How does Kaiser Permanente decide which public health causes to invest in? We asked CEO Bernard J. Tyson

Hospitals and health systems still play a largely indeterminate role in population health. Not Kaiser Permanente. 

The sprawling Oakland, Calif.-based nonprofit health system has carefully been advancing a population health strategy that touches the social, environmental, economic and physical aspects of health. 

To name a few strides this year: In May, the system invested $200 million in programs to prevent and reduce homelessness and address approaches to affordable housing. In April, Kaiser Permanente invested $2 million in gun violence research. In June, it struck a partnership with Atlanta-based Emory Healthcare to reduce healthcare disparities in Georgia. In September, it pledged to go carbon neutral by 2020 to help foster healthier environmental conditions. 

"Our line of sight is around population health, individual health and community health," Bernard J. Tyson, chairman and CEO of Kaiser Permanente, told Becker's Hospital Review. "We know now that creating more health through those vehicles and those opportunities has a direct impact on the individual's health. And when we talk about health, we're talking about physical and mental. Managing to stress and mental challenges is as critically important as managing to diabetes or heart disease."

Becker's caught up with Mr. Tyson to discuss Kaiser Permanente's population health strategy, from prioritizing needs to measuring success. 

Note: Responses have been edited lightly for length and style. 

Question: Kaiser Permanente has been busy striking partnerships and investing in various population health initiatives and research. What is the overarching strategy driving these investments, and how has that strategy changed in 2018 compared to years prior?

Bernard J. Tyson: We have always been engaged in our communities and we have provided community benefits for years. Our model is set up to build the best health possible for our communities. How we have evolved over time is more the transition from, "How do we contribute?" to "What's our integral role in helping to solve?" In terms of our overall strategy, we believe and know now that health is determined by critical factors outside of the "medical care extreme."

We provide both healthcare and coverage, and we are also a mega-health system. The question is how do we connect our competencies, capabilities and resources to community assets to produce value for the entire community and for the communities in which we serve? Therein lies our strategy for community health. We know where you live matters in terms of the overall effect on your health. We know what you eat matters. If you don't have healthy venues to buy healthy foods, your risk of developing certain illnesses and diseases earlier on in your life is highly probable. We know exercise is critical to maintaining, regaining and having good health. If your environment is such that it's unsafe to go outside to exercise and move freely around, or if the community lacks those kinds of infrastructures, you will have a hard time exercising. It's those kind of direct connections back to healthy lives that we've rallied around.

Q: With so many social, economic and health issues out there to be addressed — and for a system as sweeping as Kaiser Permanente, with a range of needs across markets — how does the health system prioritize issues and communities to invest in?

BJT: There are a lot of commonalities around the factors of good health. The issue is the inequities of our communities around the country. The solutions must be tailored to their priorities and needs. For example, we have a universal, accepted understanding that healthy eating contributes to good health. In some communities, grocery stores and choices of grocery stores with fresh fruit and vegetables and a fresh food selection is a non-issue. In other communities, you can't find them. If we were prioritizing resources, we wouldn't put energy into getting more food in communities where they already have choices. We would put our energy in communities where they don't have any. 

The second thing is we regularly complete a comprehensive community assessment across all our markets. We work within our communities, so they never feel like we're the big healthcare organization telling them what they need. It's a very collaborative process in which we're working out of mutual respect, trust and alignment that we're all trying to do the right thing. Community voices are critically important to help to guide how we prioritize our time, resources, energy and effort.

Q: Can you walk me through the decision-making process for these kinds of investments at Kaiser Permanente? I.e. who champions the ideas, who is the final decision-maker, etc.?

BJT: A lot of different people can come up with ideas. We have a fluid process where we encourage and engage ideas from throughout the organization, and an infrastructure for ideas is headed by the chief community health officer [Bechara Choucair, MD], whom I recruited and brought into the organization a couple of years ago. By design, I brought Dr. Choucair into the organization with the clear direction that his responsibility is to represent the voice of the 68 million people who live in the communities in which Kaiser Permanente exists. He works with the teams on the ground to tailor programs to the individual communities. At the very top, there's a community health committee of the board. That's how seriously we take this. It's the board of directors who ultimately makes the decisions for capital and other investments brought to them by the management team. The board plays a critical role in both the strategy and the funding of major initiatives to make sure we are achieving the purposes and mission of the organization.

Q: How does Kaiser Permanente measure and track progress?

BJT: Sometimes we have tangible goals and expected outcomes, and we measure ourselves against them. In other cases, we identify the outcomes we want to impact and we measure those over time to see if we are achieving the results intended. If we're not, then there's the question of why not, and that can present both opportunities and challenges. 

We continue to learn when we conduct the community health assessment. After the assessment, we identify the two or three top problems, and then we do another assessment three or four years later to determine whether we've made progress in the hearts, minds and realities of the people we care for. And in some cases, we track ourselves against public data. Did we lower crime in a particular community over a time period? Even though you may not be able to contribute everything to our individual effort as an organization, we track to see if the outcome was achieved. It's often not one solution or answer that solves a problem. 

Q: Leavitt Partners published a survey in May that found the majority of physicians believe social determinants of health matter — yet most physicians do not believe it is their responsibility to address them. With that in mind, how should health systems approach population health work?

BJT: That certainly is not the mind, attitude and behavior of our Kaiser Permanente physicians in the Permanente Medical Groups. They lead of a lot this work. I was just reading about one of our areas that's teaching eight-week classes on our eight-step program for healthy eating, meditation and activities for patients with Type 2 diabetes, and this is physician-led. 

Q: How does Kaiser Permanente engage physicians around your community health goals? 

BJT: They are directly involved. Many of our efforts are inclusive of physician leadership and equivalent. They're in it. They bring their expertise into the communities, into the thinking. It enriches and enhances our messaging, actions, behaviors and credibility. Because the community holds our physicians in the highest regard, it adds to the credibility of what we're trying to accomplish in our communities around the country. 


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