Larry Hanover

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Climbing the Career Ladder: Fourth of 10 profiles of healthcare executives and their careers.

Threats of violence and virulent anti-Semitism were the future for then-11-year-old Ramin Davidoff had his family stayed in the city of Urmia in northwest Iran as the nation’s revolution unfolded in 1979.

His parents, however, decided to flee for a month or two until the revolution subsided, and headed for northern Utah, where his uncle was attending Utah State University. The revolution dictated that the short stay would become permanent.

With the chance to fully use his talents, Davidoff would soon be on a steep ascent that in January 2021 landed him as co-CEO of the Permanente Federation, a consortium of all the Permanente Medical Groups in the nation, supporting nearly 23,000 Permanente physicians.

“We were very fortunate to move to the United States, which really has become for me a land of opportunity, although at 11 I did not realize that,” Davidoff says.

Davidoff’s career path has been on an upward trajectory. He went to University of California, Irvine, for eight years, first as an undergraduate and then as a medical student, completed his residency training in urology at Kaiser Permanente Los Angeles Medical Center and chose to remain in the system.

“Medicine for me truly was, right from the beginning, about what’s best for the patient,” Davidoff says. “When that happens in training, then it stays with you, and I truly appreciated that brand of medicine.”

Davidoff never envisioned going into administration. His opportunity came at Baldwin Park Medical Center when he took on the role of physician director of risk management and patient safety. He saw it as a way to improve patient care more broadly by focusing on safety. Tearing down the pyramid structure that saw the physician at the top was part of his strategy. “I wanted it flattened, a system where every member of the team had an opportunity to have a say in the care,” Davidoff says.

Davidoff would rise to become assistant medical director. When he was elected to the Southern California Permanente Medical Group board of directors, which he now chairs, he suddenly had an additional perspective on care, this time from the governance angle.

“That was also a very important lens,” he says. “That’s where the strategy, the business, the finance, the competitive landscape — all the things that are important to run a higher-performing medical group — came into play.”

Davidoff was fortunate to be given nine months to transition into his role as co-CEO of the Permanente Federation. Unfortunately, it coincided with the pandemic.

“I’ve always focused on our people, but even more so in the early part of the pandemic,” he says. “These people have fear. They’re worried about coming into work, eventually getting infected and taking the infection back to their families. So there was a real importance of communication and being real and genuine with them, really being visible.”

The lesson of the pandemic, he said, was innovation. The system has pivoted toward telehealth and virtual work. Many patients who normally would have been hospitalized, it turned out, could be managed safely at home with monitoring systems.

Through it all, Davidoff says, the values he learned as a boy are the same ones he urges those in the medical field to follow today.

“There’s no substitute for working hard and to always treat your people kindly, professionally and respectfully,” he says. “That will allow them to be who they are in work environments and brings out the best in them.”

Articles

Ramin Davidoff, M.D., co-CEO of the Permanente Federation, has applied lessons he learned as a child. “There is no substitute for working hard and to always treat your people kindly, professionally and respectfully.”

Ramin Davidoff, M.D., Kaiser Permanente: Ascendant Path for True Believer in Team-based Care

hether marijuana is a gateway drug is debatable. But it has certainly opened the doors for a projected multibillion-dollar market for psychedelic drugs as treatments for a variety of mental health disorders.

Pushback against psilocybin (the active ingredient in magic mushrooms) and MDMA (3,4-methylenedioxymethamphetamine, known as ecstasy or molly) in the ’70s and ’80s culminated in their criminalization. But with the legalization of marijuana for medical use in many states in the ’90s and now a wave of legalization for recreational use, research into psychedelics for medical purposes is booming.

Author Michael Pollan wrote a book, “How to Change Your Mind,” that kick-started interest in psychedelics. Kevin O’Leary of “Shark Tank” is a big investor. The psychedelics market is projected to grow by 16.3% over the next eight years to nearly $7 billion by 2027, according to Data Bridge Market Research.

Now two recent studies published in prestigious journals are lending credence to psychedelics as a possible and entirely research-worthy way of treating mental health disorders.

 published the results of a phase 3 study that showed MDMA is effective in treating post-traumatic stress disorder. A few weeks earlier, British researchers reported results from a phase 2 study in 

 that showed psilocybin was considerably more effective than Lexapro (escitalopram), a selective serotonin reuptake inhibitor, in treating depression. Some of the researchers involved in that study receive support from companies developing psychedelics for medical use.

Matthew Johnson, Ph.D., associate director of the Johns Hopkins Center for Psychedelic & Consciousness Research, says to be prepared for explosive growth. “When I started 20 years ago, you knew (pursuing psychedelics) might be career suicide,” Johnson says. “Since then, it’s been a bit of a risk, but the data keep speaking for themselves.”

Researchers need to be careful. In a pilot study on smoking cessation with psilocybin that Johnson was involved in, there were four to eight hours of therapy as preparation, and two people had to be in the room monitoring the patient during treatment. “A person, even though it’s physiologically very safe compared to many compounds, can feel like they’re going to die,” Johnson says. “There has to be a trusted person to say, ‘We’re here with you; just keep breathing, trust, let go and be open.’”

Jason Luoma, Ph.D., CEO of Portland Psychotherapy, has focused his research on people struggling with shame and found MDMA effective. “MDMA tends to create the experience of feeling a sense of love, a sense of connection with other people, and that is pretty profound,” he says.

Luoma adds that despite the myths, psilocybin has no addictive potential, and MDMA’s potential is low. Approvals of psychedelics probably will need to be associated with FDA risk evaluation and mitigation strategies (REMS) to ensure no off-label uses, in Luoma’s opinion: “The big fear is people who are really, really antidrug will pick up the one adverse reaction that happened out of 10,000 patients and … blow it up and essentially harm the whole research agenda.” 

Larry Hanover is a freelance writer in southern New Jersey.

Research and investment are increasing into psilocybin and MDMA as treatments for several mental health disorders.

Psychedelics Take a Long, Strange Trip to Respectability

Five years ago, Prime Therapeutics, a fast-growing pharmacy benefit manager (PBM) owned by 19 Blues plans, realized that its portfolio of leased office spaces had grown expensive and unwieldy. The company’s leaders decided to consolidate its four Twin Cities offices at a gleaming new headquarters in nearby Eagan, Minnesota, and keep seven floors of offices at a location in another suburb.

An analysis had revealed that much of the existing space went unused, so company executives designed the Eagan building with flexible workspaces to encourage collaboration and meeting spaces that could be made smaller or larger as required, says Kim Gibson, assistant vice president of real estate and facilities at Prime. They suspected telecommuting would become a growing trend and felt the new building could accommodate such a transition, she says.

Then the pandemic hit. A change intended to be gradual took place almost instantaneously and worked out better than expected. In a mid-2020 poll, almost all (93%) of Prime’s employees said they were faring well at home, and two-thirds wanted a hybrid arrangement that would allow working remotely part time when the Prime offices eventually reopen.

Thus was born the “hub and home” strategy. Prime recently announced that employees will work from home 50%-65% of the time when reopening occurs, rotating into the office on set days of the week or month. With teams sharing spaces, Prime will be able to vacate the Bloomington offices by mid-2022 when the lease expires, reducing its footprint by one-third.

“To be an employer of choice, we’ve got to listen to our employees and bring the work to them, and I think this hub-and-home model does that,” Gibson says. “I would even say that if we didn’t offer something like this, we might be losing out on talent in the future. I’d say it’s critical to our future. I would suspect other organizations are considering the same.”

Indeed they are. Many health insurers and PBMs have not announced plans, but those contacted by 

® indicated that they are either proceeding with or contemplating remote and hybrid work schedules.

“They’re definitely not planning to get everyone back in the office,” says Lisa Slattery, vice president of accreditation and recognition operations for the National Committee for Quality Assurance (NCQA), the nonprofit accrediting organization for health plans. “We hear some will be selling off properties, reducing footprint and continuing a lot of work from home. A lot of leaders didn’t think things could be as effective from a work-from-home perspective, but they’re seeing this is a viable solution that was accelerated by the pandemic.”

Companies in the healthcare industry that do not involve direct patient-clinician interactions are a microcosm of what is happening nationally. Target Corporation, headquartered in Minneapolis, announced that it will shed nearly 1 million square feet of office space, shifting 3,500 employees into other buildings and having many work from home. Michigan-based Ford Motor Company has announced plans to shed a significant office space.

A survey conducted by PwC in November and December 2020 showed that fewer than 1 in 5 executives wanted to return to the office as it was pre-pandemic. Most (87%) executives expected shifts in their real estate strategy, including consolidations, although many said they would open new satellite locations. Results of a June 2020 Gartner Inc. survey showed that 82% of company leaders intended to permit remote arrangements some of the time as employees return to the workplace.

Blue Cross and Blue Shield of North Carolina is among the handful of companies talking openly about upcoming shifts in their real estate. The company has allowed some office lease spaces to expire and will make real estate decisions based on how employees are working, not on cost.

“We do not anticipate ever going back to the traditional, pre-pandemic way of thinking that being in the office every day is necessary and/or expected,” the company said in a statement. Employees will work remotely at least through June.

Independence Blue Cross faces a major crossroads. In June 2020, it paid $360 million to repurchase its Philadelphia headquarters building, which it sold to Prudential Insurance Co. in the 1990s. The 45-story tower — the city’s eighth tallest building — houses 2,500 employees. Officials say they are not ready to announce plans.

“We are committed to this region and here for the long term,” the company said in a statement. “Purchasing our building at 1901 Market St. last summer was a further demonstration of that commitment.” The company did say employees would return in a phased approach.

Other companies are similarly reticent, perhaps to keep their options open. Optum, the PBM and care services subsidiary of UnitedHealth Group, said in a statement that they are “using this time to listen to our employees at all levels of the organization to best understand their preferences for the post-pandemic work environment. We are not rushing into any long-term decisions.”

A spokesperson for Centene Corporation, a publicly traded health insurer with headquarters in St. Louis, says the company will begin returning a small number of employees to the office Sept. 13. Employee schedules will include remote and in-person time as well as flexible start and end times.

Erin Feigal, Prime Therapeutics’ chief human resources officer, says that a key part of the reopening plan involved a team designed to connect with employees, collect feedback and ensure that employees felt ownership of the hub-and-home approach. “It was an evolutionary process,” she says.

As a result, 2,200 workers local to Minnesota will cycle through the single Eagan campus, including 700 shifting over from Bloomington, Gibson says. Each team will have its own hub area and can adjust the space as needed on in-office days. Some workstations were replaced with team-centric furniture so that teams can shift tables, whiteboards and video systems and collaborate as best works for them.

Companies looking to follow Prime’s lead should test their technology and have it ready to operate efficiently across divisions, Gibson says. That means getting laptops into employees’ hands and adequately training employees to use video technology. “Gaps in technology will hurt you as an organization if you don’t get that right,” Gibson says.

The other key area to address is expectations, she says. “You have to address new working norms, understanding what expectations are — to show up online every day,” she says.

NCQA, which is headquartered in Washington, D.C., is dealing with the pandemic realignment not only in its role as an accrediting organization but also internally. The organization was unintentionally almost pandemic-ready, says chief operating officer Tom Fluegel. Two-thirds of employees were either part- or full-time remote before COVID-19 hit, and NCQA was preparing to offer an all-virtual option to health plans undergoing accreditation review. By having companies send screenshots and other documentation electronically, the organization has been able to perform accreditation work without conducting onsite visits.

Pattie Graves, human resources knowledge adviser for the Society for Human Resource Management (SHRM), says the healthcare sector and industries in general that perform office work are on the same wavelength. Companies are regularly making inquiries to SHRM about transitioning to hybrid work plans, and she sees no turning back: “I think it’s going to be the future.”

There’s no going back to the ways of working before COVID-19’s arrival, say many in the industry. Insurers and PBMs are reducing their footprint as work becomes part remote, part in person.

It Will Not Be Your Pre-pandemic Office 

The twin crises of the COVID-19 pandemic and the racial justice outrage sparked by the killings of George Floyd and Breonna Taylor convulsed the country last year. While COVID-19 was killing Black Americans at three times the rate of Whites, African Americans and others protested unjustified killings of Black people by police.

The nation’s four historically Black medical schools have labored throughout their existences to address racial disparities in healthcare and garner respect and recognition. Now, though, the 2020 crises and fresh awareness of how Black Americans historically have been mistreated by the healthcare establishment have resulted in large donations to the medical schools, seeding some hope for breakthroughs in narrowing disparities and training more Black physicians.

The money started to flow in September when former New York City Mayor Michael Bloomberg announced a $100 million gift to be distributed for scholarships for current students at the four historically Black medical schools: Meharry Medical College in Nashville, Tennessee; Howard University College of Medicine in Washington, D.C., Morehouse School of Medicine in Atlanta and Charles R. Drew University of Medicine and Science (CDU) in Los Angeles.

The gift has created momentum. Morehouse recently announced it is joining up with CommonSpirit Health, one of the country’s largest health systems, in a 10-year, $100 million deal to train more Black doctors. Morehouse plans to establish five new regional medical school campuses as well as graduate medical education programs in at least 10 markets in partnership with CommonSpirit. Meanwhile, Meharry and Morehouse are seeking to double enrollments. All four medical schools report that they are experiencing an upswing in donations.

“I think writ large what’s happening is there’s an epiphany happening among major organizations, corporations and foundations to recognize that the health disparities we’re witnessing — the racial disparities, the bias and all of that — need to be addressed if our whole society is going to advance forward as we’d like it to,” says James E.K. Hildreth, M.D., Ph.D., president and CEO of Meharry.

The leaders of the four medical schools hope the infusion of funds will increase the number of Black doctors. But the goal goes beyond that. By training more Black doctors, they hope to influence the quality of care received by the African American community. Research has shown that Black patients fare better, on average, when treated by a Black doctor than by a White one. Other research has identified race-based misconceptions. For example, a study published in the 

Proceedings of the National Academy of Sciences of the United States of America

 in 2016 found that half of White medical students believed that Black patients have higher pain tolerance than White patients.

“Clearly we know that the issues of health disparities are not new,” says Valerie Montgomery Rice, M.D., FACOG, president and dean of Morehouse School of Medicine. “What COVID-19 has done is allowed us to pull back the curtain to see these inequities and their impact on underserved communities, particularly the Black and brown community. When you add the number of social injustice events that we saw, you had the opportunity for people actually to see it in real time because many of them were on pause from their daily distractions.”

The Bloomberg donation is called the Greenwood Initiative, a reference to the Greenwood community in Tulsa, Oklahoma. In 1921, White residents massacred 300 Black residents of Greenwood, which was nicknamed the Black Wall Street because of the number of Black-owned businesses there.

There is no single source of Black mistrust of White doctors and nurses, although the infamous “Tuskegee Study of Untreated Syphilis in the Negro Male” looms large. For 40 years, the U.S. Public Health Service conducted a study of 600 Black men, 400 of whom had syphilis that was intentionally not treated. Rebecca Skloot’s book “The Immortal Life of Henrietta Lacks” brought attention to the story of Lacks, an African American woman whose cancerous cells were used without her consent to create the HeLa cell line. Black women were sterilized without their consent during the mid-20th century; the procedures were nicknamed the “Mississippi appendectomy.”

“There’s a legacy, a foundation for distrust,” says David M. Carlisle, M.D., Ph.D., president and CEO of CDU. “When you talk to people about why they have vaccine hesitancy, this is very often cited. They want to make sure that the health system has their best interests at heart, and they’re not sure that’s necessarily the case.”

The legacy of racism is also evident in the racial makeup of the medical community itself. More than 100 years ago, the Carnegie Foundation and the American Medical Association tasked education specialist Abraham Flexner to standardize medical education and anchor it in science. Flexner’s 1910 report resulted in the closing of numerous medical schools, including five of the seven existing Black medical schools. Howard and Meharry were the lone survivors.

Until 2008, only about 2.5% of American doctors were African American; now that proportion is 5%, according to the Association of American Medical Colleges (AAMC). The relative scarcity of Black physicians has persisted in unexpected places, such as Detroit, a city that is now 79% Black. In 2015, a task force found that Wayne State University School of Medicine in Detroit accepted only five African American and two Hispanic students out of a class of 290. It nearly went on accreditation probation for that lack of diversity and other issues but quickly increased those numbers.

“This is not to cast all of them in the same light, but White medical schools have got to do a better job of diversifying their classes,” Hildreth says. “Even if Meharry, Morehouse, Drew and Howard all doubled our class size and all of our kids were Black — and they’re not — that still would not move the dial very much. We’ve got to have the other schools doing their part.”

Black men are particularly absent from the physician ranks. White male doctors outnumber Black male doctors 15 to 1. In 2020-2021, only one-third of African American medical school applicants were male, according to the AAMC. School officials hope the new funding coming into their institutions can help them address the issue.

Carlisle called the donations from Bloomberg and others “transformational.” Black students typically have higher debt than Whites because many come from lower-income families. Now every student at the historically Black medical schools not already covered by a full scholarship will receive a $100,000 pay down, $25,000 per school year. “It’s the kind of paradigm-changing gift that really sets the bar,” Carlisle says.

For Morehouse School of Medicine, the Bloomberg donation helped create the momentum to team up the with CommonSpirit, which will transform the reach of the school. “The urgency definitely became more real with the pandemic,” says Montgomery Rice.

Howard University College of Medicine’s $32.8 million share of the Bloomberg gift is the largest donation the school has ever received. Officials there are looking forward to how the money can help increase the number of Black doctors. “Healthcare disparities exist for myriad reasons related to systemic issues, not the least of which is the dearth of Black doctors,” Wayne A.I. Frederick, M.D., MBA, FACS, president of Howard University, said in a statement. He continued, “Black doctors with cultural competency are a major part of the solution, but their path is often hampered by a compromised financial situation.”

Historically Black med schools step forward

The pandemic has galvanized the historically Black medical schools into action. They have played a role in community outreach, advocacy and publicity to spur higher testing and vaccine rates in the Black community. Frederick, Montgomery Rice, Carlisle and Hildreth co-wrote an opinion piece published in the 

 in September that argued for the importance of diversity among the COVID-19 vaccine study volunteers. “As with all drug trials, the impact of medication can differ significantly, depending on the genetic makeup of the population. This is even more so with vaccines that depend on altering the immune system,” they wrote.

Carlisle says his school has learned the hard way about the difficulties in getting resources to low-income communities, in which many frontline workers could not social distance and wound up bringing the infection home with them. Last summer, CDU collaborated with county officials and the Los Angeles fire department on setting up and operating drive-through testing sites. But many in the community don’t have cars and some don’t have internet access, meaning they couldn’t schedule appointments. So CDU sent some of its students to neighborhood locations such as malls to try to get individuals tested for COVID-19, Carlisle says. Such outreach helped reduce hesitancy not only among African Americans, but also immigrants who have language barriers and often fear government.

The four historically Black medical schools and other medical organizations have organized several town halls to address the issue of vaccine hesitancy and distrust in the healthcare system, Montgomery Rice says. The events have drawn online crowds ranging from 8,000 to 20,000.

In December 2020, she and CNN’s Sanjay Gupta, M.D., got vaccinated live on the network broadcast. And in January, Morehouse hosted an event where former U.N. Ambassador Andrew Young, former HHS Secretary Louis W. Sullivan and Hall of Fame baseball player Hank Aaron were vaccinated. (Aaron died shortly after from a non-COVID-19-related illness). Throughout the month, the school held “Vaccination Saturdays” for anyone 75 or older. Montgomery Rice says the school had administered 1,800 vaccinations as of late February. It went from having to search for people willing to get vaccinated to a waiting list of 6,000. “We believe we’ve moved the conversation from vaccine hesitancy to vaccine acceptance,” she says.

Hildreth is encouraged by what he sees from the Biden administration, which appointed him to its COVID-19 Health Equity Task Force and made equitable vaccine distribution a focus.

“From my perspective, it all comes back to two things: structural racism and implicit bias,” Hildreth says. “We find a way to deal with those things, these problems would take care of themselves.”

The four historically Black medical schools are part of the answer as U.S. healthcare  reckons with racism and inequity. They are expanding and receiving record levels of donations.  


Larry Hanover

Articles

Ramin Davidoff, M.D., Kaiser Permanente: Ascendant Path for True Believer in Team-based Care

Psychedelics Take a Long, Strange Trip to Respectability

It Will Not Be Your Pre-pandemic Office

Four Historically Black Med Schools Address Disparities