‘We don’t need to be big­ger for the sake of be­ing big­ger’

Modern Healthcare - - Q & A -

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.

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