- Kaiser Permanente has launched Thrive Local, a social health network aimed at reducing homelessness, food insecurity and other critical needs that affect the health and wellbeing of communities.
- Besides connecting to Kaiser Permanente's EHR, Thrive Local's care coordination resources will be made available to community-based organizations to reach the greatest number of people.
- The new network — a partnership with population health platform Unite US — will begin rolling out this summer and should be available by 2022 to all 12.3 million Kaiser Permanente members as well as 68 million people in communities the integrated health system serves.
Kaiser Permanente's Thrive Local initiative comes as more health systems are attempting to tackle social determinants of health and cut down on accompanying high medical utilization costs. In Sacramento, Dignity Health provides temporary housing for people who are experiencing chronic homelessness and have some type of disability. St. Joseph Hospital in Humboldt County, California, offers respite beds to homeless patients transitioning from inpatient care and provides them with follow-up medical and social services.
And last year, Intermountain Healthcare announced it was investing $12 million to address housing instability, utility needs, food insecurity, interpersonal violence and transportation issues in a joint effort with city, county and state government agencies and community-based groups in Utah. The American Hospital Association has also stepped up with a guide on the impact of housing on community health, including recommendations on how hospitals can assist.
Still, a 2018 Patchwise Labs analysis found fewer than 4% of health systems and managed care organizations have invested in SDOH technology, suggesting a market of $88 million to $92 million.
CMS is now allowing Medicare Advantage plans to offer more flexible nonmedical benefit options, a move that will likely lead to more commercial and government coverage that takes aim at SDOH.
Kaiser Permanente said up to 29% of its members with the greatest medical challenges struggle with food insecurity and up to 23% live with housing instability.
"Health care in this country must continue to evolve — from acute episodic care, to an integrated coordinated system focused on prevention and coordinated care management," Imelda Dacones, president and CEO of Northwest Permanente, said in a statement. "This tool will accelerate our evolution as a sector to next-generation care delivery — a community-integrated model that connects physicians, our patients, and health care systems to community resources that address our patients’ socioeconomic needs."
Integrating the EHR is key, as it will allow providers to track referrals and service outcomes to assess how well patients' needs are being met.
A study last year in the Annals of Family Medicine of three clinics that piloted EHR-based tools to screen for and document SDOH found that 97% to 99% of patients had at least one SDOH needed noted in their EHR, and 19% got an EHR-related referral. However, the majority of patients with a documented need weren't interested in a physician's help to address it — leading the researchers to conclude that more study is needed to understand the barriers to SDOH efforts involving EHRs.