Reno, Nev.-based Renown Health, a nonprofit academic health system, decided to seek a value-based care partner a few years ago. Armed with a short list of possible partners, the health system began a journey that led them to Kaiser Permanente.
Meanwhile, Oakland, Calif.-based Kaiser Permanente was on an expansion journey as well. The health system had tried taking the model that worked so well in California and dropping it into new communities, but couldn’t replicate the results. KP started thinking differently and sought a partner to try a new model of localized innovation in value-based care. The result was Kaiser Permanente Nevada — a jointly owned health plan announced in September 2025 and finalized in February 2026.
Both organizations say Kaiser Permanente Nevada represents fully aligned incentives between a payer and a health system.
Shelby DeCosta, senior vice president and chief business development officer at Kaiser Permanente, and Anna Loomis, CFO of Renown Health, appeared together for the first time onstage since the venture’s launch at Becker’s 16th Annual Meeting in Chicago and made the case that what they’ve built is structurally different from every payer-provider contract that came before it.
“A standard contract between a health system and a payer doesn’t necessarily — I know this is a shocker — doesn’t necessarily align incentives to get to the right outcome,” Ms. DeCosta said. “We feel like we have nailed that.”
But it wasn’t easy or turnkey.
Kaiser Permanente has operated a single integrated model for 81 years that produces measurable outcomes: members are 33% less likely to die prematurely of heart disease and 20% less likely to die of cancer than the general population. But despite those numbers, Kaiser touches only about 4% of lives across the country.
“It’s one thing to feel like, oh gosh, we got this system that works, we’ve been perfecting it, and yet there’s so much that is challenged and broken across the system,” Ms. DeCosta said. “We come from it from a place of mission orientation and wanting to have a greater impact. We also come to it with a lot of humility because if anyone’s followed our growth, we’ve tried to just pick up our California model and drop it into other communities. And that didn’t go so well.”
Nevada had long been on Kaiser’s radar. The market sits next to California, has attracted businesses and retirees migrating from the state, and counts roughly 100 of Kaiser’s employer clients as having operations there. But every conventional path to entry — building hospitals, competing with entrenched health systems — was expensive and slow.
Renown, meanwhile, had owned a roughly 70,000-member insurance product called Hometown Health Plan for years. The quality was strong, patient experience high, staff dedicated. But it lacked scale.
“We knew that we didn’t have the expertise or the scale or the capabilities really to use that health plan the way it needed to be to really advance in order to be able to meet that objective of really ensuring access to high quality care and affordable care,” said Ms. Loomis.
The joint venture restructures Hometown Health Plan as Kaiser Permanente Nevada, with both organizations holding roughly equal stakes. The equal ownership was non-negotiable from the start.
“One of the principles that we came up with early on was that we wanted equal skin in the game,” Ms. DeCosta said. “We wanted this to matter to both organizations.”
The structure goes beyond the health plan itself. Kaiser is building and operating new primary care medical offices in Nevada, while Renown’s medical group, more than 500 physicians embedded in the community, is being integrated into jointly operated facilities where KP primary care physicians and Renown specialists now work side by side.
The hospital relationship is also nontraditional. Rather than Kaiser acquiring or building its own inpatient infrastructure, the vast majority of care is still delivered through Renown’s facilities, with joint operating committees in place to transplant KP’s clinical protocols and its “care without delay” discharge model.
“We have over 9,000 protocols,” DeCosta said. “We didn’t bring them all at once, but we looked at where the opportunities were and we actually have great partners in our Permanente medical group in Northern California who kind of stepped up and said, we’ll come out and we’ll help and we’ll train.”
At the center of the model is a payer contract that both executives said bears little resemblance to the documents it replaced.
“I think these contracts were written, I don’t know, 100 years ago,” Ms. DeCosta said. “What you would traditionally do is just go to the contract, which is 100 or 200 pages, and look for the couple of numbers that translate to a little bit of upside and figure out how you are going to work this so that maybe you get 0.2% more by doing X process. We took the opposite approach. We threw out the old contracts and said how do we make sure that if we do the right things for our members, we all benefit financially.”
Ms. Loomis said the resulting payer agreement was the longest-term contract she’s ever been part of. It was built on the philosophy that short-term contracts and misaligned incentives have made it nearly impossible for health systems and payers to move past their chronic tensions.
“There are so many hard conversations between payers and providers; we’re battling all the time in so many different ways,” Ms. Loomis said. “It’s not good for anybody. We all know that. But we’re all struggling to break that cycle. I truly think this is a model that has the potential to do that, and that could be groundbreaking in so many ways, not just beneficial for Nevada, but across the country as well.”
Negotiations were intensive. Ms. DeCosta and Ms. Loomis described a process of dismantling every assumption about how hospital economics work — what happens to Renown’s revenue if admissions fall, what Kaiser needs to do inside the hospital to drive quality — and rebuilding the financial relationship from first principles. Both said the trust they built made what would ordinarily take years go relatively fast.
“It actually felt long at the time, but we negotiated in a very short period of time because of the trust that had been built up and we knew how important it was to have our interests fully aligned,” Ms. Loomis said.
Ms. Loomis, who came to Renown after the partnership conversations had already begun, said she was initially skeptical.
“My first reaction was, what? What are we trying to do here?” Ms. Loomis said. “Then the more I was at the table and just seeing the cultural fit and the mission fit that we had, I was probably a little skeptical in the beginning. Now I’m the biggest supporter of it because I truly believe it’s going to be successful.”
Early signals have been encouraging. Since the September 2025 announcement, Kaiser Permanente Nevada has seen double-digit membership growth across all lines of business. Ms. Loomis attributed part of that momentum to Nevada’s proximity to Northern California, where the Kaiser brand is well established, but said she believes the community response would have been positive regardless of geography.
For Kaiser, the joint venture is a proof of concept for a broader ambition. Ms. DeCosta described an evolving portfolio of partnership models, including Habitat Health, a PACE-model venture for elderly patients developed with Town Hall Ventures, and Risant Health, a multi-payer, multi-provider value-based care platform that counts Geisinger Health and Cone Health among its members, that could allow Kaiser Permanente to touch millions more lives without replicating the full capital cost of its California model.
“If there is a way to touch more lives across the country with our brand of value based care, we’re willing to think about how to do that,” Ms. DeCosta said. “We probably don’t want 75 models, but we think there’s more than three that will make sense for us to deploy. Having that short list to us means we can touch millions more lives. That’s really what we’re here to do.”
Both executives said the partnership’s durability comes not just from its contractual structure, but from the way the two organizations approached the hardest conversations, with a willingness to take timeouts, revisit assumptions and prioritize the outcome over the process.
“We really had to stay focused on what our objectives were; that was always at the forefront,” said Ms. Loomis. “That was always grounding us. It’s about being open, it’s about being creative and it’s about building that trust.”
Ms. DeCosta echoed that framing, pointing to the flexibility both teams maintained even when they thought they knew the answer.
“Sometimes what we thought the outcome was going to be wasn’t the right answer when we modeled it or when we tested it with clinicians,” Ms. DeCosta said. “So we reiterated a lot, and we have a commitment that if we didn’t get the contract perfect, which Anna and I think we did, years down the line, we’ll come back and we’ll fix it.”
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