1. TOWARD TOTAL COMMUNITY HEALTH Annual Institute for Governors’ Health Policy Advisors Raymond J. Baxter, Ph.D. Senior Vice President, Community Benefit September 9, 2004 PARTNERSHIPS: PROTECTING THE HEALTH CARE SAFETY NET

2. 2 Community Health: Part of Our Mission for Nearly 60 Years 8.2 million members 8.2 million members 11,700 physicians 11,700 physicians 136,500 employees 136,500 employees “..to improve the health of our members and the communities we serve” and the communities we serve”

3. 3 More Critical Than Ever Today State and local crisis: shrinking tax base, increasing poor, federal subsidies declining (DSH, UPL) Market developments: rising costs to employers and consumers Market failure: growing uninsured Policy failure: Medicaid Population health crisis: obesity, asthma, racial and ethnic health care disparities Pressure on the Safety Net: more uninsured and under-reimbursed; fewer providers

4. 4 Kaiser Permanente: Toward Total Community Health Coverage for Low-Income Families Community Health Initiatives Disseminating Knowledge/Informing Public Policy and Safety Net Partnerships

5. 5 What is the Safety Net? 1999 Institute of Medicine Study “organization that provides a significant level of care to vulnerable populations, Medicaid and the uninsured” “providers that maintain an open door, regardless of ability to pay” Examples: community clinics, migrant health centers, public hospitals, family planning and school-based clinics, homeless and health programs Patchwork organization and funding of Safety Net means “access depends on where you live” Safety Net “intact but endangered”

6. 6 Why Has Kaiser Permanente Focused on the Safety Net? Our heritage Common values The Safety Net crisis The potential in partnership

7. 7 Our Heritage: KP and the Safety Net Sidney Garfield at LA County Hospital 12-year relationship with Community Health Clinics and Primary Care Associations in California Partners in Community Health Initiatives School health in Colorado, breast cancer in Hawaii, “Zap Asthma” in Georgia, pharmacy for uninsured in Ohio, local health officers in MAS, “Neighbors in Health” in CA, CO; more under way Partnership with California Association of Public Hospitals Volunteer MDs Technical assistance Equipment Grants Cooperation in advocacy, legislation, regulation

8. 8 Common Values With the Safety Net Rooted in social mission, not-for-profit Physician driven, uniquely aligned with labor Will to serve vulnerable populations Committed to innovation and social change Incented toward population health, not just “sick care” Leaders in diversity, cultural competence, elimination of disparities and barriers

9. 9 The Safety Net is in Crisis Triple whammy on Safety Net Increase in uninsured and “vulnerable insured” state/local budgets dropping federal subsidies declining If Safety Net collapses in a region it is a calamity for the entire health care system in that region Handful of chronic diseases drive health care costs - need to focus on social/environmental determinants of health

10. 10 Our Multi-Layer Approach to Helping The Vulnerable Populations of LA Work collaboratively with counties, community agencies, school districts, foundations, other nonprofits Dues Subsidy Programs, charity care, Medi-Cal Train our residents in community clinics Provide specialty care Share technology and equipment Share research, clinical expertise Direct operating and capital grants

11. 11 Caring for the Uninsured Children of Los Angeles

12. 12 Together, Could We Bring More to the Table? We’re centered around clinical care, evidence- based medicine, population management Expertise in chronic condition management Wide ranging capabilities -- research, education, technology, and more Incentive to improve health Commitment to cultural competence, elimination of disparities Strong track record of partnership -- we understand none of us can do it alone

13. 13 “Yes We Can” Highly successful Urban Asthma Partnership founded in San Francisco in 1997 Partnership leverages knowledge, clinical practice and Safety Net Prevention-oriented, culturally sensitive model of asthma care for low-income children We contributed funding, clinical expertise and key contents for the innovative “Yes We Can” Toolkit “ Kaiser Permanente’s most significant contribution was its willingness to share its knowledge with those in the community safety net” - Vicki Legion, Yes We Can Project Director

14. 14 A Partnership with Measurable Outcomes A 2002 study of results at the Pediatric Asthma Clinic of San Francisco General Hospital, a demonstration site for the “Yes We Can” clinical model, showed changes

15. 15 State - California Campaign to Eliminate Racial and Ethnic Health Disparities Local Health Departments - STEPS Sustainment Grants Advance promising partnerships with local health departments developed in response to HHS’s STEPS to a HealthierUS, but not funded federally. Communities across the USA: Denver, CO; DeKalb County GA; Prince George’s County, MD; San Francisco, San Diego, Santa Clara counties, CA; Multnomah County, OR; Cleveland, OH. Community health issues ranging from diabetes and obesity prevention to improving the skills of community health workers Partnering with State and Local Health Departments

16. 16 Evolving into True Partnership: From Giving $$ to Exchange of Expertise Volunteerism Volunteerism Grantmaking Grantmaking Volunteerism Volunteerism Grantmaking Grantmaking Sharing expertise Sharing expertise Technical Assistance Technical Assistance Volunteerism Volunteerism Grantmaking Grantmaking Sharing expertise Sharing expertise Technical Assistance Technical Assistance PARTNERSHIP: Two-way exchange of information/expertise PARTNERSHIP: Two-way exchange of information/expertise

17. 17 Far More than Dollars... We are supporting development of clinical information systems to improve care to vulnerable populations Sharing our nationally recognized models for culturally competent care -- tri-lingual manual Working directly with clinicians and organizations to build capacity Clinician professional development Leading edge improvements to quality and access Demonstrating how community and clinical interventions intertwine

18. 18 Kaiser Permanente: Toward Total Community Health Coverage for Low-income Families Community Health Initiatives Disseminating Knowledge/Informing Public Policy Safety Net Partnerships