Healing the whole person—
Premera leads effort to focus on behavioral health
Homelessness. Domestic violence. School suspensions. Drug abuse. Criminal activity. What’s one common thread that runs through all of these issues? Behavioral health problems.
And yet for many people — and society in general — the subject is still taboo. When someone is diagnosed with cancer, their community rallies around them. When someone has mental illness, the topic is hidden. It’s difficult to talk about and even more difficult to treat.
“If you go back to when I was being trained, the image of a patient with mental health conditions was a homeless person talking to himself,” said Dr. David Wennberg, chief science officer of Quartet Health, a company that helps connect primary care physicians and their patients to behavioral health services. “While that is a huge societal issue, that’s a relatively small proportion of the behavioral health world. It’s overwhelmingly depression, anxiety and substance disorder. One in four Americans will face a behavioral health issue annually.”
The prevalence of behavioral health conditions is greater than the five most common chronic health conditions combined — heart failure, coronary artery disease, chronic obstructive pulmonary disease, asthma and diabetes.
Historically, people with behavioral health problems have not only been stigmatized, but faced the challenge of obtaining services, which often were not covered by traditional health insurance. In addition, services between medical and behavioral professionals are not always coordinated, adding to the challenges of treating the entire person.
And yet the importance of treating the whole person — physically and mentally — is important to help people achieve optimal health. “If you don’t treat the mind, the body isn’t going to do as well,” Wennberg said. “If someone has heart disease, they could have depression. And if you don’t treat the depression, the heart disease will get worse. If someone has diabetes, heart failure, coronary disease or pulmonary disease and a mental health condition, they’re 1.5 to 2.5 times more likely to end up in a hospital than if they didn’t have the mental health condition. They’re not in the ER for the mental health condition, but the physical condition that they’re unable to manage well because of overall anxiety, depression or substance abuse disorder. If you treat their mental condition, they feel better and don’t end up in the ER as much.”
Wennberg noted that mental health conditions are in the top five reasons for disability, absenteeism and productivity problems at work.
Treating behavioral health problems as early as possible is especially important, said Neil Peterson, founder and chairman of Edge Foundation, which provides coaching to children with Attention Deficit Hyperactivity Disorder and to those who have experienced adverse childhood experiences. “For the individual child, obviously for their health and wellbeing, (treating these conditions) is crucial. From the point of view of society, if the interventions are not provided and you become an adult with these kinds of issues, the impact in society is significant — two times as likely to commit a crime, be unemployed, be divorced, four times as likely to be in an auto accident and seven times as likely to have a substance abuse issue. It translates into tremendous costs to society in each of these arenas. We would be well positioned as a society to provide early interventions when these kids are kids so they don’t fall into the category when they’re adults.”
According to the National Alliance on Mental Illness, individuals living with serious mental illness face an increased risk of having chronic medical conditions and adults in the United States living with serious mental illness die on average 25 years earlier than others, largely due to treatable medical conditions.
Funding innovative programs
Recognizing the importance between behavioral health and overall health, Premera Blue Cross launched the Premera Social Impact Program aimed at supporting behavioral health issues, particularly in underserved communities. Premera, which serves Washington and Alaska, believes that overall health will improve by addressing behavioral health issues — especially for people of color and low-income populations where community health data consistently shows treatment disparities exist. By treating behavioral health, people’s physical health will improve — something that’s good for the company and good for the community.
“It is clear that behavioral health is inseparable from physical health. If you are severely depressed, you will not be able to effectively manage your diabetes, control physical pain, and you may self-medicate with alcohol or other drugs which can lead to addiction,” said Dr. Shawn West, Medical Director for Provider and Customer Engagement at Premera. “For the majority of people who are suffering from psychological distress, whether it be depression, anxiety, or other conditions, there is safe, effective treatment that can vastly improve their quality of life.”
Premera is not alone. Consulting firm Milliman estimates that integrating behavioral and medical care could save the industry $26 billion to $48 billion annually.
“When we think of a large healthcare company like Premera, we think of physical well-being,” said Paul Hollie, who heads Premera’s Social Impact Program. “But behavioral health plays a significant impact in all of our lives.” The company is not only supporting behavioral health through its philanthropic efforts, but has also partnered with Quartet to help medical providers to connect patients to behavioral health services.
“We’re trying to help deliver those tools to our physician partners, to take the stigma and the barriers away from behavioral healthcare,” Hollie said. “Taking active steps both on our philanthropic side and business side is something Premera is focused on doing.”
Depression, anxiety and mood disorders are the top conditions that prevent people from achieving optimal health, according to the Blue Cross Blue Shield Health Index.
In 2018, Premera announced an additional $40 million community investment, following recent changes to the U.S. corporate tax system resulting in a one-time-only refund to the company.
Premera Social Impact financially supports 26 evidence-based programs and pilot projects with the potential for significant impact in Washington state and Alaska. The focus, for the most part, is on prevention rather than intervention — to have the biggest potential impact.
2017–2018 Social Impact Grant Recipients
Alaska Children's Trust Anchorage, AK
Boyer Children's Clini Seattle, WA
Catholic Charities of Spokane Spokane, WA
Center for Human Services Shoreline, WA
Childhaven Seattle, WA
Cocoon House Everett, WA
Community Youth Services Olympia, WA
Covenant House Anchorage, AK
Hopelink Redmond, WA
Housing Hope Everett, WA
Navos Seattle, WA
Neighborcare Health Seattle, WA
Pioneer Human Services Spokane, WA
Plymouth Housing Group Seattle, WA
Senior Services of Snohomish County Everett, WA
SideWalk Homeless Services Olympia, WA
Sound Mental Health Seattle, WA
Sunshine Community Health Center Talkeetna, AK
Transitions Spokane, WA
United Way of Snohomish County Everett, WA
Wellspring Family Services Seattle, WA
YMCA of Snohomish County Everett, WA
Youth Eastside Services Bellevue, WA
YWCA Seattle-King-Snohomish Seattle, WA
“We’re at the forefront to do new and interesting things with these entities. We believe that this work can help make a small dent in ending the stigma associated with behavioral and mental health issues,” said Hollie, noting that according to a U.S. Centers for Disease Control and Prevention survey only 25 percent of adults with mental health symptoms believe people are sympathetic and caring to those with mental illness. “The stigma, unfortunately, keeps people from getting the treatment they need.”
Focus on children with adverse childhood experiences
To demonstrate how its program, which is funded by a $150,000 Premera grant, helps children facing adverse child experiences that result from domestic violence in their homes, Sound Mental Health employees recently enacted a situation that routinely plays out at its clinics. Charlotte, playing the role of an abused mother, walked into the Sound Mental Health clinic in Auburn apprehensive and emotional. Her husband, who has a record of beating her, is in jail – again. Her two young children are fatherless and traumatized from seeing their mother victimized. She and the kids could benefit from behavioral health support. But she’s afraid her husband could use that against her in a custody battle.
Once inside the doors of the clinic, Charlotte was warmly greeted by four advocates waiting to support her. They included two clinicians from Sound Mental Health and two from DAWN, the Domestic Abuse Women’s Network. They took her to a small quiet room, sat her down, and explained how they could support her with a variety of wrap-around services, from counseling for her and her children to help finding housing. They explained the pros and cons of seeking behavioral health services. And they listened as she broke into tears, telling her story about the trauma she and her children have experienced.
Then it was up to Charlotte to decide how much help she wanted from this team.
“We are so grateful and thankful to Premera,” said Susie Winston, Sound Mental Health chief quality and clinical excellence officer. “This has been the most successful endeavor that I’ve been part of.”
In March 2018, Premera invested $1.6 million in Cocoon House to support the construction of the new facility in downtown Everett, Wash. Cocoon House uses trauma-informed approaches to outreach and empower at-risk and homeless young people throughout Snohomish County. The new facility will not only expand the ability for Cocoon House to be a service location for young people, it will expand programming to become the only housing program of its kind in Snohomish county dedicated to serving people age 12-24 years.
Equipping all staff with behavioral health training
Hopelink, a non-profit focused on ending poverty in King and Snohomish counties, is using its $200,000 Premera grant to launch a program to train staff and volunteers about how the toxic stress and trauma of adverse childhood experiences impact its clients. The goal is for staff to use this knowledge and understanding to help clients exit poverty.
Adverse childhood experiences, which can include everything from abuse to parental alcoholism to living a life of racism or poverty, not only can have a lifelong impact on an individual’s mental health, but their physical health as well, according to a landmark study by Kaiser Permanente and the Centers for Disease Control and Prevention. The study has led treatment providers to offer what’s known as “trauma-informed care,” which focuses on what happened to an individual rather than what is wrong with an individual. Hopelink is integrating the research into trauma-informed care in the way its staff work with clients.
“Our Premera partnership is really exciting,” said Meghan Altimore, Hopelink’s vice president of community services. “Really understanding new techniques to engage with the people who are coming for our services is going to deepen those relationships and help people achieve even more after they’re done with Hopelink.”
Added Hopelink chief executive Lauren Thomas, “The more we can get involved in adverse childhood experiences and trauma-informed care and equipping our staff with the most recent research about what our clients experience, the better outcomes we’ll have.”
Dr. Megan Beers, senior director of infant/early childhood mental health services at Wellspring Family Services in Seattle, noted that while the medical profession separates mental and physical health, the body doesn’t make that distinction, illustrating the need to improve behavioral health services. “What happens to you when you’re little matters on how happy and how successful you’ll be, but also whether you’ll have heart disease or cancer. We can have a much greater impact if we equip all providers with this info. Hopelink is training its staff and integrating this knowledge that impacts behavioral health to everyone who works with children day to day.”
Coordinating care for the poor and uninsured
While the Hopelink staff undergo training in trauma-informed care, a team of healthcare coordinators for Neighborcare Health are busy focusing on improving the health of King County’s poor and homeless. The nonprofit organization, which provides primary medical, dental and behavioral healthcare services to patients who are low-income or without health insurance, is using its $175,000 Premera grant to implement a new Health Homes program aimed at improving patients’ health and reducing medical costs.
Washington state four years ago adopted a Health Home model, as required by the Affordable Care Act. It targets high-risk and high-utilizing Medicaid and Medicare patients at risk for seeking urgent care and emergency room services during the coming year. Care coordinators who are funded through the program work with these high-risk patients on setting and meeting goals that ultimately are aimed at improving their health.
Care coordinator Nelson Lopez, for example, works with Lieu Hoang, a Vietnamese immigrant who has survived cancer but was on the verge of losing her home. When Lopez introduced himself to Hoang as she waited to see a Neighborcare dentist last year, he asked how she was doing. Though reluctant at first, Hoang eventually disclosed that she wasn’t sleeping at night because of anxiety over where she and her husband would live after their landlord sold the house they had rented for the past several years.
With a monthly income of only $1,040, Hoang said the couple didn’t have enough money for rent and explained to Lopez that worries over her living situation were negatively impacting her health.
Lopez told her not to worry and that he would help her find a new place to live. He worked with Neighborcare social workers to eventually find Hoang and her husband new housing, which they moved into in December.
The Premera grant not only funds the program at Neighborcare Health, but also helped the organization launch a quality improvement program to improve its processes to better serve more people like Hoang.
“Health Homes was something we were trying to start for six months before we got the Premera grant,” said Health Homes program manager Josh Martinez. “So the grant really accelerated what we had planned to do and moved us forward a lot faster than we had originally planned.”
Serving rural Alaska
Neighborcare Health’s program serves a dense metropolitan area where housing is scarce, but patients are close to healthcare providers. But Premera’s support extends far beyond the boundaries of urban centers. It also extends to rural communities in the far reaches of Alaska, where patients live as many as 70 miles from the nearest health clinic or pharmacy.
“Premera is the only insurance company serving the individual market in Alaska and is an integral part of those communities,” Hollie said.
Covenant House Alaska (CHA), based out of Anchorage, provides housing and behavrioal health services for homeless youth. The nonprofit received a $1 million Premera grant to support their Rapid ReHousing program, which will move 30 you, ages 18-23 from temporary shelters into apartments.
“Putting a roof over someone’s head often means the difference between life and death, and that makes homelessness a healthcare issue,” said Jim Grazko, President and General Manager of Premera’s Alaska office. “We are excited to partner with Covenant House and help them fulfill their bold vision of eradicating youth homelessness.”
Alaska Children’s Trust, also in Anchorage, received a $220,000 Premera grant to support the Alaska Resilience Initiative (ARI) formed to further advance the dialogue in Alaska on brain architecture, adverse childhood experiences and how communities can prevent trauma.
Sunshine Community Health Center of Talkeetna, Alaska, is using its $95,500 grant to expand and fully integrate behavioral health services into primary care clinics and public schools over a 12,000-square-mile geographic area that sits between Anchorage and Denali State Park in southern Alaska.
Some 6,000 people live in the area in remote population centers with 500 to 2,000 residents. Many live off the land in dry cabins accessed only by snow mobile during part of the year. Sunshine is using most of the grant money to fund behavioral health programs inside the schools. It pays for a behavior health specialist who offers group and one-on-one counseling, parenting classes and health awareness events for issues such as tobacco awareness, cyber safety and suicide prevention. The money also subsidizes transportation, a critical need when patients live so far from their medical clinic or pharmacy. “A huge thank you to Premera for helping us to help the children in our community,” said Sunshine Executive Director Melody West.
Premera grant used as catalyst
Sometimes a Premera grant funds an entire program. Other times the grant serves as a catalyst to convince other funders that a program is worth funding. That was the case for Catholic Charities of Spokane, which received a $175,000 grant to launch its fundraising efforts for Rising Strong, a multi-million dollar project to help families at risk of child neglect due to alcohol and substance abuse. The program includes housing, drug treatment, behavioral health and other wrap-around services for families with children pulled from their homes by Child Protective Services.
“You can’t improve the child welfare situation substantially without tackling addiction,” said Mike Yeaton, chief strategy officer with Empire Health Foundation, a Catholic Charities partner on the program. Every family admitted to the program receives subsidized housing and treatment. The goal is to catch families and offer services early enough to keep the children out of foster care. “The premise of this model, which has been shown to be effective, is that if you allow families to stay together during treatment you reduce trauma to the kid and increase success for the parent,” Yeaton said.
Premera also kicked-off the capital campaign for Volunteers of America East Washington& Northern Idaho (VOA) for a new women’s shelter in Spokane with a $1 million grant. It will allow the shelter, Hope House, to expand their services, move to a new shelter in December 2019 and triple the number of women they serve each year.
Setting an example
Ultimately, Premera hopes to set an example for the rest of the healthcare community about the importance of treating behavioral health as a way to treat the whole person. “We wanted to really put a stake in the ground in where we do business. We’re part of Washington; we’re part of Alaska. We want to let folks know we want to help make our communities better in a meaningful way and this is one way we can do it,” Hollie said.
Beers, of Wellspring, sees Premera’s efforts as leading a sea change. “In our current mental health system, we devote a lot of money to responding and not a lot of money preventing,” she said. “Most mental health dollars go to higher needs crisis interventions. How can Premera become a change agent to moving earlier? Just like we have to keep our physical systems healthy, we need to keep our mental health systems healthy, so investing earlier should be a focus.”
Premera employees are passionate about their communities — it’s part of the culture. They’re also not afraid to roll up their sleeves. Once again, co-workers teamed up to participate in Seattle Works Day. The volunteer effort spread teams from Bothell to Shoreline, to South Seattle and to West Seattle. The work was hard, but colleagues came together to clear brush and plant healthy gardens.
“It was rewarding to see the team getting to know each other,” said Premera volunteer Janna Turner. “We were working together to contribute to the community that can benefit from the food grown here on this farm.”
“There was a lot of sweat and numerous scratches from blackberry stickers,” said Jemima Monroe, another Premera volunteer. “But most importantly, we made a difference.”
When Premera employees weren’t picking or pruning, they were hitting the road. Events like the JDRF Beat the Bridge and the Puget Sound American Heart Association Heart and Stroke Walk gave colleagues a chance to represent Premera’s commitment to good health along with families and friends. Premera captains encouraged their teams through various fundraising activities and it all paid off as the walkers far surpassed their $45,000 goal.
Premera showed its generosity again during the annual United Way Campaign — this year becoming the largest corporate supporter in Snohomish County. Companywide, employees outdid themselves by encouraging fun and engaging ways to learn more about the United Way and its programs. In total, Premera employees generated more than $730,000 in support.
Proud to be supporting Pride
In addition to funding new programs, Premera also donated $42,500 to past grant recipient Seattle Pride. The money not only supported the LGBTQ organization and the 2017 Seattle Pride Parade, but also allowed parade participation by Nexus Youth and Families, a nonprofit that addresses behavioral health, homelessness, housing and other needs of at-risk and in-crisis youth, young adults and their families.
Having support from an insurance company sent a great message, said Seattle Pride President Kevin Toovey. “When I first learned about the potential relationship, I was a little shocked and taken back because you generally don’t hear about health insurance companies really diving into the LGBT community,” he said. “To see a health insurance company step in and say `we want to partake in this and we want to support you,’ it was definitely different, but in a great way. We are extremely happy to see that relationship form and we hope to continue with it as well.”
While Premera focused its giving on behavioral health, “we’re trying to make ourselves relevant and pertinent in the entire community,” said Paul Hollie, head of Premera’s Social Impact Program.
- American Cancer Society
- American Diabetes Association
- American Heart Association
- American Red Cross
- Asian Counseling and Referral Services
- Atlantic Street Center
- Big Brothers Big Sister
- Boyer Children's Clinic
- Center for Human Services
- Children’s Alliance
- Cocoon House
- Commonwealth North
- Confluence Health Foundation
- Edmonds Community College Foundation
- Edmonds Senior Center
- El Centro de la Raza
- Evergreen Healthcare Foundation
- Foundation for Health Generations
- Fred Hutchinson Cancer Research Center
- Goodtimes Project
- Entre Hermanos
- Hope Community Resource Inc
- Housing Hope
- Inland Northwest Blood Center
- Juvenile Diabetes Research Foundation
- Lilac Bloomsday Association
- March of Dimes
- Mary Bridge Children’s Foundation
- Mat-Su Services For Children & Adults Inc
- Philanthropy Northwest
- Seattle CityClub
- Seattle Out and Proud
- Seattle Works
- Second Harvest Food Bank Of Inland NW
- Senior Services Snohomish County
- Sherwood Community Services
- Snohomish County Health Summit
- Social Venture Partners
- Sound Generations
- Special Olympics Washington
- Spokane Hoopfest Association
- Spokane Neighborhood Action Partners
- Strengthen Orlando
- Susan G Komen For The Cure
- Swedish Medical Center Foundation
- United Way King County
- United Way of Spokane County
- United Way Snohomish County
- University of Washington Foster School of Business
- Urban League Of Metropolitan Seattle
Social Impact Report Team
Steve Kipp, Premera Blue Cross
Bo Jungmayer, Premera Blue Cross
Sheena Lintz, Premera Blue Cross
Paul Hollie, Premera Blue Cross
Gloris Estrella, Premera Blue Cross
Kelly Guenther, Guenther Group
Cynthia Flash, Flash Media