AI, prevention, cost-efficiency: Here are top priorities for health care leaders in Sonoma, Solano, Marin, Napa, Mendocino, Lake counties

We asked leaders at health care institutions serving the North Bay about about what’s ahead and what’s new in patient care.

Answers have been edited for clarity and length.

What services did your hospital expand or end in 2023?

Mark Behl: Despite the challenges of the past couple of years, NorthBay Health has been able to expand services in primary, specialty and urgent care services in Fairfield, Vacaville and American Canyon. In addition, we have completed a new primary care site in Dixon that opened in January. Our mission is to deliver compassionate care and advanced medicine closer to where people live and work throughout the communities we serve.

Tosan Boyo: In response to growing patient demand, Sutter Solano expanded access to Diagnostic Imaging by increasing hours and the number of available appointments. We also added elastography to our diagnostic imagery services.

Elastography is a type of imaging test used to check a patient’s organs, most commonly the liver, to see if it is stiffer than normal which may be a sign of disease.

Abhishek Dosi: Through deep partnerships in the local community, Kaiser Permanente (Santa Rosa) is working to improve health equity by increasing access to culturally-responsive behavioral health providers; addressing the need for more affordable housing; and working alongside community clinics and other local health systems to provide treatment and care to the uninsured in our community.

We recognize that diverse perspectives are important to our mission, and are proud that many of our employees are bilingual and come from multicultural backgrounds. We have streamlined health care services through our virtual care options. With telehealth services, our members have the option to schedule virtual appointments through a phone or video visit.

David Klein: In 2023, MarinHealth brought in 57 new medical providers and added new specialties, including but not limited to dermatology, a Spine Institute, nephrology, and expanded access in clinic locations beyond Marin County such as Santa Rosa, Napa, Petaluma, and Sonoma. MarinHealth also expanded orthopedic and behavioral health services.

Denise Laws: According to the Census Bureau, 34% of Marin County’s population is expected to be age 60 or older by 2030. At Kaiser Permanente San Rafael, 62% of our patients are older than 65. One of the areas we have been focusing on to care for these older patients is a program called NICHE (Nurses Improving Care for Health System Elders). The goal of this program is to enhance nurses’ knowledge, skills, and use of evidence-based practices to improve health outcomes for older adults.

In 2016, Kaiser Permanente San Rafael Medical Center was awarded a NICHE certification. Since that time, we have grown the number of geriatric resource certified nurses and nurse assistants in our hospital who are focused on providing high-quality care and treatment to our older patients. Examples of outcomes we measure related to the NICHE program include sleep quality, delirium, and care experience data.

Wojtek Nowak: We continued to provide complex care management services for all high-risk patients, and various other disease management programs such as a diabetes program (A1C monitoring), Heart Failure program for our heart failure patients. We provide utilization management, care management, and quality of care services for all patients.

Christina Oh: I’m proud of two advancements we’ve made in neuroscience for patients in the Bay Area. Most notably, we are the first to treat patients with a groundbreaking Alzheimer’s therapy. Through our work with respected physicians at CPMC’s Ray Dolby Brain Health Center in San Francisco, we became the first system in Northern California to deliver the Alzheimer’s therapy Lecanemab, shown to slow the progression of the disease and shown to be effective at helping patients when caught early.

Also, we launched a mobile stroke unit designed to care for stroke patients closer to home. “Time is brain” when it comes to stroke treatment, so we are proud of our physicians who have worked hard to make stroke care faster and available for people across the Bay Area.

Garry Olney: Every three years we (Providence in Northern California) work with community partners to compete a “Community Health Needs Assessment” which tells us how to expand and evolve our care to best meet the changing needs of our community.

The 2023 assessment identified that fewer people saw a primary care doctor or dentist in 2022. We are addressing this challenge upstream by expanding our fleet of mobile clinics so we can bring care to people where they live and work.

In 2023, we multiplied our fleet, adding a 25-foot box truck clinic with one private exam room for primary care and a new cargo van which will provide preventive screenings, treatments and referrals to mental health and substance use support — which were also identified as key focus areas.

We also operate a 40-foot-long RV clinic with two exam rooms and a mobile dental van. We plan to add another mobile dental clinic — in a 25-foot-long box truck — later this year to bring our mobile care fleet to five and increase health care access in rural communities.

Another program that continues to grow is our CARE Network. Through this service, our social workers, community health workers and nurse case managers visit the homes of our most vulnerable patients, including those who are low-income to provide disease education, connections to financial resources and more.

Pedro Toledo: Over the past year, Petaluma Health Center has significantly expanded its telehealth services. When the COVID-19 pandemic hit, the organization quickly adapted to ensure uninterrupted health care access. Telehealth options were implemented, allowing patients to receive medical, dental, and behavioral health care remotely. This expansion of telehealth services has benefited the community, particularly those facing language barriers.

We also expanded access to primary care services through the launch of the Mobile Medical / Dental Unit. Collaborating with school districts in Rohnert Park, Petaluma, and West Marin, the Mobile Clinic offers services, such as sports physicals, well child checks, dental visits, vision services, and urgent/same day care on school campuses. This outreach now extends to community resource centers on school campuses and includes primary care for adults.

Chris Walker: We (Kaiser Permanente Napa-Solano areas) have enhanced our access to care by increasing both in person and virtual visit options for our patients. We’ve continued to hire physicians from some of the best training programs in the country.    We’ve also added a second robotic surgical suite at our Vallejo Medical Center so we can offer even more cutting-edge surgical care to our members in Napa and Solano counties. We opened a Level 2 NICU at our Vacaville Medical Center enhancing the high-quality, specialized care for newborns closer to their homes.

What is your organization’s top priority for 2024?

Behl: To continue to stabilize from the challenges brought by the pandemic-initiated financial injury. We have seen steady improvements based on slower expense growth driven by contract staffing, supply chain, and other operational costs. As a result, we must look toward the future and begin planning for strategic growth in Northern California.

Boyo: We know accessing quality health care is a challenge for far too many people in California. So, at Sutter Health, among our top priorities are improving access to care and continuing to elevate quality. In Solano County, we are working to achieve this by expanding access to primary care, supportive and diagnostic services, and in-demand specialty care like neurosurgery through expanded physician partnerships within Sutter’s integrated health system, including Sutter Medical Group and Sutter East Bay Medical Foundation. We are also upgrading oncology and orthopedics services and equipment.

Klein: Expanding access to care throughout the North Bay remains MarinHealth’s top priority. Primary care and specialty care provide a wide range of essential services, including preventive care, diagnoses, and the management of acute and chronic diseases. Physicians serve as the gateway to MarinHealth, acting as the central point for all necessary health care services.

While every health care institution is facing a shortage of primary care providers, it’s important to note that recruiting new physicians and providers is difficult, especially with the high cost of living in Marin and Sonoma counties.

Olney: We see 2024 a year of transformation and collaboration. In line with that theme, one of our top priorities for this year will be to re-imagine delivery of care to ensure it is in line with the changing needs of our community. We are developing road maps that reflect how our communities are evolving, how technology has advanced and how it impacts our current infrastructure. Maturing as an integrated delivery network is central to this work and will help us navigate and lead into the future.

Continuing to prioritize our relationships with like-hearted organizations will continue to be fundamental to who we are and how we operate. In the last year, we gave over $6.6 million to dozens of community-based organizations, permanent supportive housing projects and community partners that support social determinant of health needs locally. These partnerships are deeply rooted in our Mission and will continue to allow us to expand health care services to more of our neighbors.

Toledo: Petaluma Health Center's top priority in 2024 is to reduce health disparities, improve health outcomes, and strengthen community resilience in a financially sustainable manner. We are committed to creating neighborhood-level resilience hubs that provide essential medical services and social support during emergencies.

With our recent acquisition of a 15,000 square foot medical building in Rohnert Park, in partnership with community-based partners, we are working to transform it into a resilience hub that will serve as a lifeline during climate-related emergencies like flooding, extreme heat, and power outages. Additionally, the renovated facility will allow us to provide same-day primary medical care, mental health, and social supports to an additional 8,000 patients annually. Through our efforts, we will continue to make a lasting impact on the lives of our patients and communities, ensuring that no one is left behind.

Please describe one cost-efficient change or major improvement to your organization in 2023 and how it worked out.

Behl: One of the major improvements at NorthBay Health was to flatten the organization. The more layers that exist between the front line and the senior team, the more complex and less nimble the organization is in terms of innovation, change management, and operational and strategic decision-making. (This) has yielded a great deal of positive results. We are making decisions faster. We are responding to employee needs quicker and we are able to adjust sails when the winds change before it’s too late.

Boyo: It’s no secret that staff turnover and burnout are critical problems within the health care field. Caring for our clinicians, nurses and other staff and reducing staff turnover is an area of continuing focus for Sutter Health leaders. I’m proud to share our leadership team at Sutter Solano reduced first-year hire and overall employee turnover rates by 50% each in 2023.

Dosi: Kaiser Permanente’s integrated model of care is focused on keeping our members and community healthy, so we continue to invest in recruiting the best physicians as part of our focus on increasing access to care. We know this allows us to intervene sooner and help our members and patients on their road to recovery. Prevention and early intervention leads to higher-quality care and ultimately leads to a more cost-efficient health care system. We also remain committed to reducing our carbon footprint, and Kaiser Permanente has pledged to achieve carbon positive status by 2025. This includes using renewable energy sources at our medical offices, installing solar panels, and using carbon offsets.

Klein: MarinHealth has been focused on continually delivering high-quality care. Through the addition of key leadership roles and process improvements, the results of these efforts have helped MarinHealth to improve quality and earn numerous awards and accolades for it, including the prestigious 5-star rating from the Centers for Medicare and Medicaid Services (CMS), a Hospital Safety Grade of “A” by Leapfrog, and, more recently, a rating from Healthgrades that puts MarinHealth among the top 5% of hospitals nationwide.

Laws: One of the areas we are working to improve is reducing hospital readmissions. A readmission is defined as any patient who returns to the hospital within 30 days of discharge. We have a strong program to identify patients who may be at risk for re-hospitalization. This information is communicated during the patient’s hospital stay and throughout the entire continuum of care. One of the most exciting changes that has occurred over the past two years is we have been effectively identifying patients who may be at highest risk for readmission by using their electronic medical record to collect information that could put them at higher risk of re-hospitalization.

Nowak: The Sr. Leadership team continues to embrace Lean Culture through Performance Improvement, ensuring that we make decisions using Lean methods. One of our 2023 Lean initiatives focused on streamlining processes that align with our Auto-Administration Policy to decrease turnaround times for common and routine referral requests. Through Kaizen Events, we brought together a cross functional team which included Credentialing, Contracting, Provider Relations, and Data Entry to streamline and improve our provider onboarding process.

Olney: Last March, Providence Santa Rosa Memorial opened its second state-of-the-art catheterization lab, which is expanding and enhancing our ability to provide the best cardiovascular and vascular care. Having two rooms with advanced imaging technology allows us to take on the complex cases we are known for simultaneously and perform them more efficiently with less radiation exposure. We expect to complete upgrades to our third cath lab this year which will further enhance our ability to care for our community members.

We also made improvements at Petaluma Valley Hospital, including renovating our emergency department, investing in new surgical/radiology equipment and updating our air handlers. Healdsburg Hospital transitioned to Epic’s electronic health record system and we made other upgrades to support that transition.

In addition, Providence Queen of the Valley recently began a $14 million upgrade and expansion of its emergency department to include upgraded patient rooms, a cutting-edge stroke and diagnostics center and a fast-track unit for patients with minor and non life-threatening emergencies.

Toledo: In 2023, Petaluma Health Center implemented Epic, a new electronic health records (EHR) system across the organization. This change streamlined workflows and improved care coordination among providers, resulting in enhanced patient safety and quality of care. The system greatly enables secure and seamless sharing of patient information, leading to more effective health care delivery. The transition to the new EHR system has proven to be a major improvement for Petaluma Health Center, benefiting both patients and health care professionals.

What has been your biggest success of 2023?

Behl: When I was approached by the opportunity, I was familiar with the system and the region but I wanted to understand more about the opportunities, the challenges, and the overall healthcare environment that NorthBay operates in. During the process, my wife Sara and I fell in love with the North Bay Area. There is something special about the sense of community within this area, not to mention the beauty, proximity to metropolitan cities, and of course the climate. I am beyond thrilled and energized to help build something very special in Northern California. At NorthBay, we believe health care is local. To deliver the best care, one must understand the needs of the community. There is something special about being able to meet with community leaders, local businesses, and physicians and clinicians to hear what the needs exist within our health system. We are building a system that is led by people who live and work in the communities we serve. This role helps me connect to my mission of wanting to make a difference in the world, and for that, I am so thankful for the opportunity to lead this organization going forward – it’s going to be an exciting 2024.

Boyo: We streamlined and improved patient flow in the Emergency, Diagnostic Imaging and Surgery departments to minimize waits. In 2024, we are continuing this work, with the goal of making Sutter Solano the best place to work, practice, and receive care in Solano County.

Dosi: This past year, we were honored with numerous recognitions including an “A” grade by the Leapfrog Group in the fall of 2023 for providing safe patient care. Kaiser Permanente also continues to be recognized as a leader nationwide in providing high-quality care. This year, Kaiser Permanente Northern California was recognized by the National Committee for Quality Assurance (NCQA) for providing high-quality, equitable care.

Laws: My biggest professional success has been being named the Chief Nurse Executive and Chief Operating Officer at Kaiser Permanente San Rafael. I began my nursing career as a bedside staff nurse at Kaiser Permanente San Rafael the day after I graduated from Dominican University (Dominican College back then). I was fortunate enough to be hired upon graduation and had an extensive orientation to Kaiser Permanente.

Olney: Serving in this new role as chief executive for Providence in Northern California is an honor. Starting a new position is an exciting challenge and it is also an invitation to evolve, innovate and offer new perspectives.

It’s been nearly a decade since I joined Providence and while Northern California is new to me, I feel right at home here in our hospitals in Sonoma, Napa and Humboldt counties. That’s because the thread that weaves us all together within Providence — no matter your location — is our commitment to living our values and treating all we serve with compassion, dignity, justice, excellence and integrity.

Toledo: One of the most significant successes this year has been the creation of a program to train the next generation of Spanish-speaking mental health counselors. Petaluma Health Center recognized the significant disparities that Spanish-speaking community members face in accessing mental and behavioral health services and could no longer wait to see a solution, and instead realized the Center had to be a part of the solution its community so greatly needs.

As a first critical step, PHC established a training program that provides career advancement opportunities for employees and community members while addressing a critical need in the community. With the program, PHC is confident that it can reduce the health disparities experienced by the Spanish-speaking community members and provide them with the support they need to live a healthier and more fulfilling lives.

Walker: All of my successes are because of the great people around me. The biggest point of pride for all of us at Kaiser Permanente is that we achieved blood pressure control in 84% of the patients we serve with hypertension.   In diverse communities like the ones we serve, this equates to hundreds of fewer heart attacks and strokes per year. This is the highest level of control we’ve ever achieved, and we will aim to go even higher.

How are you using AI in the workplace?

Klein: Some key areas most impacted include diagnosis, assistance, imaging enhancement, patient monitoring, such as rapid response or warning systems for the ICU, provider documentation and virtual scribes, predictive analytics for population health, length of stay monitoring and alerting, and clinical decision support.

In addition, MarinHealth is implementing several cutting-edge technologies and solutions for our cardiac care services, including AI image-guided technology for detecting Abdominal Aortic Aneurysms (AAA). This is in addition to a new AI cardiac MRI program that increases scanning throughput for myocardial function with quick ejection fraction, stroke volume, and mass calculations. This means physicians will have access to enhanced images and more accurate data regarding a patient’s heart and its function to make better, more informed decisions regarding patient care.

Oh: Sutter is using AI to help us safely and privately review potential life-threatening illnesses across thousands of patient records. We use the information gleaned from AI to make faster and more accurate treatment recommendations for referring physicians and their patients.

Toledo: AI-powered chat responses have already been implemented to enhance the Petaluma Health Center staff efficiency in handling patient inquiries. The organization is interested in exploring how AI can facilitate quicker access to patient information, appointment scheduling, and answers to frequently asked questions.