Kaiser Permanente started out in the 1930s as a prepaid health care system for workers building dams in the Californian desert, where there was a strong incentive to reduce injuries through prevention. The apocryphal story of Sidney Garfield (the first doctor who worked for Kaiser Permanente) hammering down rusty nails to avoid workers being injured and requiring expensive medical care illustrates what this meant at the time.
Today, Kaiser Permanente is a non-profit health maintenance organisation serving around 9.5 million members, their families and wider communities across the United States.
Kaiser Permanente’s structure and its longstanding efforts to integrate services are well known and described in detail elsewhere. Key organisational features include its role as both insurer and provider of care (within and outside of hospitals), and the use of capitated budgets for members’ care across regions. Among other things, integration of care at Kaiser Permanente is supported by population risk stratification, an emphasis on prevention and self-management, disease management and the use of care pathways for common conditions, case management for patients with complex needs, extensive use of technology and population data, and a model of multispecialty medical practice where unplanned hospital admissions are seen as a ‘system failure’.
Tailoring interventions to people's health needs
Over the past decade, Kaiser Permanente has shifted its focus from people with long-term conditions with the most complex needs ‘at the tip of the triangle’ to all of those for whom it has responsibility. It uses data about the population it serves, available through its system-wide electronic health record, to understand members’ health needs and the distribution of health outcomes. Using these data, Kaiser Permanente offers a range of interventions tailored to the needs of different individuals and population groups to support people to remain healthy and to deliver the right treatments when they become ill.
One example of this is Kaiser Permanente’s approach to preventing and treating heart disease. It has focused heavily on preventive interventions like smoking cessation, promoting exercise and other lifestyle changes to reduce the risk of developing heart disease across member populations.
Between 2002 and 2005, in Northern California, Kaiser Permanente helped reduce prevalence of smoking among its members by 25 per cent, compared with a 7.5 per cent reduction across California as a whole. Smoking cessation interventions have been combined with a range of other interventions – from primary and secondary prevention through to acute care and the management of chronic illness – to form a systematic approach to the prevention and treatment of heart disease across Kaiser Permanente member populations. Among its members in Northern California, the rate of heart disease mortality decreased by 26 per cent from 1995 to 2004, and members were 30 per cent less likely to die from heart disease than other Californians in 2004.
Across Kaiser Permanente as a whole, the success of this approach to improving members’ health is evidenced by the organisation’s consistent high performance in national Healthcare Effectiveness Data and Information Set (HEDIS) measures, as well as its strong performance compared with other health systems across the world, including the NHS.
Improving the health of the broader community
As well as focusing on improving members’ health, Kaiser Permanente has been involved for a number of years in efforts to improve the ‘total health’ of the broader communities it serves. For example, to help improve the availability of healthy food, Kaiser Permanente supports food stores in deprived areas to stock fresh fruit and vegetables, sets up farmers’ markets at Kaiser Permanente facilities and in the community, and works with local schools to offer healthier food and drink options for pupils. It also provides financial support for food banks and other food assistance programmes. In schools and community centres, Kaiser Permanente runs a range of educational theatre programmes using music, comedy and drama to help educate children and adults about their health and wellbeing. These programmes have reached around 15 million children over the past 25 years.
As part of these efforts, Kaiser Permanente has also established a range of Community Health Initiatives to support the development of place-based interventions to improve population health. It has sponsored or co-founded more than 40 Healthy Eating Active Living (HEAL) collaboratives since 2006, typically focused on:
- ensuring that health is considered in local government plans and policies (for example, through creating bike paths or walking trails)
- improving access to green spaces and community gardens
- improving access to healthy food in schools, workplaces and deprived areas
- promoting physical activity across the whole population
- utilising community assets to support and sustain initiatives.
Working in partnership
These initiatives involve collaboration between a range of organisations and groups across different sectors working in partnership with their local communities. They have had some positive results – for example, increasing levels of physical activity and improving aerobic fitness among school-age children. Evaluation of these place-based initiatives continues, and findings and key lessons are shared online.