Executive Letter

The Affordable Care Act ushered in a series of reforms to health care over the last five years with some impressive results. Since its implementation, we have seen the number of the uninsured fall to 11 percent in 2015. At Kaiser Permanente, we were proud to be a part of this coverage expansion, extending Medicaid, Children's Health Insurance Program and our own unique Charitable Health coverage to almost 1 million people (938,336) in 2015, subsidized by our $1.8 billion investment.

Yet millions of Americans remain uninsured, and we know that expanding coverage is only part of the equation needed to make a quantifiable impact on individual and community health. Making a significant contribution toward solving the entire equation is the opportunity facing Kaiser Permanente and its Community Benefit program.

We can play an essential role in picking up where the Affordable Care Act left off and rise to the challenge of expanding access to affordable coverage and quality care for those left out of health care reform. Our Community Health Needs Assessment — a critical tool that helps us identify and measure the needs in a local community and deploy our resources accordingly — provides a foundation for how we think about the next chapter of health care reform. We can create a comprehensive strategy that brings all of Kaiser Permanente's Medicaid, Charitable Health Coverage and Medical Financial Assistance resources, and our extensive safety-net partnerships, to bear.

In 2015, we used our Community Health Needs Assessment to guide all of our investment in Community Benefit, activities such as bringing healthy food to corner stores in the impoverished Tenderloin neighborhood of San Francisco, partnering with Feeding America's Senior Nutrition Program in Southern California to increase access to healthy eating for residents living in food deserts, and supporting the Oregon Community Health Workers Association to create models of integrating community health workers in community and clinical settings. Now we have an opportunity to use our Community Needs Assessment to tailor care and coverage to the needs of our most vulnerable populations.

But to truly improve the health of all our members and our communities, we must look beyond our current strategies and toward deploying all of Kaiser Permanente's resources to address the root causes of poor health — social and environmental factors deep-seated in inequity. These factors include living in poverty, exposure to violence and lack of access to health-related resources such as quality education and toxin-free environments.

Our work now is to use all of our financial, technical, clinical and knowledge resources to help our members and communities realize total health — a healthy mind, body and spirit — in every environment, including school, work, neighborhood and at home.

On the ground, we are building on the accomplishments of our Community Health Initiatives — which reached 665,000 people in more than 50 communities across Kaiser Permanente's regions in 2015 — to support healthy eating and active living through environmental and policy changes. We are building on our Thriving Schools work, which reached 209,000 children in more than 300 schools across Kaiser Permanente's regions last year to make them safe, nurturing environments that support healthy eating and physical activity for students, staff and educators alike. We've expanded on our efforts to reduce greenhouse gas emissions by taking on an ambitious set of goals for our Environmental Stewardship work.

This work includes building on how we care for our members, thinking beyond our traditional approaches to clinical care to address the social and economic issues that determine health and providing the services and support we all need to thrive.

At Kaiser Permanente, we are striving to use every resource at our disposal to achieve our mission to provide high-quality, affordable health care services and improve the health of our members and of the communities that we serve. Our Community Benefit work is at the heart of this mission. If we succeed at connecting our members and the communities we serve to not only the health care and healthy environments they deserve, but to the resources that will address social and economic inequity, we will realize that mission.

Raymond J. Baxter, PhD
Senior Vice President
Community Benefit, Research and Health Policy
Kaiser Permanente

Cynthia Telles, PhD
Chair, Community Benefit Committee
Board of Directors
Kaiser Foundation Hospitals
Kaiser Foundation Health Plan Inc.

Healthy People

We are more than a health system — we are rooted in the communities that we serve, both as a neighbor and a partner.

We believe that, in a healthy community, no one gets left behind. That's why we spent so much of 2015 focused on not only expanding coverage but also on improving health and access to care for those who can least afford it.

A win for California's children, thanks to
an assist from KP »

And a boost for kids’ health in five other states »

Powerful partnerships address the
root causes of poor health »

Bringing the clinic and community together »

Healthy Knowledge

We serve 10.6 million members at our 38 hospitals and thousands of outpatient clinics in eight states — so we have some insight to share when it comes to what works in health care.

That's why we pioneer health research and work with policy leaders and community partners to publish and promote best practices.

Research that improves people's lives,
research that saves lives »

Collaborating to improve the effectiveness of care »

Discovering new ways to prevent disease »

Healthy Investments

Our investment in the health of the communities we serve is about more than dollars and cents.

It is about direct funding, the dedication of our employees and the strength of our partnerships.

The people of KP live our values »

Ending domestic violence to improve
the health of families and communities »

Grants that change lives,
grants that save lives »

By the Numbers

2015 Community Investments

$209.9M
Charitable Health Coverage
$18.2M
Children's Health
Insurance Programs
$259M
Medical Financial
Assistance Programs
$970M
Medicaid Members
$347.1M
Medicaid Non-members
$5.5M
Other Government
Funded Programs
$101.6M
Health Professional
Training Programs
$21.4M
Consumer Health Education
$44.2M
Medical Research
and Libraries
$2.1M
Public Policy
$41.9M
Grants and Donations
$20.5M
Payments to States
$70M
Other Community Benefits
$2.1B
Total

By the Numbers / Subsidized Care

Subsidized care icon
850,461
Members served by Medicaid and CHIP
87,875
Members served by our Charitable Health Coverage
200,000+
Medical Financial Assistance individuals approved

By the Numbers / Regional Community Benefit Investment

Piggy bank icon
$34.7M
National Community Benefit
$897M
Northern California
$732.2M
Southern California
$114.9M
Colorado
$42.6M
Georgia
$47.7M
Hawaii
$100.6M
Mid-Atlantic States
$141.6M
Northwest

By the Numbers / Research

Research icon
$44M
Community Benefit-funded
medical research
153
Investigators within our seven
regional research centers
4,531
Medical studies conducted
50+
Partnerships with thought leadership organizations in health care, policy and academia
1,173
Articles published
898
Clinical trials conducted

Looking Forward

The mission before us is to improve the physical, mental and emotional health of our members and the communities we serve — or, more simply, to improve total health.

To fully realize our mission, we must address what may be the greatest challenge facing us: entrenched social inequity that is becoming more extreme throughout our nation. If we truly "stand for health," as Kaiser Permanente's Thrive campaign promises, we must understand that inequity in all its forms is the ultimate barrier to total health.

Addressing this barrier requires us to broaden our thinking by asking, “Why are some populations at greater risk of illnesses and preventable deaths than others?” We have the tools to begin to answer that — within Community Benefit, we have already established a track record of rigorous analysis using our evaluation and learning platform. Now we are making these tools even more powerful with our Community Health Needs Assessment process and our emerging performance measurement strategy. In response to the data we gather through the assessment, we then create implementation strategy reports describing our response to community needs. But in the years ahead, we need to bring that work to the next level, moving beyond enthusiasm and toward more evidence. We need to expand our planning and evaluation to include more voices from the communities that we serve. Just as critical is the need to capture the voices of our members.

We must foster communities that promote equitable health and support the institutions and public policies needed to make that happen. We must focus on the root causes of poor health, the social, environmental and behavioral dimensions — the social determinants of health. This requires broadening our definition of “health” to mean one's overall quality of life, an analysis of socioeconomic factors (including education, income and wealth inequality) and a willingness to address racial, ethnic and social inequality. We can't fully improve the health of the diabetic who has no access to healthy food or a safe place to walk. We can't truly help the asthmatic child who lives in a city without clean air. We can't fully provide high-quality care to the cancer patient who lives in a neighborhood with poor public transportation, limiting her access to timely, appropriate care. Our work to date in Community Benefit has shown us that, when we get to these root causes, the health of communities and individuals can change for the better.

Our next endeavor is to move beyond tackling these challenges as discrete problems. We want to bring all of Kaiser Permanente's resources to bear, to focus on big picture solutions. We want to put our members, patients, customers and the communities we serve first, so everyone receives a consistent level of support wherever and whenever they need it.

We have already collectively taken the notion of community benefit from an accounting exercise, what can we count and report to the Internal Revenue Service as a community benefit expenditure, to an accountability standard — what can we demonstrate that we have actually done to measurably improve community health.

Fostering total health is not just the work of Community Benefit — it's the mission of Kaiser Permanente. The $60 billion we take in to care for almost 11 million members and to run Kaiser Permanente, the billions that we reserve and invest to cover pensions and other obligations, the jobs we create and the benefits and wages we pay, the materials and services we purchase, the buildings we construct, the training we offer, the technology we build, the waste we create, the energy and water we use, our greenhouse gas emissions — these all present opportunities for positive change. We've already begun this work in places such as Baltimore, Oakland and South Central Los Angeles, bringing all our organization's resources to bear in an effort to bolster the local community.

For example, we know the Affordable Care Act left millions without coverage. But we can't think of this as just a coverage problem when we seek to improve the total health of our members and the communities we serve. To begin to make an impact on the major diseases of our time — diabetes, heart disease, chronic lung disease, cancer and mental illness — we need to use all of our resources to get at the root causes of these diseases. Each of these conditions has powerful, interacting environmental and behavioral components. We need to use our clinical resources to take culturally competent care and precision medicine to a new level. We need all our employees to be models of civic engagement in our local communities and we need to focus our advocacy work on generating public policies that create healthy communities and a healthy planet. The list is long when we start to think beyond the clinic walls.

Our work to date on Thriving Schools provides a blueprint to accomplishing this work. Key ingredients include working directly with members of the local community and forming lasting partnerships with other community leaders. Our work with our safety-net school-based health partners has proven that it is a successful formula. We are playing a critical role, not only in providing health care services in places where students, staff and teachers spend a majority of their day, but also in championing healthy behavior changes from within the school environment.

Looking ahead, we have a huge opportunity to harness a vast array of additional resources and commitment in Kaiser Permanente to achieve the mission of total health. If we can do that, we will transform the meaning of Community Benefit. More importantly, we will achieve total health for individuals and communities.

IN RECOGNITION

Raymond J. Baxter
Retiring senior vice president of Community Benefit, Research and Health Policy and Research of Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals; retiring president of Kaiser Permanente International.

One of Ray’s favorite quotes is, “And what does the Lord require of you, but to do justice, to love kindness and to walk humbly... ” — Micah, 6:8

Long before there was a Community Benefit at Kaiser Permanente there was a belief at Kaiser Permanente, captured by this passage, that we must be ready to intervene in our communities — whether it's in the doctor's office, the workplace, the neighborhood, the home, the school or the environment — if we really want people to be healthy.

Since joining Kaiser Permanente in 2002, Ray has helped Kaiser Permanente translate this profound understanding into action through his significant contribution to the creation of our Community Benefit function. He has unyieldingly pursued building Kaiser Permanente's Community Benefit into something that reflects the spirit of Kaiser Permanente's founders and the organization's understanding of why we are a not-for-profit charitable institution.

This durable commitment to encouraging us to focus our efforts on improving the health of our members, workforce, neighborhoods, communities, the nation and the world, matched with his deep knowledge of philanthropy, research and public policy, have helped to make Community Benefit possible. Without Ray, we would not be where we are today.

Ray will be greatly missed, but more importantly, we wish Ray well as he begins this next journey in his life.

Thank you, Ray.

Leadership team

2015 Community Benefit Committee of the Boards of Directors
Kaiser Foundation Hospitals
Kaiser Foundation Health Plan Inc.

Bernard J. Tyson, Chairman and CEO
Cynthia A. Telles, PhD, Chair

Thomas W. Chapman, EdD
Jeffrey E. Epstein
J. Eugene Grigsby, PhD
Leslie Stone Heisz
Judith A. Johansen, JD
Kim J. Kaiser
Margaret Porfido, JD
Leadership Bios