‘We don’t need to be bigger for the sake of being bigger’
Kaiser Permanente features basketball star Steph Curry in a new mental-health ad campaign that illustrates how even the Golden State shooting phenom must overcome doubts about his game. Kaiser Permanente, the nation’s largest integrated health system, has made mental-health awareness a priority this year as it seeks to promote the total health of the individuals and communities it serves, according to Chairman and CEO Bernard Tyson. Earlier this year, Tyson sat down with Southern Bureau Chief Dave Barkholz in San Francisco, just across the bay from Kaiser Permanente’s Oakland headquarters, to discuss mental health, the social determinants of health and Kaiser Permanente’s always-active expansion strategy. The following is an edited transcript.
Modern Healthcare: Kaiser Permanente has made mental health awareness a big priority this year. Why?
Bernard Tyson: We need to talk more about the stigma (that’s associated with mental health) and move the paradigm from people thinking of it in less-thandesirable ways that we have done historically as a country, as a world, to seeing it as common and as predictable as heart disease and cancer. That’s part of our strategy. Second, we want to focus a lot more on early detection. Screening and finding early signs and early warnings are part of what we are building on and building out.
MH: What are you doing on that front?
Tyson: We are looking at redesigning our care delivery system by integrating mental health services into our primarycare settings. We have several experiments going on around the country. One example is in Colorado where we have the behavior health, psychiatry and psychological services embedded and integrated into the primary-care visit. Just like we do in any other situation where you see your primary-care physician and say, “I’m having knee pains,” and he or she might go down the hall and ask the orthopedic surgeon to come in and take a look at it, we want to do the same thing with integrated behavioral health and psychiatry services. We want to bring them into the mainstream. We still need to realize though that some of our members don’t want that, and so we are also studying that and paying attention to it.
We’re also looking at the other end of the spectrum, which is comprehensive care and services, hospitalization, long-term therapeutic care. We’re also starting to think about how we want to get involved with mental health research going forward and are beginning those conversations with other organizations as well.
MH: You’ve been running ads in your markets talking about putting an end to the stigma of behavioral health disease, ads that come across more as public service announcements than marketing or promotional pieces. How did those come about?
Tyson: Exactly what you said, they are intended to be more of a public service announcement showing that we are working for the greater good, not for the self-interest of Kaiser Permanente. We’re uniquely positioned to do that. We are a large, not-forprofit mega-system that has integrity and credibility, and so, in this case, we’re leveraging the bigger message that is intended for the entire population, not just focused at Kaiser Permanente. We did that, by the way, with many of our “Thrive” ads as well, taking the position that we want to deliver a public service message of good health, as opposed to targeting membership growth and membership retention.
MH: Speaking of public health, a recent Kaiser study delves into social determinants of health, with healthcare service being the smallest part of overall personal health, behind personal behavior, genetics and social and environmental factors. How much of that has informed Kaiser’s approach to mental and public health?
Tyson: We’re still in the learning phase on mental health, but it impacts us very directly. For instance, if you think about how sleep is related to stress and mental health challenges, there’s a clear relationship, just like we think about eating and physical health. There is also a whole set of studies about food being a substitute for other needs. This is really more about mental health as opposed to physical health.
Social determinants of health are also tied to how we invest more upstream. We have real opportunities in getting engaged and involved in other aspects of our members’ lives, such as food, sleep, exercise and stress management. Those are some examples of what we’re doing. There’s a reason why we have farmers markets around the country and, particularly, in communities that are generally missing some of the infrastructure like grocery stores, etc. We’ve adopted schools in all our markets and we’re going in with life-changing programs, teaching children about good eating and food habits. In some cases, we have food gardens to help parents orient their children toward healthy eating-habits that will last a lifetime.
In that same vein, we have a great dental program. In the Northwest, for example, we care for over 200,000 members who belong to our dental program. We’re studying that to see if the model can be leveraged in other markets around the country.
MH: Let’s turn to strategy. Does Kaiser need a bigger national footprint?
Tyson: We don’t need to be bigger for the sake of being bigger, because, by all accounts, we are a mega health system. The lens of our mission requires us to be more ambitious and to take our value proposition into more markets. We also believe that to continue to show how robust and relevant our delivery system is, showing up in new markets adds to the validity of the current footprint.
We are acquiring Group Health in Seattle. We do not have a one-and-done growth strategy; our growth strategy for new markets is going to be very strategic. We actually have three parts to our strategy: Continue to grow in our core markets; grow the next ZIP code over; and enter new markets. And we still have a lot of growth opportunity in California.
MH: Where does Detroit fit into that? We’ve heard a lot of rumblings about you having talks with Henry Ford Health System. Is Detroit on your radar screen?
Tyson: No. We look at markets around the country, so we would have looked at Detroit, just like everywhere else, but currently it’s not on the radar screen. I’ve heard that rumor. We’ve had a longterm relationship with Henry Ford. Our medical groups work together and will continue to work together. I suspect those kinds of speculations, in part, are driven by the fact that we’ve had long-term relationships.
We’ve heard rumors about other markets, too, in part because we look across the country, and at times we may have conversations and people may speculate, “Oh my God, what are they doing there?”
MH: A lot of the hospital deals that are going on around the country are strategic deals. Do you expect to be doing any more this year? Will we be hearing about anything percolating?
Tyson: It’s hard to say. We continue to look at the possibilities, but it really is going to depend on if we think it is the right strategic arrangement for us. Buying a hospital, going in for a hospital in a market in which we don’t have the Kaiser Permanente system would not serve the purpose of our strategy.
MH: What’s the typical profile of a system that you would look at then?
Tyson: It’s driven more by how we want to show up in our markets and new markets, which is the value proposition of Kaiser Permanente. We have the health plan. We have a strong delivery system. We have the integration of the Permanente Medical Group.
The Group Health acquisition is an excellent alignment and match to our brand and strategy and mission. Fortunately, they are very well-aligned. In fact, there are great similarities to Kaiser Permanente in terms of how they started.
We would also want to make sure that we add value to the market, especially being a mission-driven, not-for-profit organization. So we would want to know that over time we’re going to impact the cost of care in that market and the continuity of care in that market, which is, obviously, part of the brand of who we are as Kaiser Permanente.
MH: You have talked at length about the Affordable Care Act and the current debate on repeal. You’ve said that the ACA should be the starting point of a replacement plan, not the end of it. What are you referring to?
Tyson: No. 1, more than 24 million people have coverage through the front door of the U.S. healthcare system (because of the ACA). I would hate for us to wake up tomorrow and the starting point is now 10 million, 5 million or 3 million.
No. 2, children are able to stay on their parents’ health insurance until the age of 26. That has added a lot of benefit and value to families and to kids in college.
No. 3, we have addressed the pre-existing condition issue with the ACA. No. 4, there’s a menu of preventive services that everyone is expected to provide, and so you have, in essence, a baseline of accountability now being imposed on the healthcare delivery system, and the industry has responded. No. 5, it has eliminated some of the discrimination of pricing of male to female, and so, I would hate for us to lose traction on that. No. 6, you’re not capping coverage, so families don’t have to worry that they’re going to run out of coverage while they’re still dealing with longterm illnesses like cancer and those kinds of things. No. 7, you have Medicaid expansion, which is helping fill the gap for people who are a little above the poverty level but still not at the point that they can afford all of the healthcare costs. And then you have the people who are at the poverty level whom the expansion has helped.
How is that for a start? It’s my hope that we build from there.