Lynn Todman, PhD, the executive director for population health of Spectrum Health Lakeland (left), asks questions of Dr. Bechara Choucair of Kaiser Permanente during his July 17 presentation.

 

3 ways Health Systems Can Make Communities Healthier

By TED HARTZELL                                                                                                                                                                                                 CGR Communications

BERRIEN SPRINGS, Mich. – Kaiser Foundation Health Plan Inc. and Hospitals—known as Kaiser Permanente—is a huge health system that operates in many states. It has 39 hospitals, 697 medical offices, and approximately 22,900 physicians, 59,000 nurses and 217,700 technical, administrative and clerical employees and caregivers. Its annual operating revenue is $80 billion-plus.

And so when Dr. Bechara Choucair, Kaiser’s chief community health officer for the entire system, talks of doing things “at scale,” as he did often in his presentation July 17 (see accompanying story, “How Housing = Health … Or Illness”), he’s talking about an aggressive scale few systems enjoy.

For example, Dr. Choucair said he is always challenging himself and his team to think of nonconventional partners in addition to the common go-to experts such as ones dealing with problems like diabetes, smoking and obesity. One novel partnership is with artists in every region of the health system. He said there are probably about 100 artists hired by Kaiser to create plays about local health concerns and perform them in schools. Each play is followed by a lengthy discussion.

 

‘The Will Is 80% of the Way There”

Still, the lessons from his presentation would appear to apply even to much smaller health systems. Responding to an audience member’s question about what infrastructure is needed to make a visible and practical impact for a community’s overall health, Dr. Choucair said, “I think the most important thing is you need the will. And the will is probably 80 percent of the way to get you there. Because once you have the commitment, then the resources will follow.”

“I think the most important thing is you need the will. And the will is probably 80 percent of the way to get you there. Because once you have the commitment, then the resources will follow.”- Dr.Choucair

He was clearly offering his host, the Spectrum Health Lakeland system, headquartered in St. Joseph, Mich., options it could consider for helping to change the communities it serves for the benefit of all residents. Lakeland’s service area is essentially Berrien County, which has a population of about 154,000 people. But the larger system to which it belongs, the Grand Rapids-based Spectrum Health, is an integrated system with 1 million insured members, $6.5 billion annual operating revenue and many locations in western Michigan. It is western Michigan’s largest employer, with 31,000 employees, 4,200 physicians and advanced practice providers, 14 hospitals and 230 ambulatory sites.

Dr. Choucair was invited to speak in southwest Michigan as part of Community Grand Rounds: Healing the Trauma of Racism, a project headed by Lynn Todman, PhD, the executive director for population health of Spectrum Health Lakeland. The two had met when she served on the board of the anti-poverty organization, Heartland Alliance, in Chicago, and he was executive director of Heartland Health Centers.

Todman said she invited him to speak because of his role at Kaiser Permanente. “As the person overseeing some of the most progressive and forward-thinking work involving hospitals’ efforts to address the social needs of the communities they serve, I thought his remarks would provide food for thought and insights to a path forward for Spectrum Health Lakeland,” she said.

“As the person overseeing some of the most progressive and forward-thinking work involving hospitals’ efforts to address the social needs of the communities they serve, I thought his remarks would provide food for thought and insights to a path forward for Spectrum Health Lakeland.”-  Lynn Todman, PhD

Dr. Choucair’s presentation zeroed in on how Kaiser is working in its communities to improve the social determinants of health (SDoH), such things as food stability, housing security and good education.

 

Getting to Problems ‘Upstream’

Whether small or large, or using orthodox or unorthodox approaches, the important point Dr. Choucair stressed is health systems need to foster a healthy environment for their communities “upstream” of problems. That means to keep those problems from developing in the first place. As a family physician he would get discouraged because he felt his work with individual patients was always “downstream,” after avoidable health problems had been created upstream by the wrong social conditions.

“And there were a lot of things that we could do more upstream that would help us change those environments, change those policies, change those systems so that we’re not having to deal with those issues downstream, but really create the right place for people to live the lives they want to live.”

He said it is essential for health systems to identify and collaborate with the right partners in a variety of ways to help improve social conditions. This mission is even more needed in a country like the United States. It invests far more in clinical health care than any other developed country, but far less in the social services infrastructure. This leads to Americans having lower life expectancies and worse health outcomes than residents of most other developed countries, Dr. Choucair said.

Here are brief looks at three ways he said Kaiser is reaching into the communities where its 12.4 million members live.

 

WORKING WITH SCHOOLS

The Thriving Schools program is in more in 750 schools and has reached more than 500,000 students, 24,000-plus teachers and administrators. It works with students, teachers and administrators on a variety of things, including healthy eating and active living. Dr. Choucair said the health system has documented more than 4,000 changes in healthy eating and active living in the last decade.

Kaiser is preparing to introduce another program to help people in the school setting — students, staffs and parents — with their mental health and resiliency. He said this is critical in a country where children are exposed to “a tremendous number of adverse childhood experiences” (ACES) such as physical or psychological violence, substance abuse and other problems causing stress.

 

SUPPORTING SMALL BUSINESSES

Kaiser Permanente isn’t just a health system. It’s also a huge purchaser of goods and services. As an anchor institution in many communities, how it spends its dollars can make a big difference in economic vitality, Dr. Choucair said. The health system wants to ensure that a dollar spent in a community provides a financial return, but also helps lift up the community.

In 2014 Kaiser reached its goal of buying $1 billion annually from businesses owned by women, minorities and veterans. In 2018 it nearly doubled the effort, spending $1.9 billion. Some of its suppliers themselves have committed to spending $400 million in the supplier diversity effort.

Through a partner Kaiser has invested in, the health system also has helped more than 580 small businesses in recent years create hundreds of jobs as they have become savvier and gained access to more capital. More than incidentally, by strengthening these small businesses Kaiser helps them do business with itself. Dr. Choucair said it can be intimidating for a small business to try to do business with Kaiser Permanente, because “We’re an $80-plus-billion organization, so we have lots of lawyers, we have lots of procurement people.”

 

CARING FOR THE ENVIRONMENT

“The science is very clear” that climate affects health, he said. Kaiser has set ambitious goals for: buying locally grown food from producers using environmentally sustainable practices; reducing waste; conserving water; and increasing its purchases of safer products and materials, those meeting environmental standards. In the last year the health system has been shifting to greater use of “clean” power. It is on track to reach its commitment to become carbon-neutral in 2020. He said the health system since 2008 has cut carbon emissions by nearly 30 percent even as it has grown more than 30 percent. It is halfway to its goal of cutting water usage 25 percent per square foot by 2025.

“This is one of my favorites,” Dr. Choucair said. “We’re really avoiding tailpipe emissions. Last year we filled over 24 million prescriptions by mail. Think about all the cars that didn’t have to drive for our members: 24 million prescriptions. Those are all people who were going to drive from their home to the pharmacy to pick up their prescription.”