How text messages from Kaiser put 11,000-plus Californians on road to food, better health
In the last three months, the health care team at Kaiser Permanente used text messaging to sign up more than 11,000 of its neediest California members for a government program that will give them up to $200 a month for groceries.
Known as CalFresh, California’s supplemental nutrition program has one of the lowest enrollment levels of any such program in the nation. Yet in Sacramento County alone, 14 percent of roughly 1.5 million residents are food insecure, according to River City Food Bank.
If you burrow down to the neighborhood level, you might find that percentage is even greater, according to a news release from the food bank. In Arden Arcade, for instance, one in five of the 92,000 people living there are food insecure, it says.
And, food insecurity is linked to some of the nation’s most serious and costly health care problems. Obesity is more common, for instance, among adults who don’t get enough to eat to support an active, healthy lifestyle. A serious health problem, obesity is associated with a higher risk for diabetes, hypertension, heart disease, respiratory illnesses and other chronic illnesses.
Kaiser and other health care providers and insurers have widely acknowledged that food insecurity and other social disparities play a greater role in shaping the well-being of many community residents than medical care does, and they are developing comprehensive approaches to improving social determinants of health for their most vulnerable patients. The CalFresh texting campaign is one of several strategies Kaiser is undertaking as part of a strategy called Food for Life.
“Our higher-level aspiration is that no one in America should ever go to bed hungry,” said Pam Schwartz, senior director of community health at Kaiser Permanente. “Everyone should have access to healthy food that they can afford. ... We know that people who are food insecure have a greater chance of disease — nutrition-related disease like diabetes, for example. We know that health care costs are greater for food-insecure households.”
Still, many of the people who need CalFresh most give up during an application process that takes them days or weeks to complete. The three-part CalFresh application requires that individuals provide documents to verify information, answer many questions and submit to an interview during business hours. The hurdles pose a challenge for people trying to hang onto low-wage jobs or trying to get hired for one.
The Kaiser team worked on a way to make the complex process as simple as responding to text messages, Schwartz said, and they provided encouragement to ensure members didn’t give up.
“Don’t miss out on a free CalFresh debit card to use for monthly groceries,” one text stated, setting off the CalFresh name with an emoji of a pita stuffed with veggies. We see that you started, but not finished the application. Do you need help with Step 3 of 5: Estimating Your Income? Chat with a CalFresh expert.”
As they developed the texting campaign, Kaiser’s staff also had to figure out which of their more than 9 million California patients should receive the initial message, Schwartz said. Kaiser didn’t have income data or other ways of identifying who would be eligible, she said, so their team settled on using something called the neighborhood deprivation index. It uses census data on social determinants to identify ZIP codes where people are more likely to have poor health outcomes.
After identifying ZIP codes, Kaiser decided to send out text messages to members in about 435,000 households inside those geographic areas. The initial texts went out Aug. 30.
Since then, more than 11,000 Kaiser members completed applications, and an additional 21,000 members have started applications. Many of the households had more than one eligible Kaiser member living in them.
Residents in the many communities that Kaiser serves expressed concern about food insecurity, Schwartz said, when the health care giant conducted its most recent community health needs assessment. In this comprehensive survey, nonprofit hospital companies collect information and data on the health status, needs and issues of residents in regions where they operate. They use the information to craft plans to improve public health concerns.
Inside Kaiser, the health care system also asked employees what they felt were the most pressing needs of their communities, and over and over again, employees urged the company to help solve the issue of food insecurity.
Kaiser’s work will go beyond the CalFresh texting campaign, Schwartz said, and the company also is working to improve other social disparities that are undermining health.
Also as part of Food for Life, Kaiser is looking at ways to get medically tailored meals delivered to members trying to manage chronic conditions such as allergies, cancer, diabetes and kidney disease.
“The idea is it would help patients recover from hospitalization,” Schwartz said. “We’re also exploring the idea of providing meals to the household, not just to the member who was recently checked out of the hospital but to the family, so the food-insecure member isn’t giving the medically tailored meal to their child who’s hungry.”
Schwartz said that Kaiser plans to start providing some meals as part of a pilot program to show how doing so makes for good medicine. The health care giant also has pledged to invest $200 million toward affordable and supportive housing as part of an effort to end homelessness nationwide.
Kaiser is by no means the only health care organization to be developing an extensive plan to combat social disparities. Anthem Blue Cross has moved to connect adults in its Medicare Advantage program with with community-based resources such as housing assistance, food assistance, transportation, and health services, and it has medical teams going to patient homes to provide care management to people with multiple chronic conditions.
Blue Shield of California is experimenting with ways to remove transportation as a barrier to care. In the Sacramento region, it is testing out whether they would benefit from free Lyft rides to some Sacramento-area patients for medical services involving primary care appointments, lab and imaging exams, or pharmacy visits. This initiative is part of broader effort at Blue Shield to integrate so-called social care with health care delivery.
Dr. Chris Esguerra, a psychiatrist and senior medical director for one of Blue Shield of California’s health plans, recently worked on a committee that produced a 195-page report on social care recently released by the National Academies of Sciences, Engineering and Medicine.
Titled “Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health,” the paper noted that when industrialized nations devote more resources to social services than health care, those countries tend to have better health outcomes. While the United States spends about 90 cents on social services for every $1 spent on health care, other industrialized countries spend $2 on social services for every $1 spent on health care, the researchers noted.
Kaiser leaders said that alleviating hunger is a critical part of social care. Studies show, they said, that people who do not have consistent access to adequate food spend about 45 percent more money on medical care each year than individuals in food-secure households.
“Food for Life builds on our existing community health work – such as preserving affordable housing, researching firearm injury prevention, and teaching resiliency in schools – to improve health outcomes, decrease the cost of care and create systemwide change,” said Dr. Bechara Choucair, the chief community health officer at Kaiser Permanente.
This story was originally published December 2, 2019 at 5:00 AM.
