Kaiser Permanente is interested in the community. No, not the fictional TV series Community, but rather the stuff that surrounds Kaiser Permanente’s many hospitals and clinics. You know, that stuff that its patients live in each and every day.
This interest is not a passing fad like the Running Man Challenge or UGG boots. Over the past decade, Kaiser Permanente has launched various large efforts outside their hospital and clinic walls. One example, which I covered previously for Forbes, is their pair of programs aimed at making changes in communities to reduce obesity: the Community Health Initiative and Healthy Eating Active Living initiative. Then there’s their goal of going carbon neutral by 2020, which includes putting in solar panels.
More recently, they’ve been trying to address the homelessness and the housing crises, which is especially acute near the Kaiser headquarters in Oakland, California. This has included launching a $200 million Thriving Communities Fund last year and in January committing to provide housing for 500 people in Oakland.
In March of this year, Kaiser Permanente announced a partnership with Community Solutions, nonprofit organization based in New York City. Kaiser will contribute $3 million over three years to Community Solutions’ Built for Zero initiative, which uses data and technology to help local leaders to better understand and address homelessness. The focus of the Kaiser-Community Solutions partnership will be 15 different communities that fall within Kaiser’s footprint: seven communities in California plus Washington, DC; Baltimore and Montgomery County in Maryland; Arlington and Fairfax Counties in Virginia; Denver, Colorado; Atlanta, Georgia; and Honolulu, Hawaii.
Then there’s the ongoing partnership with the National Basketball Association (NBA) that focuses on building healthier communities. Here’s the kick-off (or rather tip-off since its basketball and not that other sport) in 2015:
Speaking of the NBA, I had a chance to chat with Bernard Tyson, Chairman and CEO of Kaiser Permanente, at the NBA and Kaiser Permanente Total Health Forum in New York City. Besides trying to keep my computer from auto-correcting Permanente to “permanent,” one of the things on the top of my mind was asking him about Kaiser’s community strategy.
Tyson responded, “Yes, it’s an important focus of ours. How can we create healthy communities around the country? How do we make sure that we are engaging communities everywhere, particularly disadvantaged communities? How do we bring our resources and work with communities?”
Ah, but this isn’t what all health systems typically do, especially ones that own lots of clinics and hospitals. Some may talk about the community, hold some health fairs, and plaster their billboards in communities, but how many are truly dedicating time and resources to improving the communities? What makes Kaiser Permanente different?
“It’s in our DNA,” Tyson responded. “Working with communities is not an extracurricular activity. It’s been in our mission for a long time, a dual focus as a health system, focused on communities in which our health care facilities exist.” He emphasized that “great health care is not just treatment. Why not intervene earlier, rather than waiting until patients have problems?”
I didn’t take a sample of Kaiser Permanente’s DNA and send it off to 23andMe, Natera, or Myriad Genetics, but it does make sense that Kaiser Permanente would have a vested interest in improving their patients’ communities. After all, Kaiser Permanente serves as an insurance company too, covering around 12.2 million people. They have an incentive to keep their members healthy and well, as more distress and more disease would lead to more costs. Tyson said, “This is a a resource issue, too. Investing in communities and preventing disease help health care become more affordable. Such activities will eventually yield high returns.”
What further distinguishes Kaiser Permanente’s line of thinking and resulting strategy is more of a systems approach than just an individual approach to wellness. Rather than sending its members an endless barrage of advice pamphlets telling them to eat better, exercise, and not smoke, there is a recognition that people are affected by the systems around them.
For example, a person who smokes doesn’t see a pamphlet and say, “really? Smoking is bad for me? No one told me that. Who would have thought that inhaling smoke into my lungs would do anything bad?” He or she probably started smoking because of social and cultural influences, stress around him or her, and other reasons and may struggle to quit due to addiction and the surrounding systems.
Similarly weight issues are not simply due to bad decision making or lack of self-control. Otherwise, why would obesity rates be increasing around the world? It’s not as if someone started a hashtag #letsalladoptunhealthyhabitstogethernow and amasses millions of followers. Tyson emphasized that “improving health also has to do with addressing the social determinants of health such as discrimination, crime, and violence and the lack of basic infrastructure. The question then is what can be done upstream. Otherwise, the community is just a system that is waiting for people to get sick.”
Tyson did mention a lot of the habits that can help promote health such as “healthy eating, getting exercise, and getting adequate rest” but did emphasize that these are affected by “what’s going on in the community around a person.”
Moreover, many of these systems and social determinants begin affecting people early, when they are just children. For example, in a study just published in the American Journal of Preventive Medicine, a team of researchers from UCLA (Adam B. Schickedanz, MD, PhD, José J. Escarce, MD, PhD, Neal Halfon, MD, MPH, and Paul J. Chung, MD, MS) and the University of Michigan (Narayan Sastry, PhD) found that those who had more adverse experiences as kids ended up more likely to have higher household out-of-pocket medical costs as adults. This brings new meaning to the expression, “you’ve got to be kidding,” when you see your medical bills.
Therefore, improving communities for kids can help improve the health of future Kaiser Permanente members. Tyson said, “a study with the Centers for Disease Control and Prevention showed that the effects of adverse childhood experiences carried out through the rest of life. If we can solve such problems early on, we can do a lot to help mental health and well being for the rest of life. This is looking at the whole person, proactive and not just reactive treatment, and connecting the head to the body.” Most will agree that connecting people’s heads to their bodies is a good thing. Not everyone may realize or admit how much your childhood really affects the rest of your life.
Case in point, Tyson’s childhood did affect what he does today, in a positive way. He explained, “I was greatly impacted by my wonderful mother, who has been sick all of my life, and the wonderful doctors who took care of her and us. For the longest time, I assumed that this type of care is what everyone got. But when I learned no, this led to a passion to reduce disparities of care.” Tyson added, “The fact that someone may not be getting what they should be getting because color of skin or sexual orientation is unacceptable. Period. No sentence to follow.”
Tyson also credited his father, “who was a minister. His line of sight was always the community of the congregation. The community was the family. I had a support system that I could rely on and that was in my corner, encouraging me to be all that I can be.”
Tyson added one more thing about what Kaiser Permanente is doing differently: “consistent with our model in KP, we aren’t just throwing money at the problem.” Although many people may not be opposed to having money thrown at them, his point is that money alone doesn’t solve major health problems and money is certainly not the only thing that Kaiser Permanente brings to the table. Kaiser Permanente has a unique and wide array of health professionals and experts who can help structure programs appropriately and directly engage communities. He described Kaiser Permanente as a “group of like-minded individuals. People who are going to do good with returns going directly back into communities around the country. Our doctors, nurses, and other health professionals want to take care of members and members’ families. They view our members as more than individuals.”
Health care needs to adopt more of a systems approach that includes the community as well. Hospital care should be only one small part of health care. Many times people don’t reach clinics and hospitals until they are too sick and unfortunately beyond repair. Focusing too heavily on the reactive care that many hospitals currently offer would be like saying, “I’m not going to flush any toilets or take out the trash and will let everyone take dumps all over the place. Then, after several decades, we will see what results and try to clean up the mess.” Moreover, simply blaming individuals for their health problems would be like yelling at Luke Skywalker for not being more lighthearted. People live within and are affected by the community systems around them. It’s time for health care to be more about improving these systems.
Date: May 06, 2019