Stepping Up to Total Health

1. Union Delegates Conference 2012March 24, 2012Raymond J. Baxter, PhDSenior Vice PresidentCommunity Benefit, Research and Health Policy Stepping Up to Total Health

2. Kaiser Permanente’s History Our Mission for Generations: “To provide high quality, affordable health care, and to improve the health of our members and the communities we serve” Grand Coulee Dam - 1942

3. We’re #1…Market-leading Prevention HEDIS Measures 2011 KP REGIONAL MARKET RANKING NCAL SCAL HI NW CO GA MAS OH Breast Cancer Screening 1 1* 1 1 1 1 1 1 1 Childhood Immunization Status – Combo 2 & 3 Chlamydia Screening in Women - Total Appropriate Treatment for Children w/URI Adult BMI Assessment Weight Assessment for Children – BMI Percentile Comprehensive Diabetes Care – Medical Attention for Nephropathy 1* 1 1 1 1 1 1 1 2 1* 1 1 1 1 1 1 1 1 1* 1 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1* 1 1 1 1 1 1 1 1 1* 1 1 1* 1 1 1 1 1 *NCQA market ranking based on state boundary, and not KP regional market. SCAL and NCAL ranked first within each of its KP regional markets, but second in NCQA state market only to each other.

4. We’re #1…Market-leading Care NCQA ranking of 341 Medicare health plans in US (2011) KP Medicare Ranking National1 State 1 1 Northern California 2 2 Southern California 4 Colorado 3 1 31 1 Georgia Hawaii 7 1 Mid Atlantic2 17 4 1 Northwest3 19 1 Ohio 1 KEY: 1\ Medicare ranking out of 341 ranked health plans 2\ Mid Atlantic ranked #1 for Medicare in VA, DC, and MD 3\ Northwest ranked #1 in OR and WA 4\ Second only to the other KP plan in California

5. Pills, Knives, Devices and Gene Therapy Will Not Be Enough

6. We Must Address Health At All Levels Deploying Kaiser Permanente Assets for Total Health Physical and Mental Health Care Clinical Prevention Health Education 1 Research Individual / Family Access to Social and Economical Supports Home / School /Worksite Walking Promotion CommunityHealth Initiatives Neighborhood / Community WorksiteWellness Public Policy Environmental Stewardship Society Public Education

7. Many Factors Shape Health Health is driven by multiple factors that are intricately linked – of which medical care is one component. Drivers of Health PersonalBehaviors 40% Family Historyand Genetics 30% Environmental and Social Factors 20% 10% Medical Care Source: Determinants of Health and Their Contribution to Premature Death, JAMA 1993

8. Behaviors Shape Health Actual Causes of Death in the U.S. in 1990 and 2000 *Data are from McGinnis and Foege. Percentages are for all deaths.

9. We Have to Disrupt Current Defaults…

10. What We’re Up Against

11. What We’re Up Against Change in price of items since 1978, relative to overall inflation, as measured by the Consumer Price Index. The price of carbonated drinks, for example, has fallen 34 percent relative to all other prices. Source: Leonhardt, 2010

12. What We’re Up Against

13. What We’re Up Against Slide courtesy of Richard Jackson, MD

14. Interventions: Individual We know what to do… Screen Advise Assist Refer … we have the tools… … and we need to do it with each and every member.

15. Interventions: Individual/Family Exercise As Vital Sign, Exercise Rx Tools, Tips, Motivation and Support Smith, John W • Recommend at least 150 minutes of moderate to strenuous exercise per week. • Office-based • Direct-to-member • Online tools • Cooking tips

16. Interventions: Activity Evidence of Short and Long Term Benefits Aerobic exercise helps strengthen the heart, lungs, and muscles Gain 1.3-1.5 healthy years of life Helps people with diabetes to control their blood sugar Improves mood and energy Reduces risk of oseteoporosis and broken bones Raises HDL Regular walking can prevent misery of colds Reduces the pain and swelling from arthritis

17. Interventions: Institutional KP Farmers’ Markets Cafeteria menu labeling, KP Healthy Picks KP facilities as community assets Environmental stewardship Supplier diversity initiative

18. Interventions: Employers We have begun to offer a portfolio of services that can help KP customers, prospects and other organizations improve the health of their workforce. Lifestyle Telephonic Health Coaching Analytics & Reporting Communications • Standard & customizable print/web communications • HealthWorks Workbook • Inbound coaching • HealthMedia Reporting • Exercise Pgm. Reporting • Rewards reports • Kp.org activity reports

19. Interventions: Community Health Healthcare • BMI as a vital sign • Breastfeeding promotion • Hospital cafeterias Schools • Cafeteria reforms • PE standards, after school programs • Joint Use Agreements • Safe routes to school Worksites • Stairwell prompts • Lactation support • Worksite wellness programs Neighborhoods • Parks, trails and other active public spaces • General Plan amendments • Corner store conversion efforts • Farmers markets and community gardens Schools Healthcare Worksites Neighborhoods

20. Interventions: Getting to Scale www.communitycommons.org 20

21. Current regional average = 43% Big Opportunities Exist for the U.S. and Kaiser Permanente KP target = 100% Less Than Half of the U.S. Population Meets Healthy People 2020 Objectives for Diet and Exercise Kaiser Permanente Members With 150 Minutes or More of Exercise Per Week(1) (1) Southern California Source: BRFSS, 2007

22. An Integrated Approach to Diseases and Risk Factors 4 Diseases, 4 Risk Factors*  4 Kaiser Permanente Actions Cardiovascular Disease Economics Encourage Groups Support Individuals RISK FACTORS Unhealthy Diet Inactivity TobaccoHarmful use of Alcohol Cancer Diabetes Physical Chronic RespiratoryDisease Social Track Outcomes Change Communities *Aligns with World Health Organization’s framework for monitoring non-communicable diseases

23. A Total Health Portfolio Total Health will require a coordinated set of activities, focusing on some key initial areas while developing core capabilities and enhancing efforts on work underway. Focus as first and relatively complete demonstrations of Total Health, done everywhere in KP Total HealthFocus Areas • Healthy Schools • Workforce Wellness • KP Integrated Care Model • Behavior Change strategies • Member Assistance Program • Effective Communications Core Capabilities“Fundamentals” Essential components needed to realize Total Health • Every Body/KP Walk! • The Weight of the Nation • HEAL/obesity prevention and treatment • Hypertension control • Disparities elimination Work underway butTotal Health lens can help deepen the work and re-double our efforts Applications of Total Health

24. Why Schools?

25. Vision: Schools Served by KP are the Healthiest Schools in America • What makes a healthy school? • Multi-component interventions • Multi-stakeholder engagement • Consultative support and technical assistance * Draws from CDC Coordinated School Health, Alliance Healthy Schools Framework & WELCOA (Wellness Council of America)

26. 1 Individual / Family Home / School /Worksite Neighborhood / Community Society KP Is Already Delivering on Many Total Health Components for Schools, Their Staff and Students • Comprehensive services for KP members • Forty CHI sites integrate student health components at a local level • Grantmaking, technical assistance and advocacy support district- and state- level change • Employee wellness offerings are available to schools across KP through HealthWorks (~250 CA school districts) • Immunizations • Self-care tools & resources • Best-practice care • Proactive outreach • Referrals without pre-approval • Registry data tracks risk factors • Preventive care: EVS & BMI and counseling • E-mail providers • Health education & promotion including classes for families • Online resources & telephonic coaching • Well child visits and sports physicials • Menu Labeling

27. * Lower Reach / Higher Intensity Healthy Schools: Tiered Model for High Reach and High Impact • Offer a “KP Healthy Schools” tiered product available to all schools within Kaiser Permanente’s existing footprint. Leverage and integrate existing KP assets including HealthWorks, Community Benefit and the delivery system alongside a national partner. * Higher Reach / Lower Intensity Launch Fall 2013 Launch Fall 2013 Launch Fall 2012

28. KP’s Origins: The Health of the Workforce Our Mission of Generations: “To improve the health of our members and the communities we serve”

29. Total Health Aspiration: KP Workforce is the Healthiest in Healthcare Workforce Vision KP workforce is productive, healthy, thriving, leading satisfied lives and fulfilled careers, committed to KP vision, highly skilled and engaged in learning and improvement, creative, flexible, positive, resilient

30. Healthy Hospital Choices: Recommendations and Approaches from an Expert Panel • Health sector and public health have an opportunity to address the nation’s chronic disease burden and health care costs by promoting healthy hospital food environments. • Healthy food is to be defined not only by nutrition standards but also by an economically & environmentally sustainable food system. • Current food environment measurement tools should be further adapted for hospitals. • Food policies should cover all venues, including cafeterias, vending machines, snack carts and gift shops. • Promote trails, public spaces and use of hospital facilities for physical activity opportunities. • Create policies that promote access to facilities and time for physical activity during all hospital shifts. • Connect physical activity strategies to emerging evidence and national efforts to combat obesity. • Breastfeeding is encouraged by most major health agencies. • Hospitals are a unique setting in that they can support breastfeeding for employees, patients and visitors. • Hospitals should support breastfeeding by providing break rooms and time for expressing breast milk for employees and, where possible, for visitors. • Customary hospital practices and resistance from employees and patients who smoke may pose barriers to efforts to implement tobacco-free hospital campus policies, but these barriers can be overcome with careful planning and preparation. • A tobacco control model can incorporate Joint Commission performance measures and achieve a high level of compliance to effective policies and practices. • Coverage of tobacco cessation treatments varies by health insurance plan and availability of services varies across communities. • Successful strategies to improve hospital environments include identifying partners, such as public health, with clearly defined wellness goals, tailoring messages and garnering executive endorsement. • Healthcare providers can be engaged as effective advocates to disseminate and make changes to nutrition and physical activity environments within their own institutions. • Demonstrating linkages to other hospital priorities and creating a recognition system is a key element. • A national assessment tool and indicators for large scale success will help in disseminating best practices.

31. Workforce Wellness: Where to Start? Healthy Eating Healthy Physical Environment Healthy Activity at Work

32. Workforce Wellness: “Champion” Level Fundamentals Required for Transformation to Champion Level • Create the Vision • Commitment to healthy culture • Connect vision to business strategy • Engage leadership in vision • Leaders are held • accountable • Align Workplace • with Vision • Engage everyone • Brand health management strategies • Integrate policies into culture • Create Winners • Help employees not get worse • Help healthy employees stay • healthy • Provide improvement & • maintenance • strategies • Reinforce • Culture of Health • Reward champions • Set incentives for healthy • choices • Reinforce at • every touch point • Outcomes • Drive Strategy • Integrate all resources • Measure progress • towards goals in • first 4 pillars • Strategic, Systemic, • Systematic, • Sustainable Senior Leadership Operations Leadership Self Leadership Reward Behavior Quality Assurance Source: Dee Edington, Zero Trends: Health as a Serious Economic Strategy, Health Management Research Center, University of Michigan, 2009 Note: HERO, WELCOA, and NBGH models contain same fundamentals

33. Kaiser Permanente has assumed a leadership role in promoting the power of walking Collaborative development of two dynamic online programs: For Kaiser Permanente Employees: KP Walk! Get Involved: www.KPWalk.com For All Americans: Every Body Walk! Get Involved: www.EverybodyWalk.org We Have to Engage People in the Solutions

34. We Have Become the Benchmark May 2012

35. The Road Ahead is Challenging…But We Can Find A Way