In four years, national health reform will extend coverage dramatically. But in the meantime, millions have lost access to health care at a time when they are financially vulnerable. State and county health care budgets will continue to struggle with reduced revenue and increased need for services. So in 2010, we will continue to help uninsured families and individuals make the transition into public health care programs and into our own charitable care and coverage programs.

We will also begin to design a system that can help those in need easily determine whether they are eligible for public insurance, for our charitable coverage, or for other charity care. This system will also help people understand what additional services they may be eligible for, including food stamps, earned income tax credits, and reduced-cost, school-based meals for children.

Even though health reform has been signed into law, myriad details of new regulations, policies, and procedures remain to be determined and implemented. We will have the opportunity to help shape that process so that the result will contribute to improved health and health care for the most vulnerable members of society. Nearly half of the newly insured will be low-income Americans participating in Medicaid, which means we at Kaiser Permanente will have to find a way to scale up our participation significantly.

The harsh economic realities that made 2009 a challenge continue to stretch the health care safety net to its limits. Even with the help of badly needed ARRA funding, our critical safety net partners are struggling to keep up with the demand.

These institutions need steady support, not only with charitable contributions, but also with planning and capacity development. With broad and consistent support, the key safety net providers can manage future challenges, improve their performance, and build vital, sustainable partnerships.

This makes sense, because safety nets, by definition, are made of strong connections. So in 2010, we will be defining a working model for how Kaiser Permanente and our safety net partners can build a collaborative service program. We can draw on our experiences with charitable surgical days, specialty care referrals, shared strategies in chronic care management, and the use of population management tools to develop partnerships in care delivery.

After many years of hard work and cooperation, we have all gained experience in the best practices that provide high-quality care to underserved populations. We want to bring these initiatives together, harvest their lessons, and make real progress in creating a coherent, patient-centered system that works for everyone in the community.

We will have the opportunity to help shape health reform so that the result will contribute to improved health and health care for the most vulnerable members of society.

We are proud to be a founding partner in the partnership for a Healthier America, a national effort that supports Michelle Obama’s let’s move campaign.

Between new ARRA prevention grants and the enactment of health reform, there is now substantial funding for community-based prevention.

First Lady Michelle Obama has taken a leading role in advocating for a comprehensive, clinical, and community-based prevention approach to the obesity epidemic through her Let’s Move campaign. We are proud to be a founding partner in the Partnership for a Healthier America, a national effort that supports the Let’s Move campaign.

Many current Kaiser Permanente Community Health Initiative sites were among the first in the nation to adopt the comprehensive healthy eating/active living efforts called for in new federal programs. So they are well positioned to receive additional dollars that can expand their efforts. Early indications are promising, with several Kaiser Permanente states and communities receiving ARRA prevention grants in the first round of awards made in early 2010.

At the intersection of community health and sustainability, entirely new opportunities are emerging. In 2010, the U.S. Department of Housing and Urban Development, the Transportation Department, and the Environmental Protection Agency will issue a joint Funding Opportunities Announcement for Sustainable Communities Initiatives.

This new federal program will support local strategies to address land use and transportation and will promote agriculture strategies that feature sustainability and community health goals.

These solutions that generate dual benefits are the center of our focus on environments and health. By participating in the Convergence Partnership, we are helping create these solutions through grant-making, commissioned papers, and consultation with policymakers.

Despite additional national funding, 2010 is expected to bring a slow recovery, with continuing stress on state and local budgets. This fiscal reality will mean that new sources of funding for prevention and sustainability may have to be used to offset cuts to core public health functions.

In the best of circumstances, local health departments and agencies will implement innovative approaches that may partially mitigate the impact of reduced staff and lower overall capacity. Community partners implementing HEAL strategies will continue to address multiple challenges, including joblessness, economic development, and community violence.

Fortunately, there are some potentially powerful models available to meet these kinds of challenges. They include efforts by several Kaiser Permanente communities in Colorado and California that address the intersection of HEAL and violence prevention, and Kaiser Permanente’s multi-faceted support of the Atlanta BeltLine. Our role there includes support for trail development that will bring biking and walking opportunities to metro Atlanta, support for job training for residents in lower-income communities close to the trail, and even the provision of Kaiser Permanente charitable health coverage to those trainees. It is multi-dimensional initiatives like this that suggest the full potential for Kaiser Permanente to be a total community health organization.

In our efforts in environmental stewardship, we will continue to focus on four areas: safe chemicals, climate action, sustainable food practices, and waste reduction. We will expand our efforts by formalizing our water conservation efforts and exploring opportunities to reduce the environmental impacts of pharmaceuticals. We will continue to engage our employees and physicians through internal networking. We will educate members and communities. And we will use our research capabilities to better understand the links between the environment and health.

To carry out this work, we will partner with nongovernmental organizations, community groups, industry stakeholders, and others. Our collaborations include supporting the Healthier Hospitals Initiative, which we founded, to improve sector-wide performance on sustainability and safety. We will also accelerate our education strategy to reduce the health impacts of environmental toxins on our workforce, our members, and our communities.

This year, we committed to deploy 15 megawatts of solar power by putting solar power systems at 15 facilities across California by the summer of 2011. This launches one of the largest sustainable energy programs in U.S. health care.

We are launching one of the largest sustainable energy programs in U.S. health care.

Through our electronic health record, Kaiser Permanente HealthConnect®, our analysts and researchers have access to business and clinical data of unparalleled detail and depth. We intend to share our experience and learnings as broadly as possible.

Our Procurement and Supply Department will continue to ask suppliers for information on hazardous ingredients in their products. We are now requiring suppliers to provide environmental data for $1 billion worth of medical equipment and products used in our hospitals, medical offices, and other facilities through our Sustainability Scorecard, the first of its kind in health care. Our goal is to collect enough information to implement a program that substitutes safer alternatives for existing high-priority products.

We are expanding our view of environmental stewardship to be part of the larger context of healthy environments. We will work to better understand the linkages between environmental sustainability, health disparities, and community health initiatives. For example, access to fresh food is a key element in every healthy environment.

Today, through our electronic health record, Kaiser Permanente HealthConnect®, our analysts and researchers have access to business and clinical data of unparalleled detail and depth. To get the most value from our new analytic tools, we are creating forums where analysts and researchers can share successful practices and common problems, and coordinate training and professional development opportunities.

As our analysts and researchers engage in new levels of collaboration, the result is the acceleration of new discoveries that will benefit everyone. We intend to share our experience and learnings as broadly as possible. We hope this will accelerate the spread of health information technology and comparative effectiveness research throughout American health care and improve care for people everywhere.

With the size of our staff and the scope of our activities, it is easy to get lost in the details. But as we move forward, we will measure every program and every project by asking the same three basic questions: Will this help make people healthier? Will it help make the environment healthier? Will it lead to new knowledge that produces healthier practices? We invite you to look at our activities the same way, and to share your thoughts with us.