About Colin Cave
Colin Cave, M.D., is a head and neck surgeon and the medical director of External Affairs, Government Relations and Community Health for Northwest Permanente (NWP), the medical group for Kaiser Permanente Northwest. Having held many previous leadership positions within the company of more than 1,500 physicians, clinicians and administrators, he now leads NWP’s Corporate Social Responsibility program, including its community engagement and B Corp activities. He also heads NWP’s regional and national leadership efforts in addressing climate change and greenhouse gas emissions, developing mitigation and resilience strategies and enacting NWP’s Climate Action Plan. He serves on the Board of Oregon for Climate Action. Dr. Cave completed medical school at UC San Francisco and residency at Stanford.
About Northwest Permanente
Northwest Permanente is the largest medical group in Oregon and Southwest Washington. We’re made up of more than 1,300 physicians and clinicians, as well as sub-specialists in virtually every area of medical and surgical practice. Our integrated health care model, chronic disease management programs, electronic medical record, and state-of-the-art clinical support tools provide the foundation for our physicians to practice Permanente Medicine at the highest level.
Northwest Permanente physicians receive top honors and recognition for their work. We have had the most physicians named “Top Docs” by Portland Monthly magazine for 3 years running. We received the highest rating of 3 stars from the Society of Thoracic Surgeons for both cardiothoracic and thoracic surgery — the only program in Oregon to receive this top rating. And we’re recognized as one of the top 3 healthiest employers in Oregon.
For the physicians, clinicians, and administrative team of Northwest Permanente, our calling goes well beyond the clinic. For nearly 80 years, we’ve worked to provide best-in-class care for our patients, but also to be best for the world. That’s one of the reasons Northwest Permanente became the world’s first physician-led medical group to be certified as a B Corp. Being a B Corp means that the organization focuses on the triple bottom line of balancing people, planet, and prosperity. This aligns with our commitment to our community, our workers, and the environment. In 2019, we were proud to earn B Corp’s “Best for the World” designation for the third year running in 2 categories, “Best for Workers” and “Best Overall,” plus a designation in a new category, “Best for Customers.”
Medical Travel & Digital Health News (MTDHN): Please tell us about your organization and how you became involved with telehealth.
Colin Cave (CC): Northwest Permanente is one of the eight Permanente medical groups around the country. We have a 1,300 physician multi-specialty group responsible for the care of over 600,000 members in Oregon and Southwest wide.
In 2016 we became certified as the first physician-led B Corporation in the world. Our mission is to improve the health of our members and the communities we serve.
As the whole concept of climate change and global warming became more apparent, we felt the physician voice was extremely important in this discussion. Northwest Permanente aims to become an environmental leader as the first major medical group to create a climate action plan. This is especially important because of the impact climate change is having on the Pacific Northwest and flooding in other areas, as well as the increase in insect-borne diseases. There’s a direct link between health and the quality of air we breathe and water we drink.
We became one of the first major medical groups in the country to roll out telehealth and virtual visits back in 2015. Virtual visits are a huge patient satisfier, as well as for businesses that offer our products. A patient can have a 15-minute visit from work and avoid drive time, waiting at the doctor’s office. Less driving has a huge impact on greenhouse gas emissions.
When the COVID-19 pandemic hit, we had already been leading the way with virtual visits and were able to ramp it up to meet patient need for primary, specialty and behavioral care. We want to continue to provide virtual visits because it’s high-quality medical care that also has a positive impact on the environment. We’ve published a paper demonstrating this connection.
MTDHN: Can you give us highlights from your research?
CC: Year over year from 2015, our total outpatient visits increased, with a greater proportion of virtual visits and a slower rise in face-to-face visits. We wanted to capture these changes and their effects on our overall emissions and came up with the concept of ambulatory visit carbon intensity. This newly defined measure is the total number of emissions normalized by the total number of outpatient visits.
We have a graph showing that even though the in-person visits were going up, the total telehealth visits were also going up at a greater rate. By not having people drive and opt instead for virtual visits, we grew our membership as carbon intensity measurement went down.
Without virtual visits, our ambulatory visit carbon intensity would have gone up as our membership increased. Because of telehealth, carbon intensity plummeted while quality of care remained superior.
MTDHN: Talk a little bit about the behavioral health value.
CC: With virtual visits you talk with your mental health therapist and still get the benefits of a face-to-face visit, with the same warmth and connection that you would get in person. All that’s missing is the long drive, missing work, and polluting the air.
MTDHN: How would you characterize the cost?
CC: We’ve been able to close several outpatient clinic environments to match the face-to-face need with actual in-person appointments by consolidating in larger centers. So, preliminarily, we’ve closed a couple of primary care small offices because of the great increase in telehealth and the reduction in the need for face-to-face visits.
These closings led to savings in terms of not paying rent and electricity bills. This also lowered emissions that these buildings would have otherwise generated. This has the impact of lowering costs, creating healthier air quality, and reducing illness in the communities.
MTDHN: Do you communicate this to patients?
CC: We communicate the values of virtual visits and amplify that positive impact in terms of making it convenient for them and how Northwest Permanente is going to be carbon neutral by 2025. Kaiser Permanente as a national entity is already carbon neutral—the first major health system in the country to do that in 2020. Carbon neutrality is extremely important to us.
MTDHN: What about government support for extending telehealth benefits beyond the pandemic?
CC: We support that because we know the benefit that it provides our patients. We appreciate that the government is paying attention to how important virtual visits have become to many patients and healthcare organizations during the pandemic and beyond.
Anything that improves our ability to provide quality care in a way that works best for patients we absolutely support. Going forward, health care must rely on a hybrid model. Right now, so many people want to work from home. Many more want to avoid driving to doctor appointments for conversations they could have virtually or checking their own vitals at home for virtual monitoring.
At the same time, there is a core group of people that absolutely have to have in-person appointments for a specific reason or a more complex issue that requires an in-person examination.
Whether the hybrid model is 80-20 or 50-50, it’s hard to know. I don’t think we know yet. The patients will tell us what that percentage should be.
MTDHN: What is the next step with this research?
CC: We have over 600,000 patients and five or six years of virtual care data, so we can quickly look at one specific component, which was our members driving to and from the appointment.
Our paper lets people know we’re looking at this and that we believe it matters.
We believe hospital systems can build less, waste less and use fewer resources more wisely. So, we’ve come up with this new measure so that anything you do to impact outpatient care and help decrease the carbon emissions actually improves your carbon footprint number. The other aspect of this research looks at emissions and operational cost savings.
If rural populations areable to have adequate telemedicine abilities, you can provide a lot of care to people without making them drive long distances. And increased virtual visits are beneficial to people who live in cities as well.
For many rural areas, internet connectivity is a big challenge, specifically related to high-speed internet. But from a health equity and cost saving perspective, it’s very important for rural and inner-city communities alike.