While most passengers were asleep on a recent red-eye to Chicago, Bernard Tyson was bouncing in his seat along to Whitney Houston's "I Want to Dance With Somebody."
"Everybody else was passed out on the plane," the CEO of Oakland, Calif.-based Kaiser Permanente recounted to Modern Healthcare staff members that afternoon on Sept. 30, briefly belting out lyrics to the song in case anyone wasn't familiar.
Tyson's unexpected death over the weekend at the age of 60 shocked the medical community and beyond, prompting heartfelt remembrances from his colleagues, fellow health system leaders, academics—even politicians and celebrities. In addition to describing a generous, gregarious man who loved music, they described his strong legacy that Kaiser's leaders plan to carry into the future.
Many count Tyson as a giant working to hasten healthcare's transformation for the better over the course of his more than 30-year career at Kaiser, including serving as CEO since 2013. In fact, last year, Modern Healthcare included him in a group of 12 disrupters who were part of the 100 Most Influential People in Healthcare, a list Tyson was chosen for five previous times. Those who knew him personally also remember his humility, his sense of humor and his ability to put people at ease.
"He kind of in a self-deprecating way will make you laugh and relax," said Dr. Regina Benjamin, former U.S. surgeon general and a member of Kaiser's board of directors. "He's a genuine guy but he's also very funny."
Born Jan. 20, 1959, in Vallejo, Calif., Tyson was one of seven children. He told Bloomberg News that he traced his interest in healthcare to his mother's medical problems.
"My mom was sick from diabetes, so we were in hospitals a lot, and I decided I wanted to run my own," he said in 2015. He earned a bachelor's degree in health service management from San Francisco's Golden Gate University in 1982 and an MBA at Golden Gate in 1984. He joined Kaiser three years later.
Tyson is best known for touting the importance of social determinants of health and steering Kaiser's efforts and resources around solving issues like homelessness, food insecurity and mental illness. He helped strengthen Kaiser's whole-person model of care centered around health promotion and prevention to keep people out of hospitals.
He led Kaiser's "Thrive" advertising campaign, which focuses on the health system's dedication to preventive medicine and making healthcare accessible to members anytime, anywhere.
But Tyson said the work wasn't done.
"We're building partnerships and collaborating with many others around the country to really work on social health," he told Modern Healthcare on Sept. 30.
Donna Lynne, chief operating officer at Columbia University Irving Medical Center in New York City, recalls Tyson emphasizing that strategy during her 11 years at Kaiser, where she served as executive vice president.
"It was very much, 'How do you prevent people from having to spend money on healthcare by making them healthy at the beginning?' " said Lynne, also the former lieutenant governor of Colorado.
Tyson was particularly passionate about ensuring mental illness was regarded the same way physical ailments are. In the recent meeting with Modern Healthcare, he said his industry got it wrong when it disconnected the head from the body.
He said Kaiser is working to integrate mental health services into its primary-care offices in a "warm handoff" fashion, kind of like when a dermatologist popped in on his primary-care visit.
"How do you begin to destigmatize everything that's been placed around mental health and really talk about the organ, which is the brain?" Tyson said. "Just like we talk about the heart, we could talk about the brain. Just like we talk about the kidney, we could talk about the brain."
Over the years, Tyson's near-celebrity-status boosted the visibility of this and other campaigns, not to mention the health system's gargantuan budget and impressive sponsorships of outside organizations. Last year, Tyson stood alongside top NBA athletes touting the importance of treating mental illness at a forum co-sponsored by the health system.
Dr. Ashish Jha, professor of health policy in the Harvard T.H. Chan School of Public Health, wrote in an email that Tyson was an unusual leader.
"As the CEO of one of the largest healthcare organizations in the country, he could have been the flashy CEO who talked about what America should be doing to fix its healthcare system," Jha said. "Instead, he led by action—working on diversifying his own workforce, and talking about the basic truths that few CEOs do."
In her time as surgeon general, Benjamin said Tyson's areas of focus mirrored her own, and allowed her to see some of the type of work she touted come to fruition. Tyson cared about embracing patients' mental health needs along with their medical needs, and understood that without healthy food and a place to sleep, they couldn't focus on other issues, she said.
A major part of Tyson's legacy will be the attention he dedicated to affordable housing. In 2018, Kaiser announced it would invest $200 million to fight homelessness, including investing $5.2 million to help purchase a 41-unit apartment complex in East Oakland to be used for affordable housing.
"Bernard was very focused on building an ecosystem around our members and the communities we serve so that we would move upstream and not just focus on people's illnesses," said Ruth Williams-Brinkley, president of Kaiser Foundation Health Plan and Hospitals of the Northwest.
Kaiser operates in something of a closed loop system in that its 39 hospitals and 23,000 physicians focus on caring for enrollees in Kaiser's health plan. Kaiser officials say that integrated model, strengthened by years of health plan acquisitions, keeps the system efficient and affordable.
There's some evidence the model has also helped Kaiser maintain strong quality measures. A 2016 Institute for Healthcare Improvement report touted the quality gains Kaiser made under a decade-long IHI partnership that included the health system training more than 2,000 in-house improvement advisers. In the partnership's first five years, the proportion of sepsis patients who received antibiotics within an hour of diagnosis grew by 20%.
Improving quality of care for all patients was a personal passion for Tyson.
He died as the result of his second heart attack in his sleep. In 2016 interview with Medscape, Tyson recounted undergoing double bypass surgery at a Kaiser Permanente hospital in San Francisco following what he described as a massive heart attack.
"Nowhere on my calendar would you have found an entry that evening saying I would almost die," he said. "The first takeaway is how traumatic something like that can be. It becomes very personal when it is your health, when something goes dramatically wrong."
He described how struck he was by a seemingly small event: a nurse touching his hand.
"We are heavy into technology," Tyson said. "We are heavy into how technology will enable us to do a better job in taking care of each individual and millions of people, but not at the expense of the human touch. The human touch will always be the deciding factor in how people feel about the care that they are getting."
Even so, Tyson routinely touted the importance of virtual visits, which allow people to get care in a manner that's convenient and accessible to them. In 2017, he said more than half of the more than 100 million encounters between Kaiser's members and physicians were virtual.
George Halvorson, Tyson's predecessor as Kaiser CEO, recalled Tyson championing Halvorson's decision to invest $3 billion in an electronic health record system. Tyson said the EHR would be just like the internet someday, and that the information it would yield would be integral to improving healthcare. "He was absolutely right," Halvorson said.
Dr. A. Eugene Washington, CEO of Duke University Health System and a Kaiser board member, wrote in an email that few people have so positively influenced America's health today and tomorrow as Tyson.
"Bernard's many distinguished achievements and tremendous contributions are compelling and enduring," he said. "He is a beloved, courageous, once-in-a-generation leader who will be sorely missed."
But even the most well-liked leader is going to face controversies in a massive organization with 39 hospitals, nearly 220,000 employees and $80 billion in annual revenue. Kaiser recently has found itself in public disputes with unionized workers, including a narrowly averted strike involving more than 85,000 workers in July.
About 4,000 mental health workers represented by the National Union of Healthcare Workers postponed a five-day strike that was set to begin Monday. They gave Tyson's death as the reason. Workers say they want to boost access to mental healthcare and improved retirement and health benefits.
"I believe that Bernard in his heart really wanted to achieve parity for mental healthcare, but also my belief is he was listening to other executives in the system who were telling him that everything is great," said NUHW President Sal Rosselli.
In fact, Rosselli said a cancer patient can get chemotherapy right away, while a patient with severe depression has to wait up to two months for an appointment at Kaiser.
Despite those disagreements, Tyson maintained his pro-union stance. He said "there's no way" to justify the wealth distribution in the U.S., where the average working person hasn't gotten a real wage increase in more than 20 years.
In his recent interview with Modern Healthcare, Tyson said Kaiser has to balance compensation with keeping care affordable for patients.
"We're not going to pass on additional costs beyond what's reasonable to our members, to our customers," he said. "That's our commitment to affordability."
Amid the NUHW contract negotiation, Tyson told Modern Healthcare Kaiser had proposed adding up to $140 million to provide additional training to young workers.
Tyson spoke often of the importance of equality and diversity in healthcare. In 2014, he wrote a widely shared LinkedIn article about the reality of being a black man in America and called for a better understanding of race relations. He shared his experiences of being monitored while shopping at an upscale store and being asked to show identification while using a credit card, even though white customers ahead of him were not asked to do the same.
Lynne said she will remember Tyson's "incredible" enthusiasm, especially the time they both visited the Denver Museum of Nature and Science, which Kaiser donated money to because of its work encouraging kids to be physically active and interested in science.
"He donned a lab coat, lab glasses and was interacting with all the kids as though he were a kid as well," she said. "He was very playful and enthusiastic. In spite of a suit and in spite of a high-level position, I think he really enjoyed interacting with our patients, whether they were patients or just people that somehow were benefiting from Kaiser's largesse, he got down to that level and would connect with them."
Williams-Brinkley, whose office is in Portland, Ore., said she remembers Tyson's most recent visit last summer, when he made the rounds—meeting as many people as he could and putting them at ease with his sense of humor.
"He was a lot of fun," she said.
Kaiser immediately named its executive vice president and group president, Gregory Adams, interim CEO. Adams first joined Kaiser in Southern California in 1999 and has held a number of leadership positions within the organization. In 2007 he moved to Northern California, where he was associate regional president and chief operating officer and later, president.
"That's a seamless transition for us," said Janet Liang, president of Kaiser's Northern California region. "Quite honestly, many of us were pleased to see him step into that role."
Kaiser leaders in interviews said they will carry Tyson's priorities into the future and build on his work.
Tyson built a strong executive team and led in a style that was very inclusive, so everyone participated in a shared agenda and helped shape priorities, Liang said.
"So we all own it," she said. "We all own the plan and it's a shared vision. For us, it's really natural to continue this work."
Benjamin shared that sentiment.
"We're going to work as a board very diligently and very hard to continue his legacy of affordability, of social determinants, of improving health access," she said. "I know I speak for the board when I say that."
Williams-Brinkley agreed. She said Kaiser's leadership believes in Tyson's vision and will carry it out to the best of their ability.
"We may not do it exactly as Bernard would have done it," she said. "There are few people that had the national and international stature that Bernard had, and few people had his big personality and were humble at the same time. But I believe that we're committed to carrying out that legacy and honoring him and what he stood for."
Tyson is survived by his wife, Denise Bradley-Tyson, and three sons.