
Underriner: Integration lets you focus on evidence-based medicine as opposed to what generates revenue. The other day we were discussing renal disease and if we could figure out a way to keep people from ever needing dialysis. We can think of ways that we could invest to keep people from needing dialysis.
That may be aspirational, but we have a mechanism to do these types of things because we have the continuity of membership and the ability through our HMO premium to ask: Where do we allocate for those types of things? We all have a vested interest in keeping our members as healthy as possible.
Q: How is Kaiser different from your expectations?
Underriner: It’s mostly what I anticipated. A lot of people don’t realize we have a high level continuum of care all the way up to tertiary. We operate in many areas, like cardiology or oncology.
We don’t pretend to duplicate things that are very high cost and low volume, so we’ll contract those with Queen’s or others. On the flip side we provide incredible tertiary care. The one example that I use is our neonatal intensive care unit, one of only three in the state.
If we are talking about the maternity experience, it can be going from the midwife to the OB to the neonatologist to the follow-up care and the support specialists that give babies the best care.
Q: What is your plan for the next three years?
Underriner: One question is: How do we position Kaiser to continue to grow? Hawaii is a competitive market – in a good way, with good health systems and health plans. If we are going to grow, we want to create the right experience. So, I would say taking a closer look and understanding those we serve.
And how do we keep improving access. A combination of investment in physical assets, like key locations for ambulatory care, physician offices, outpatient procedures – those kind of things. We have good locations, but I think Leeward Oahu is an opportunity to look at.
Not only physical access, but also using technology, whether it’s an e-visit or virtual visit. Prevention and affordability are also big for us. Employers and the government all want us to be more efficient and effective.
The interview was edited for conciseness and continuity.