July 15, 2020

Systems of Change: Discussing Food Insecurity with Jodie Lesh, Chief Transformation Officer at Kaiser Permanente

The promise of a well-balanced meal is something many take for granted. But even before the COVID-19 pandemic, for millions of Americans access to healthful food was difficult or impossible to obtain.

The pandemic has made millions more in America food insecure and the effects on human health are significant. Limited food access negatively impacts people’s ability to eat food that is nourishing, but also their ability to maintain a healthy, sustainable lifestyle. That’s why healthcare companies like Kaiser Permanente have been adding a new focus on food to their business model, an indicator that the traditional healthcare model is shifting.

Just ask Jodie Lesh, Chief Transformation Officer at Kaiser Permanente, whose work has long focused on the ways that healthcare can address the systemic symptoms of social needs, like food, housing and employment. Kaiser Permanente’s Food For Life program has put this mission into practice, helping provide those in need with food for dinner, but also food for survival.

Can you offer us a snapshot of how Food For Life came to be, and what it’s designed to do?

The concept of Food For Life came out of an initiative launched at the end of 2018, early 2019, where we posed three big questions to our entire workforce – about 220,000 employees. We asked them for their ideas around solving three really big problems: food insecurity, managing personal health, and preventing childhood trauma.

We found that many of our employees themselves had suffered with the issues we were grappling with. There were many deeply personal stories and insight that was garnered through this effort. We held an accelerator with about 120 employees, and out of that came the strategy called Food For Life. We’ve been working on it since 2019.

We understand deeply the social issues that our members and communities face have a significant impact on people’s health. Remember, our mission is to improve the health of our members and the communities we serve as a nonprofit. So, we care and engage at both the individual member and at the community level.

There has also been a fair amount of research that connects food insecurity to people’s health conditions. That body of evidence continues to grow, and part of our charge is also to contribute to that body of evidence to understand the interventions and whether they work and the impact that they have on health and healthcare costs. The objective of Food For Life is to help our members with food insecurity and our communities with an understanding that this will have a materially positive impact on health.

Who is most directly affected by food insecurity?

We estimated we had about 1.3 million out of our 12.3 million members who were either food insecure or who are at risk of food insecurity pre-pandemic – that’s a very significant population and it’s no doubt higher now. I know a lot of people want to think it’s only the Medicaid population at risk, but we have commercially insured members who face economic hardship and struggle will access to food, housing and other basic necessities. People in the service industry, in all kinds of industries, that might have commercial insurance through their employer, but who still face food insecurity and potentially other social issues, like housing insecurity. This is a sizable population. This population is often referred to as ALICE – Asset Limited, Income Constrained, Employed.

How does Food For Life approach these needs?

We have two big focus areas right now. One is around increasing people’s purchasing power. Obviously people’s access to money has an impact on their ability to buy healthy food. One of the first initiatives out of the gate is an effort to help our members walk through the application process for CalFresh, which is the California SNAP, or food stamp, program. We’ve had very, very positive results so far and COVID-19 has significantly fueled the need and response. We’re also going through a rigorous evaluation approach with our research department to understand the scope of this impact.

The other thing that we’re working on is what we call medically tailored meals, which is focusing on meals for people with very specific health conditions. We are looking at whether or not giving people access to that, and paying for that, has a positive impact on healthcare costs.

We know a lot of our food insecure members either rely on prepared foods in the supermarkets, frozen foods, things like that, as well as fast food. And we know that the nutritional quality of that food is low. We need to address that from both an economic and also a convenience perspective. So we’re looking at distribution as well as ways to create meals within price points that are within people’s reach. We might be looking all the way from food policy, to issues of distribution, to other areas we can disrupt and improve across the food value chain.

But we don’t want to just get people access to food. We want to get people access to the food that gives them the agency to make personal choices, whether that be based on their cultures and customs or their preferences.

Do you look at this as a preventative model as well as reactive model? Both?

Kaiser Permanente is a very unique organization in that we’ve been in the prevention space from the company’s inception. So, I see this as both.

There’s work going on, as well, on the predictive analytics side so we can foresee who is at risk for social needs. It’s not all economics, but obviously economics plays a big role in it. There’s a role that social isolation plays, the role a lack of transportation plays, so we’re working on building the algorithms for prediction. I think this is important both in terms of getting ahead of the problem, as well as the sustainability of programs like this. These needs are on a societal level; they are multigenerational-level problems. These are big issues to solve, so the ability to predict and target more effectively, and to be able to build the body of evidence is critically important.

What does success look like ten years from now?

Significantly fewer people are food insecure. That said, we want to achieve that in the most deeply human way possible and preserve people’s dignity all the way through. If we do this right, people will feel empowered and not stigmatized. That’s our objective.

We also understand that we need to address the root causes, including economic hardship and unequal access to economic opportunity. There are other important efforts happening across Kaiser Permanente to level the playing field for people and businesses so that economic opportunity is shared universally and that we support, in particular, small businesses and those that are women and minority owned. It’s critical that jobs are created and wealth accumulation can occur across all our communities.

Dignity is crucial to that end goal. How do you ensure the dignity of this population is preserved in the development of this program?

It’s in the design. It’s how we’ve approached the work right from the start. The first part of this process was engaging with people who were struggling with food insecurity. We employed a human-centered design approach to this. It was about really understanding their needs. Because, like anything, this is not one population of people. There’s lots of different needs that the solution must address. We’re trying to preserve choice, so this discount coupon program that we’re looking at has a very, very wide set of choices. We’re also using technology that allows people to scan food items in a store and see what’s covered, in a discreet way. So that you don’t have to find out you can’t afford your purchase while going through checkout, in front of other people in an embarrassing way.

When we did our research in the accelerator, we did an exercise to learn about what people could reasonably afford on their SNAP budget. And, you know, people weren’t able to do it. We talked with those who are considered food-insecure about how they navigate the system, to learn how they access different stores in order to piece together what they can afford. We learned that people are incredibly industrious, but struggle in the process.

So, our solutions have to preserve choice and agency. Using technology, for example, to help people understand the impact of their decisions in a private way, demonstrates real ways to preserve dignity.

Tell me about the work Kaiser Permanente is doing with housing. Because that is a big part of this equation. What does this shift mean for the company’s long-term vision for itself?

You know, when I came to Kaiser Permanente 17 years ago, our efforts in the community were couched in what was called “Community Benefit.” This was a budget that was earmarked specifically for things like community grants and charity care. It was directly related to our tax exemption. Then we started moving into what we call Community Health and Social Health. We started looking beyond grant making and charity care, investing strategically in building capacity in our communities to meet these needs, both for our members and the community at large.

We are building up our strategy, adding new initiatives to both identify and address the myriad of social needs of our members and communities. We are investing here because we understand the material impact on people’s overall health and wellbeing, and ultimately the cost of care which will drive affordability of care.

This changes the ball game.

This is a massive paradigm shift for the health care industry, and I expect we will see continued investment and innovation. Simultaneously meeting physical, mental health and social needs will ultimately transform health care in America. Certain changes will be needed in the industry including government reimbursement and across the regulatory landscape. But I anticipate that, over time, as we demonstrate the value of addressing upstream social, non-medical needs, these changes will ultimately occur.

It’s a shift in how we think about what a traditional healthcare system can and should do for us. Food is such an integral part of our health.

Yes, it’s a new space for Kaiser Permanente. While we’re not experts in food,we’re gaining more experience as time goes on and we’re very much in a partnership mode so we can learn from others.

This isn’t just about referring people to food banks.This is looking at the food system across America. What makes food inaccessible and unaffordable to people, and how can we disrupt that? This is rich space for innovation and Kaiser Permanente is optimistic about what we can accomplish as we dive into the deep end of meeting the social needs of our members and communities.