Events

Kaiser Permanente CEO Bernard Tyson on community health, housing as healthcare and single-payer

The CEO of country’s largest managed care organization speaks on the group’s larger strategy on community health and addressing the larger social issues affecting patients.

Kaiser Permanente CEO Bernard Tyson

With growing consensus over the effects that social determinants of health like housing, nutrition and the environment have on health, one healthcare organization that’s taken a leadership role on many of the underlying issues facing patients has been Oakland-based managed care organization Kaiser Permanente.

Kaiser Permanente Chairman and CEO Bernard  Tyson was on hand to help to kick off the company’s 2018 Community Health Summit in San Francisco and laid out the group’s wider strategy around improving community health.

“Today, as we think about it, the big question around us is the definition of a 21st century community and in a lot of ways the assessment of the state of communities around the country. Are those now environments where people can thrive?” Tyson said. “Or are people really spending all their time, energy and resources simple trying to survive?”

He outlined the management steps it took to center community health as key to Kaiser’s larger ambitions, including the creation of the executive level position of chief community health officer in 2016 with the appointment of Dr. Bechara Choucair to the role.

“Health and healthcare, related, but different. How do we think about health based in a community framework?” Tyson said. “Over time we have evolved our thinking to better understand that as a mega health system we have to think broader than just medical care.”

The emphasis on leveraging scale past Kaiser 12 million or so covered lives was an important point and Tyson spoke about making meaningful impact for the more than 68 million people who live in the communities serviced by the organization as a way to guard and improve the larger health of the communities and patients themselves.

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Community health and taking into account the social determinants which affect healthcare have also provided a direction for the company’s lobbying efforts which Tyson said “has started to pay off at the highest levels of government.”

“What will we do over the next decade with intentional leadership and engagement that will make a big difference in this country and this world? And what bold moves that is really going to make the difference? Community health is one of those things,” Tyson said.

At least for a high powered healthcare CEO, Tyson has generally not shied away from big political and social issues. During the summer of 2014 where protests rocked the country in response to the police shootings of unarmed black men like Eric Garner and Michael Brown, he penned an impassioned piece on the state of race relations in the United States.

Following a path around the political morass affecting many hot button issues, Kaiser has started to work on large social problems by positioning them as public health issues that require research and solutions regardless of their root cause.

To tackle gun violence, for example, the organization directed $2 million to study methodologies to prevent gun injuries and deaths.

“We see the aftereffects of when a gun is fired so we’re asking ourselves are there some lessons we can bring forward, upstream for preventing unintended hurt and harm and downstream about gun safety, to hopefully cut down on the amount of people who are shot,” Tyson said in a meeting with reporters.

For climate change, Kaiser has set up a defined pathway for the company to become carbon neutral by 2020 and taking a leadership role in lobbying efforts to steer environmental policy.

“We have heat maps around the Bay Area and around the country that show the disproportionate impact of asthma attacks and respiratory problems, especially in poorer communities and communities who don’t have all of the infrastructure in place for more rapid recovery,” Tyson told me in an interview in September.

That statement holds particular weight as California’s Camp Fire continues to rage as the deadliest wildfire in the state’s history.

Homelessness and housing has also been a major focus, culminating in a much-heralded $200 million investment to fight homelessness and support affordable housing. There’s also a more direct tie between homelessness and healthcare, especially considering that more than half of all bankruptcies in the country are attributed to medical costs.

Still, even with this focus on community health, Tyson didn’t say he believed  necessarily that health systems should be the major direct provider of social services and emphasized public-private partnerships as key to what he called a “working formula” to address issues.

He also commented on some of the recent healthcare news of the day where Health and Human Services Secretary Alex Azar spoke about wanting to potentially direct Medicaid dollars to allow providers to directly pay for housing, food or other social solutions.

“There’s a balancing act that we all have to think about because somebody has to pay for it,” Tyson said. “Working together as opposed to throwing the problem to your side of the fence is headed directionally in the right direction, but there are lots of details to be worked out.”

He also broached the topic of single-payer healthcare, which has received a political boost with the influx of new progressive elected officials taking office after the mid-term elections.

While he touted the need for universal access, he said that Kaiser did not support an entirely government-executed system analogous to the NHS in the United Kingdom. Instead he pointed to Medicare as a potential model, with its universal coverage promise fulfilled by private health providers and plans.

“It’s a government-sponsored program that guarantees universal access for this population. We support this concept,” Tyson said.

“Should the priority be on rejiggering the coverage or should the priority be on getting to affordability of care? The ACA was designed to deal with both sides of that coin. We’ve spent most of the time in this country dealing with the coverage side, the opportunity is how we continue to redesign care and make it more affordable.”

Picture: Kevin Truong, MedCity News