In our report, You are what you treat: Transforming the health care business model so companies—and people—thrive, we set out to discover what makes health care organizations capable of successfully addressing the drivers of health (DOH). In short, the answer lies in their business models.
To better understand what allowed certain organizations to succeed in their DOH efforts, we interviewed leaders that successfully transformed their business models to do the following:
- Enable consumers and customers to achieve their goals,
- Harness a partnership ecosystem supported by an enabling technology platform,
- Hard-code an approach to creating trust, and
- Reimagine revenue streams that are tied to new, consumer- and customer-focused measures of success.
One such organization, Kaiser Permanente, participated in our interviews and provided key insights into what this looks like for an integrated health care system. Kaiser Permanente is the largest integrated payer/provider (or “payvider”) system in the country. It serves 12.6 million members across the West Coast, Georgia, and the DC metro area. Its business model structure enables it to address the drivers of health, or what it describes as “social health”—addressing the risks and needs people have to enable them to work, play, and live their lives.
Below, we zoom in on each of its business model components to highlight how Kaiser Permanente emphasizes social health across its delivery system.
Value Proposition
Social justice has been an integral part of Kaiser Permanente’s culture since its founding. An emphasis on addressing community health and health equity is stated explicitly in both its mission and strategic plan.
Kaiser Permanente offers a two-pronged value proposition to both its individual members and the broader communities it serves. For individuals, Kaiser Permanente promises members a trusting, humanizing health care experience that sees members as people rather than symptoms. It does so by addressing social health alongside physical and mental health, and working to bring social health into every care meeting and interaction, all while building trust and understanding between patients and the health system. For the community, Kaiser Permanente builds and strengthens trusting partnerships between itself and the communities it serves. It does this to enhance the capacity of social needs organizations to improve overall community health.
Resources
To support its ability to deliver on these value propositions, Kaiser Permanente created a social health team, led by the Vice President of Social Health, in 2019. As was revealed in our interview, this team has proven to be a critical resource to knit together individual and community health needs, and to develop a systemic approach to social health. The team’s leadership has representation from all Kaiser Permanente-affiliated medical groups, not just the hospitals and payer branch, so decisions regarding social health are reflected across the entire organization.
Additionally, Kaiser Permanente finds strength in its relationship with the community. As an organization, it knows that much of the work around social health happens in partnership with trusted community organizations. These organizations are experts in identifying and serving social needs. Kaiser Permanente does not take over the work of these community organizations to address drivers of health. Instead, it provides financial support and assistance, and maintains a network of community health navigators to foster relationships with patients and connect them directly to social services.
Kaiser Permanente partners with UniteUs to further facilitate the relationship between medical care and social health. UniteUs is a technology platform enabling medical providers to refer patients to community-based organizations that can address their identified social needs, and track their progress in receiving support. For example, if a member is experiencing housing insecurity, UniteUs allows a Kaiser Permanente provider to refer the member to a housing support organization in the community and track whether or not the member received assistance addressing their need.
Processes
Kaiser Permanente works on the individual, community, and societal levels to advance social health for everyone. In addition to providing patient care and supporting community organizations with their social needs efforts, Kaiser Permanente advocates for laws and policy changes that help bolster social health, such as minimizing barriers to SNAP enrollment.
Within the scope of care, it is now standard procedure for all Kaiser Permanente members to be screened for social risks and needs at primary care appointments. In order to deliver this screening effectively, Kaiser Permanente trains all of its care providers in addressing social health. The goal is that within 3-5 years, every Kaiser Permanente member will experience social health at all levels of care and communications.
Profit Formula/Priorities
Kaiser Permanente funds its social health efforts through several channels, including charitable donations, community investments, and its operating dollars.
Building an evidence base to improve health outcomes, testing and scaling evidence based programming, and collecting information on social health are significant priorities for Kaiser Permanente. To that end, it leverages several different metrics to track its impact and success. This includes the following:
- health outcomes data,
- whether or not patients’ social needs have been addressed,
- member retention, and
- the cost versus utilization of its community investments.
Kaiser Permanente also uses a metric called “dose,” which is the strength (impact on lives) times reach (lives touched) of its investments.
Conclusion
With an eye on health equity and social justice since its founding, Kaiser Permanente developed a business model allowing it to address its patients’ social needs. Even for organizations that are not integrated payviders, much can be learned from Kaiser Permanente’s approach to DOH. It identified critical individual and community health needs, and established value propositions to effectively serve them. Then, it ensured the other components of its business model: resources, processes, and profit formula/priorities supported delivering those value propositions.
For more detailed guidance on how to develop the right business model for your organization to sustainably improve DOH, download our upcoming report, Improve or Transform: Choosing the right business model to deliver health, coming this November.
