A SURVEY OF BASIC RESOURCE NEEDS:

Kaiser Permanente (KP) Authors:

RESULTS FROM A SAMPLE OF KAISER PERMANENTE SOUTHERN CALIFORNIA MEMBERS

CARA C. LEWIS InvestigatorAssociate Clinical PsychologistKaiser Permanente WashingtonMet Park East, SeattleCara.C.Lewis@kp.org

ADAM L. SHARPEmergency MedicineRegional Planning-DevelopmentKaiser Permanente Southern CaliforniaRegional Offices - PasadenaAdam.L.Sharp@kp.org

ELLA E. THOMPSONProject ManagerKaiser Permanente WashingtonMet Park East, SeattleElla.E.Thompson@kp.org

Kaiser Permanente | SONNET Survey Baseline Results | June 2019 1

How to cite: Lewis CC, Thompson EE, and Sharp AL. “A survey of basic resource needs: results from a sample of Kaiser Permanente Southern California members.” Social Needs Network for Evaluation and Translation (SONNET). Web. Jun 2019

Background

Kaiser Permanente (KP) has offered subsidized insurance under the Affordable Care Act since 2014. Individuals and families with household incomes between 100% and 400% of the federal poverty level who legally reside in the US and lack access to affordable employer-sponsored insurance coverage are eligible for these federally-funded subsidies1. While many initiatives have focused on members with Medicaid coverage, little is known about the basic resource needs of KP members who received subsidized insurance.

Approach

To define the basic resource needs of KP members receiving subsidized insurance, the KP Social Needs Network for Evaluation and Translation (SONNET) conducted a survey in 2018-19 with support from KP National Community Health.

We randomly selected over 1,000 members with a subsidy from the Southern California region. An equal number of members ages 18-30, 30-64 and 65+ were invited to participate. The majority of participants who received subsidized insurance and were aged 65 and over were transitioning to Medicare; a minority retained a subsidized plan. A subgroup is receiving a follow-up survey 3 or 6 months after their initial survey. The survey consists of up to 48 questions from the KP-developed Your Current Life Situation (YCLS) questionnaire, the Accountable Health Communities (AHC) survey developed by the Centers for Medicare and Medicaid Services, and other sources. The survey was administered by the KP Washington Health Research Institute’s Survey Research Program. Members responded between November 2018 and February 2019 (online, phone, or paper). Each respondent received a $20 cash incentive.

We balanced sampling by gender and invited 20% Spanish and 80% English speakers to participate. 487 (48%) completed the survey (84% in English, 16% in Spanish). More women than men completed the survey (56% vs. 44%).

In this report, we focus on four basic resource needs (housing, food, transportation, and utilities), and describe: 1) the prevalence of those needs in the last 3 months; 2) members’ desire for assistance from KP in addressing those needs; 3) and the extent to which KP has helped them address these needs.

1 https://aspe.hhs.gov/poverty-guidelines

A SURVEY OF BASIC RESOURCE NEEDS:RESULTS FROM A SAMPLE OF KAISER PERMANENTE SOUTHERN CALIFORNIA MEMBERS

Kaiser Permanente | SONNET Survey Baseline Results | June 2019 2

What are the basic resource needs of KP’s subsidized exchange members and do they want KP to ask or help them with these needs?

Difficulty paying for food (11%),was the most prevalent overall, housing (10%) and heat and electricity (7%). These needs were slightly more prevalent in women. Figures 1a-d on page 2 of this report show how these needs compare across the lifespan for survey participants.

When asked, “Would you like to receive assistance with any of the following issues,” utilities rated the highest (11%), while 7% desired help with housing issues, 5% with food, 4% with transportation and 1% with safety.

Of note, some members asked for help with social needs even if they did not have trouble paying for those needs. The only need members reported being asked about was transportation (1% of the time). Only transportation assistance was reported to have been provided by KP (1% overall). Figures 1a-d show that members with needs were rarely asked or assisted by KP. Figures 1a-d: Had trouble paying in the past 3 months, wanted help, were asked

about the need or whom KP helped with the need in the last year.

Figure 2: Housing instability by age group.

Although few members reported having current difficulty paying for housing, unstable housing remained a substantial concern (Figure 2). When asked the AHC item: “What is your living situation today”, 38% responded “I have a place to live today, but I am worried about losing it in the future.”

0%

5%

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Housing Food Transp Utilities

Age 18-26

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Housing Food Transp Utilities

Age 45-61

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5%

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Housing Food Transp Utilities

Age 27-44

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Housing Food Transp Utilities

Age 62+

0%0%

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18-26 27-44 45-61 62+

Worried about losing housing Lacks steady housing

Kaiser Permanente | SONNET Survey Baseline Results | June 2019 3

Additionally, 4% told us “I do not have a steady place to live” (temporarily staying with others, in a hotel, in a shelter, living outside on the street, on a beach, in a car, abandoned building, bus or train station, or in a park). The true prevalence of homelessness is likely higher as those without steady housing are particularly difficult to survey by phone, mail or online.

Members reported considerable worry about being able to pay for health care services

Members in all age groups reported concern about paying for health care services (Figures 3a-d). This was even a concern in the oldest age group as members approached eligibility for Medicare (Figure 3d).

Figures 3a-d. Current level of worry that won’t be able to afford needed health care services.

Members generally felt that it was acceptable to be asked about social, behavioral and economic needs. Across the age groups, over 60% felt it was appropriate to be asked about social behavorial, and economic needs. Members recommended that KP should ask about needs at least once a year (Figure 4).

Figure 4. How often members recommend asking about needs.

Those who were younger, women, and English speakers tended to consider it more appropriate to be asked about their needs.

Members favored KP-offered assistance (e.g., getting to and from the clinic) or community resources coordination over KP investments in community programs.

0%10%20%30%40%50%60%70%80%90%

18-26 27-44 45-61 62+

1+ times/year < once/year Never

Kaiser Permanente | SONNET Survey Baseline Results | June 2019 4

As KP embarks on its Thrive Local initiative, findings from surveys such as this can help inform training for clinical staff to learn culturally congruent approaches to asking about needs. Thrive Local will develop to consistently collect the information and identify community to assist members who have these needs and who would like help.

In Summary• KP Southern California’s subsidized exchange members have unmet social, behavioral and

economic needs; and includes individuals with significant needs (e.g., homeless).

• Members are most burdened by medical, housing and utility costs.

• Members reported considerable worry about the stability of their housing and about paying for health care.

• Members feel it is appropriate to be asked about needs and recommend asking once a year or more. Acceptability is highest among younger adults, women, and English-speakers.

• Training is needed to help clinical staff grow more comfortable asking about needs.

• KP clinicians and staff need to have a way to respond with helpful information or referrals to community resources if a need is identified.

Looking ahead

“Sometimes it seems that [clinicians] are afraid of

giving information or they lack training and empathy”

~Survey respondent