Health Care That Targets Unmet Social Needs

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Targeting the social determinants of health is a critical piece in improving an individual’s overall well-being and total health, according to an article written by a couple Kaiser Permanente physicians in Southern California. The article appeared recently in the New England Journal of Medicine.

The authors say this doesn’t mean Kaiser Permanente should, for instance, build affordable housing for their homeless patients. But it does mean taking on the responsibility for the full scope of their patients’ needs, consistent with Kaiser Permanente’s social mission and business imperative to improve the health of the communities it serves. Kaiser Permanente has begun to bolster that effort by aiming to target their members’ unmet social needs as part of their overall health care. After all, social, environmental, and behavioral factors account for an estimated 60% of health, compared with just 10% from factors traditionally defined as “clinical.” And research shows that nations that focus on food insecurity, housing, transportation, and other “nonmedical” factors spend less overall on health care while improving quality and quantity of life.

 To achieve this goal, Kaiser Permanente is partnering with existing community organizations, identify gaps in linking with those resources, and (in the process) demonstrate the value of directly addressing the social determinants of health.

You can see the article in full here and learn more about a pilot project the organization is doing with Health Leads,  a social enterprise organization that aims “to address all patients’ basic resource needs as a standard part of quality care.”

 

Three Ways to Improve Digital Health for the Underserved

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“Nothing is more important than your health.  Not money, not anything.  Without your health you can’t do anything.  Emotionally, socially, at work; everything goes with health.…”   – Focus group participant.

“Nothing is more important than your health.  Not money, not anything.  Without your health you can’t do anything.  Emotionally, socially, at work; everything goes with health.…” – Focus group participant.

A new report from Oakland-based non-profit ZeroDivide reveals three ways in which low income women of color use digital technology to access health care for themselves and their families, as well as how they would like to use it in the future.

To determine the current use and usability of consumer-facing electronic health tools (“eHealth”) by low-income communities and communities of color, and to identify opportunities to improve the use of eHealth to address persistent health disparities in these target communities, ZeroDivide held six focus groups with over 60 diverse women in four American cities during June 2014.

In spite of a revolution in new health technologies, advancements that economically and socially privileged populations enjoy, however, have in many instances eluded underserved populations and underserved women in particular.

Through these discussions, participants shared their perceived value of eHealth tools, as well as challenges they face to eHealth adoption.

“The translation of health on the websites are atrocious, they are terrible,” one participant said. Another remarked, “You have to go through so many phases just to get to where you’re trying to go, and it’s like, I have to remember this too? My Mom ends up being more confused.”

The report offers three policy recommendations.

  1. Improve the digital and eHealth literacy of underserved consumers and safety net providers and outreach to these populations;
  2. Support eHealth tools for underserved populations that feature user-centered design and design that enhances communication with providers; and
  3. Support technology capacity building for safety net providers to strengthen the eHealth equity infrastructure.

Read the full report here.

How Community-Clinic Integration is Boosting Population Health — Part 2

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When community organizations collaborate, change happens. Earmarked as one of the next frontiers in public health, community-clinic integration strengthens the health of populations through inclusion, collaboration, and commitment.

Earlier this week, we brought you the first installment of a two-part interview between Kaiser Permanente leaders about the need for community-clinic integration. In this post, Holly Potter, vice president of Brand Communication for Kaiser Permanente, continues her conversation with Loel Solomon, vice president of Community Health for  and Jandel Allen-Davis, MD, vice president of Government and External Relations for Kaiser Permanente Colorado about the creation – and the successes – of community initiative-turned-nonprofit, LiveWell Colorado.

HP: In Colorado, LiveWell has been very successful. Can you talk about that work and what has been achieved?

Jandel: Our work with LiveWell Colorado often makes me think of that Margaret Mead quote: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” This is a program that was started in Kaiser Permanente and in order to scale it, we invited other funders to work with us to take this program to the entire community. The Colorado Health Foundation and The Colorado Department of Public Health and Environment and Kaiser Permanente are the founding funders of the organization.

One essential element of LiveWell programming is that we work with a diverse group of community members to decide on approaches to address the issue of obesity through deployment of healthy eating and active living assets. The outcome of using community based assets to eliminate or reduce obesity is that the community is deeply invested in the results, and we build tremendous capacity in its members.

Loel: A relevant proverb in this case says, “If you want to go fast, go alone. If you want to go far, go together.” In Colorado, Kaiser Permanente wanted to do a place-based initiative. The Colorado Health Foundation wanted to do something similar, and we realized that by combining our forces, we could create much more impact. Now, LiveWell has gone from three communities to 23 communities, some of which have been doing this change work for nearly eight years.

There’s an infrastructure for technical assistance and evaluation that serve all these communities, and there are these state-level policy changes that we’ve been able to generate because all of these communities are creating the public will to have healthy school breakfasts, active transportation, and other things. It’s been powerful.

HP: When you spoke of lowering barriers to food assistance and now with the work with LiveWell, you are addressing policy and systems change that address health behaviors. Why is that so important?

Loel: Policy has a huge influence on the choices people have. It influences their opportunities, and the biggest way we can impact people’s health right now is to create a policy and environmental changes that help make the healthy choice the easy choice. Whether we’re talking about policies and practices about smoking in the workplace, or we’re talking about school lunches and access to PE, or people’s ability to access food stamps, the decisions that elected officials make and the private policies that organizations adopt have such a huge impact on health.

Jandel: We need to recognize that there are no silver bullets available to solve these deeply rooted health and social issues. Addressing these will require multi-pronged approaches. Simply providing food for those who are food insecure may not solve the long-term problem, which is the reason that people don’t have food in the first place. It’s a really interesting choreography of many actions that hopefully begin to affect change on a large scale.

HP: This is the Center for Total Health blog and I know Total Health is central to what drives each of you. How does the concept of Total Health influence your work?

Loel: The way I often think about Total Health is that it requires us to identify and act on the levers of health that exist both inside and outside the walls of Kaiser Permanente. We are focusing on not only what we do as a delivery system, but also what we can influence outside our clinic walls – where our members spend most of their time. To the extent that we can, we work with community partners to address violence and access to healthy food; leverage our workforce to volunteer in schools; and our clinicians to advocate for healthy school lunches. That’s seizing the levers of health. Doing that is necessary to improve the health of the populations we serve.

Jandel: Total Health embraces the notion that Kaiser Permanente plays many of the positions that are important in addressing health. In addition to the care delivery system, we influence many of the upstream inputs related to health and wellness that solve longer-term problems. It differentiates us. If we continue this work, I think we’re unstoppable.

HP: Thank you both for your time.

How Community-Clinic Integration is Boosting Population Health

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Communities play a critical role in shaping Total Health. Too often, the ability to lead a healthy life is stymied by a person’s environment. A lack of access to healthy food, community violence, and pollution can lead to conditions like obesity, depression, or asthma.

Loel Solomon, Vice President of Community Health for Kaiser Permanente

Loel Solomon, Vice President of Community Health for Kaiser Permanente

Community-clinic integration is the next frontier in strengthening the health of populations. Holly Potter, vice president of Brand Communication for Kaiser Permanente, sat down with Loel Solomon, vice president of Community Health for Kaiser Permanente, and Jandel Allen-Davis, MD, vice president of Government and External Relations for Kaiser Permanente Colorado, to talk about what community-clinic integration is, and how it’s driving improvements in health. Today’s post is the first in a two-part series.

HP: Thank you both for making the time to talk with me. Let’s start with the basics. What is community health and how does it affect individual health outcomes?

Loel: There are two elements here. One is that community health is the health of a population, not just an individual. That means that you’re looking at those whose health is most challenged and lifting them up in order to increase the health of the whole community.

On another level, community health points a spotlight on community factors that influence behaviors – things like parks and walking trails, which can increase physical activity, or access to grocery stores and farmers’ markets, which can increase consumption of healthy food. There are other factors in neighborhoods that influence people’s health directly like pollution and environmental toxins. So community health invites us to think about both influencing the health of overall populations, as well as focusing on these things in the community environments that influence health.

Jandel Allen-Davis, MD, Vice President of Government and External Relations for Kaiser Permanente Colorado

Jandel Allen-Davis, MD, Vice President of Government and External Relations for Kaiser Permanente Colorado

Jandel: There are other contributors to health beyond our physical status. Community health also includes components of well-being such as our relationships, our community connectedness, our emotional state and our financial well-being.

HP: To address community health, you both speak of community-clinic integration. What is community-clinic integration and why does it matter?

Jandel: As a physician, I experienced 25 years of observing the impacts of social factors on health and how they play out in the exam room. I can speak to the frustration that I felt in knowing that social needs are not being met, and you don’t have the tools to deal with them. I’ve often thought over the years, “What this person needs cannot be found in a pill bottle or addressed with a scalpel.” I think that community-clinic integration has the potential for us to be thinking about, “How do we bring those resources not just to our patients, but to the providers who are doing their best every day to provide that level of care for people?” I think there’s real value for us to be able to help solve for that dilemma, which is hopefully going to improve cost, quality, and the care experience for patients.

Loel: It’s also what we do as an organization to systematically connect our members to the very rich set of assets and organizations that exist in their communities. Doing this at scale is a real challenge given how varied our members’ needs are, and how diverse the local resource landscape is. But it’s a real imperative for us to figure out how to do that, and there’s a lot of great work under way in our organization that will help us move forward.

HP: What does that really look like in practice?

Jandel: One example is our work with Hunger Free Colorado. When the recession hit, hunger became more evident among populations we typically didn’t think about. In 2011, we did a pilot program and screened our own members for food insecurity by asking the question, “When was the last time you worried whether your food would run out before you had the money to buy more?”

Of the population we screened, about 14 percent of those screened tested positive for food insecurity. These were people who had commercial health insurance, meaning they had jobs that provided health benefits. Given that, there were all sorts of assumptions about who they were and what resources they had. What we found is that if you don’t ask the right questions, this foundational need related to food access would go unnoticed. Today, under the leadership of Dr. Sandy Stenmark, we are screening all of our new obstetrical patients for food insecurity and are rolling the screening out in pediatrics.

Loel: Due to this assessment in the exam room, we were able to connect these members to community-based resources through Hunger Free Colorado. This organization helped them get food stamps (SNAP), it helped connect them to local food pantries, and with a whole variety of other resources.

Then there’s the policy change piece. Out of the 50 states, Colorado ranks at the bottom in terms of the percentage of the population eligible for food stamps who actually receives them. Through Hunger Free Colorado, we have been able to make changes in state and local policy to lessen the burden and lower the barrier for people to take advantage of food stamps.

Check in tomorrow for Part 2 of this interview.

Spreading Health: Reducing heart attacks and strokes with those at highest risk.

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What if there were a simple treatment that was proven to prevent heart attacks and strokes in people with diabetes?

In truth, this isn’t a “what if” scenario.  This exists right now.

In fact, Kaiser Permanente is furthering its reach to low-income populations with this simple treatment that has been preventing thousands of heart attacks and strokes in diabetic patients.

The organization released a video (posted above) to 55 community clinics across the country to help patients understand the significance of a treatment that could save their lives. The video (also available in Spanish) explains about a program – called “ALL/PHASE” – that includes the use of three low-cost medications to reduce heart attacks and strokes.

Since 2007, more than 60 of Kaiser Permanente’s community partners in California, the Northwest, Mid-Atlantic States and Colorado have implemented ALL/PHASE, improving the health of nearly 100,000 low-income diabetic patients.

To learn more about the benefits of the program and community outreach, we reached out to Kaiser Permanente’s Jim Dudl, MD, diabetes clinical lead, Care Management Institute, and Winston Wong, MD, medical director and community benefit director, Disparities Improvement and Quality Initiatives.

How did Kaiser Permanente’s ALL/PHASE program come about?

Dr. Dudl: “The ALL (Aspirin, Lisinopril, and a lipid-lowering medication) initiative was developed by Kaiser Permanente in 2003 to reduce cardiovascular disease among our diabetic patients over age 50 by prescribing the ALL triad of medications. It was critical to us because heart disease and stroke was – and still is – the leading cause of death and disability in the United States and the world. People with diabetes are two to four times more likely to have a heart attack or stroke and 65 percent of those will die from one of those events. But it can be prevented with this very simple and cost effective treatment.

There have a few regional variations to the program over the years to include the promotion of healthy lifestyle changes. Northern California added PHASE (which stands for Preventing Heart Attacks and Strokes Everyday). In Southern California, we have ALL HEART (Heart Smart Diet, Exercise, Alcohol Limits, Rx Medicine Compliance, and Tobacco Cessation Aspirin Lisinopril and Lipid lowering). Whether it’s ALL/PHASE or ALL HEART, the central component is the same, which is the use of the three medications.

What benefits did this program have on Kaiser Permanente members?

Dr. Dudl:  We found that over a three year period, 70,000  Kaiser Permanente members who took both the Lisinopril and the lipid lowering pills lowered their incidence of heart attacks and strokes by more than 60%. The evaluation also proved that if administered to the entire Kaiser Permanente diabetic population, ALL/PHASE would prevent more than 8,000 hospitalizations for heart attacks and strokes each year.

Based on this great success, we knew we wanted to share ALL/PHASE more broadly.

Why did you reach out to community clinics specifically?

Dr. Wong:  Kaiser Permanente is committed to its partnerships with the institutions that serve on the front lines of health care for the uninsured and underserved. These relationships are critical to fulfilling our mission, which is to provide affordable, high quality healthcare services to improve the health of our members and the communities we serve. We do this by investing in quality improvement and population health and support efforts which will transform care and improve health care access for our most vulnerable populations. Sharing our ALL/PHASE initiative is a perfect example of how we can do that. Read More

Heeding Dr. King’s Words

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In honor of Martin Luther King, Jr. Day, Ronald Copeland, MD, chief diversity and inclusion officer for Kaiser Permanente, has written an article for DiversityInc.  Reflecting on quotes from Dr. King, Copeland writes about how a trip as a student to Africa became the foundation for his own passion for social justice.  He also writes about the disparities in health and health care among people of color and the economically challenged here in the United States:

Our failure to address these gaps in sustainable ways has resulted in a crippling effect on our nation’s global economy and competitiveness.  Because of this, perhaps now we have arrived at the tipping point where the pain of maintaining the status quo has finally exceeded the pain of embracing true transformational change of our healthcare system.

You can read all of Dr. Copeland’s article here on DiversityInc’s website.

Disaster Response: One Health Organization’s Perspective

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Dinah Dittman

Dinah Dittman

As the details quickly spread in the aftermath of Typhoon Haiyan in the central Philippines, governments and organizations worldwide began looking for the best avenues to provide relief and support to survivors. As a non-profit organization with a humanitarian social mission, we tracked down Dinah Dittman, national director for community engagement and philanthropy at Kaiser Permanente, to help explain the assessment process that Kaiser Permanente undertakes following news of a major natural disaster.

Does Kaiser Permanente have a philosophy about how to respond financially or otherwise following natural disasters?

Yes, our approach has been informed by years of experience and a rational, multi-phased approach. While we are quick to pull together the appropriate folks within Kaiser Permanente to begin this assessment, we follow a process of working with our community partners about how Kaiser Permanente can be the most helpful. We are fortunate to have a team of experts in areas of philanthropy, disaster response and community engagement, to begin this assessment process following a disaster.

Immediately following a disaster, it’s human nature to want to quickly respond and do something, especially when news reports are filled with photos and stories of people who clearly need help. So many of us want to rush to the site of the disaster and provide immediate assistance – clothing, food and comfort. However, that’s not practical. The people who need to do those things are trained professionals and trained volunteers who know how to organize and cope in austere environments.  At Kaiser Permanente, our communications to our workforce emphasizes that disasters have stages of relief, recovery and rebuilding. And we reinforce best practices in philanthropy and community service — one being that during the relief phase, the best thing to do is give funding to the first responder, trained and connected relief agencies, who are working with governments and networks in the place that’s experiencing the disaster. Resources, such as how to be a “wise” donor and how to contact friends and family in disaster areas, are posted on our disaster relief website, which we make available for our employees.

Because our workforce includes many physicians, nurses, and logistics experts who are trained in disaster relief, the people with those skills are often asked by the aid organizations with whom they are affiliated, to volunteer to serve in the affected areas. We do have a website for our employees and physicians to provide their clinical or logistics skills and language abilities that would be suitable for helping in a disaster area, either in the relief or the recovery and rebuilding phases. This is the system that Kaiser Permanente’s clinical and community volunteer managers use to connect with the people of Kaiser Permanente who are ready, willing and able to serve.

Has Kaiser Permanente made any decisions on how they might support people in the Philippines?

As far as what Kaiser Permanente will be doing to help people affected by this storm, we are now gathering information and connecting with our first responder partners on the ground in the Philippines. They have told us that they now are in the “assessment” phase to find out what the local needs are, including medical and logistics skills, and how best to organize skilled volunteers to coordinate with local responders in the relief phase.

The charitable giving/nonprofit community is also in the process of assessing where the short and longer-term needs are, especially for the “recovery” phase which will be so important to people getting back to their way of life in their home villages and towns. We also don’t advise employees where to make their personal charitable contributions, but we do encourage them to be informed about a charitable organization before making a donation. The Charity Navigator site is a very useful one. They do a “quality control” assessment of nonprofit organizations and provide details on their website, which they have updated for Typhoon Haiyan.

As recovery begins for the people affected by the storm, Kaiser Permanente will stay in touch to learn how volunteers from our workforce would be needed and could serve.

That is an interesting point you’ve made about relief vs. recovery. Can you give an example of how Kaiser Permanente does that?

One example of our long-term thinking and partnership approach is the earthquake in Haiti. In January 2010, Haiti suffered a devastating earthquake that killed thousands of people, left millions homeless, and significantly damaged the country’s already fragile infrastructure, including its health system.

Among many of the buildings that were destroyed was the administrative headquarters for the Ministry of Health. This is the government agency that looks out for the public’s health in Haiti, similar to the Health and Human Service Department in the United States. Kaiser Permanente partnered with the Centers for Disease Control and Prevention, which has a large contingent of staff in the country, in its drive to support public health department assistance in Haiti. Kaiser Permanente’s donation provided a new building with offices for Haiti’s Ministry of Public Health and Population (Ministère de la Santé Publique et de la Population or MSPP). Everyone agreed that, without a decent place to work, it would be extremely difficult to coordinate efforts to rebuild Haiti’s public health infrastructure and respond to the country’s ongoing health needs. We knew this project would help the communities of Haiti for years to come.  We were pleased to join the CDC delegation that traveled to Haiti in February of this year, for the dedication of the new MSPP building and laboratories in Haiti.

In addition to the CDC Foundation donation, Kaiser Permanente supported four nonprofit agencies in 2010 that were first responders, providing much-needed relief aid to the people of Haiti. Kaiser Permanente physicians and nurses trained in disaster relief volunteered in Haiti with aid organizations they were affiliated with. To help share their experiences with other employees at Kaiser Permanente and beyond, the “Dispatches from Haiti” blog was created, which featured at least 28 posts from 11 different caregivers, among them surgeons, emergency room physicians, a nurse and a psychologist.

Read first-person accounts of on-the-ground relief aid from Kaiser Permanente clinicians on the Dispatches From… blog.

Community-Based HIV Test and Treat Initiative

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Recently, four organizations committed to HIV/AIDS care and prevention (each awarded $250,000 from the Kaiser Permanente National Community Benefit Fund at the East Bay Community Foundation) met for the first time as a group to discuss their projects and prepare for a rigorous evaluation process designed by the University of California San Diego.

As part of the health organization’s long-standing commitment to prevention and reducing health disparities, Kaiser Permanente has the Community-Based HIV Test and Treat Initiative (TTI) that supports agencies whose work is designed to establish communities as places where new HIV infections are rare, and where every person — regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socio-economic circumstance — will be aware of their status and have unfettered access to high-quality, life-extending care, free from stigma and discrimination.

Ultimately, the purpose of TTI is to improve early identification of new HIV cases and to increase the HIV care acquisition and maintenance of newly diagnosed individuals in minority communities disproportionately affected by the HIV epidemic. Four additional organizations will be chosen in late 2013.

We’ll be sharing interviews with people about this initiative over the next few days. In this first video, Kaiser Permanente’s Alexandra Caraballo and Pamela Schwartz, both of Kaiser Permanente, talk about the Community-Based Test and Treat Initiative.

The University of California, San Diego developed an evaluation design and tools to document the impact of TTI on improving testing and linkage to HIV care. In this clip, Dr. Anita Raj, PhD, of the University of California, San Diego, speaks about the importance of the evaluation process.

Committed to Advancing Public Health

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NPHW_Logo_2In honor of National Public Health Week, our friends over at the Kaiser Permanente News Center have put together a list of 10 ways the health organization demonstrates its commitment to public health.  The list includes the Every Body Walk! public awareness campaign, the Educational Theatre Program (celebrating its 25th year bringing important health information and conversations into schools), Safety Net grants and fellowships, and its efforts to fight this country’s obesity epidemic.

It is actually part of Kaiser Permanente’s mission to help improve the health of the communities it serves.  For more on KP’s contributions in the public health space, visit here.