In May 2019 Kaiser Permanente announced an ambitious plan to create social health networks in the 39 communities it serves within three years. Bechara Choucair, M.D., KP’s senior vice president and chief health officer, said recently that the integrated health system is halfway to that goal.
Last year the nation's largest nonprofit, integrated health system announced it was partnering with a company called Unite Us to connect healthcare and social services providers to address members' pressing social needs, including housing, food, safety, utilities and more for millions of people across the United States.
Even before the pandemic, the organization gathered data indicating that in certain regions, up to 29 percent of Kaiser Permanente's members who have the greatest medical challenges are dealing with food insecurity, and as many as 23 percent have concerns about housing stability – critical issues that are among the types of challenges that Thrive Local is seeking to address.
Speaking Oct. 28 at the National Center for Complex Health & Social Needs’ annual meeting, Choucair said, “This work under way has become even more crucial in the face of health and economic crises.” COVID, he added, has made an already bad situation worse.
Choucair said the pandemic has “made crystal clear that now is the time to address mental, physical and social health. We have to elevate the social health of members and communities to the same level as physical and mental health.” He said addressing social health will allow Kaiser Permanente to advance overall health goals and drive affordability.
He noted that the United States spends more than other countries on healthcare services and much less on social services. “We are an extreme outlier, with high medical spending and low social services spending. This mismatch is driving poor health outcomes.” Despite higher spending per capita, the United States does not have better health outcomes.
A recent survey across Kaiser Permanente demographics and regions asked about unmet social needs and if they posed barrier to health. It found that 67 percent said they had unmet social need on housing, food, social isolation or financial ability to pay bills. And 25 percent said they had an unmet social need that was a barrier to health in the past year. “They are having to make a tough decision to pay rent or a co-pay to get medication,” he said. “Buy food or pay a deductible for surgery. All of us know rent and food are paid for first and health later. These people are twice as likely as others to rank their health as fair or poor. One-third are not confident in their ability to access resources to help with these issues. And that was before the pandemic,” Choucair stressed, a time of relative prosperity in this country.
The pandemic has changed the landscape. He said that in 33 cities the unemployment rate is above 15 percent, and that 40 percent of low-earning households have experienced job losses. The impact has hit state budgets as well, with 34 states seeing a 20 percent drop in revenue this year compared to last year during the first half of the year. A key part of Kaiser Permanente’s plan is accelerating efforts on social needs, he said. “The pandemic reinforces what we already know. We can’t keep people healthy if they don’t have a roof over their head and food on the table.”
Choucair said in response to the pandemic Kaiser Permanente has accelerated the development of resource directories to allow providers to connect people to local organizations to offer relief programs. It also developed a COVID clinical playbook and a parallel social health playbook for providers that it makes available to other provider organizations to use. The organization also has set up a call center for its members to support members in navigating the social provider landscape.
Effort to address homelessness
In addition to a major effort to support contact-tracing efforts, Kaiser Permanente also is working on homelessness and housing insecurity in its communities. “We can’t expect people to live healthy lives without stable roof over their heads,” he said. “Common sense tells us that. The life expectancy of a homeless person is 27 years less than those housed. Think about that. We also know if you are homeless and admitted to the hospital, you stay two to three days longer and when discharged, there is a 50 percent higher chance of being readmitted to the hospital. Total cost of care is three to four times higher.”
In 2018 Kaiser Permanente committed $200 million with a focus to add or preserve affordable housing in communities. “We were able to close on 33 projects in our footprint involving 3,100 affordable units,” he said. “That is the type of impact that is so critical.”
The organization also is partnering with others on advocacy issues to push for affordable housing and zoning changes across the country. It is involved in Project Roomkey in California, a government-led effort to buy motels and turn them into permanent housing. Kaiser Permanente stepped up and dedicated $25 million for wrap-around services for people living in these motels.
“When we go upstream to address root causes, we encounter problems fueled by systemic racism and inequity as underlying factors that create these conditions,” Choucair said. One example of an effort to address these issues involved identifying more than 500 people in Oakland living on the streets with chronic health conditions. “We created a flexible pool of funding to remove barriers to getting them into housing. Because of this fund, we got them off the streets in nine months.”
Choucair has an extensive portfolio that extends beyond the social health networks. As chief health officer, he is also accountable for the care of over 1 million Kaiser Permanente Medicaid members and those who are dually enrolled in Medicaid and Medicare. He is in charge of the organization’s Environmental Stewardship work, including the commitment for KP to become carbon neutral in 2020. He manages Kaiser Permanente’s community health portfolio, including $3.4 billion dedicated to supporting medical financial assistance and charitable care as well as grants and community health initiatives.