 Nancy, all right. Wow, wow, good morning everyone. You all woke up early and I have to say you all look so awake and focused. Either you're very excited to hear what Tyler has to say or you've had a lot of caffeine already. So it's great to be here. My name is Deb Nelson. I'm the executive director of Social Venture Network and I'm thrilled to be interviewing Tyler Norris who's the vice president of Total Health Partnerships at Kaiser Permanente. And for those of you who don't know Tyler already, he is an amazing human being, very innovative, very insightful and most important and incredibly kind person. He's been a social entrepreneur for the past three decades. He founded a dozen companies and social ventures. He started a program for homeless men back in his 20s that's still growing and thriving today. He created a national park system in Tajikistan in Central Asia. He has advised over 400 cities and government agencies and philanthropic institutions and he's really a pioneer in the renaissance of healthy communities and healthy people and is just passionate about making sure that everyone has an opportunity to thrive and grow and be their best selves. So it's a pleasure to be here with you this morning. Thank you Deb. And I wanted to start with the fact that you've done such innovative work in a different area of impact investing in community health and community impact and what inspired you to do the work that you do that focuses on healthy communities and healthy people and what is the work that you're doing today that you're most excited about? Thank you Deb. Beautiful introduction. Good morning everyone. My aspiration has always been to do what I could to contribute to healthier people and healthier communities. My daughter came home the other day and plopped an Institute of Medicine report on the table that said that after a century of increasing our lifespan by 30 years that children born today will be the first generation that may live five years less than their parents. And she said, you've been on airplanes for the last 25 years, what have you been doing? And it's really this question of what is it that actually produces health if we spend $3 trillion a year on sick care services why aren't we getting a return on investment to health rather than just more and more growth in the medical care sector? So I started working with Kaiser Permanente in my previous firm as a client and helped design their community health initiatives that have been flourishing across the country. But I decided to go inside, kind of pick my favorite client and go in for this reason. That I knew that Kaiser Permanente with the Affordable Care Act was going to bring in more people through Medicaid and the exchanges who were less healthy than the people that we have right now and that we would be paid less, reimbursed less for those individuals at higher risk for health. And at the same time, how would we maintain the highest quality care in each of our markets? So high quality, more people, less healthy, less reimbursement, and that's what I said yes to. I was in for that challenge. And the reason is that that's what the country faces. We have to learn how to do that overall in the Affordable Care Act. And so Kaiser's model is a bit unique because we're both a delivery system with 20,000 physicians, a couple hundred thousand employees, and a health plan. We're actually at risk for the health of our members. In other words, we do better when people are healthy as opposed to most hospitals get paid when people are sick. And so we actually have an incentive for healthier people and healthier places and it causes us to sort of lean in more. So we're about a $60 billion company and a nonprofit. We were born in the Richmond shipyards and Rosie came out of Kaiser Permanente's early work. And I think the key piece for us is not just us, but as we look at what the incentives are for the healthcare sector, 20 cents of every dollar in the country. The incentives increasingly in the Affordable Care Act is how do we produce value for those dollars, not just more volume of care. A lot of people make money off of sickness. Our goal is to actually, how do we do better by producing health in the first place? And how do we do that in a way that's more affordable? Because clearly the costs of healthcare are on top of every product, every service, and it's attacks essentially on that and it's challenging America's competitiveness, frankly. That makes total sense, thank you. So I am a Kaiser Permanente member. Been a member for 15 years and I will always be grateful to Kaiser because their doctors and nurses saved my son's life nearly eight years ago. So you have a strategy that's brilliant and you can have, you know, any company or nonprofit can have a brilliant strategy, but if it's not working on the ground and if it's not working human to human, it doesn't mean anything. But I've been more and more impressed with your model, how innovative it is, how effective it is in terms of community impact and one of the ways that you get at that is by investing $1.5 billion in firms that are owned by women and people of color. That's off to you for that. Thank you. Now that's a big part of your work and you talk a little bit more about that and how that ties into your model for community impact and health. Sure, first of all, if we're gonna talk about impact and it looks like the slide's not loading very well, but we need to talk about what creates health in the first place. Only 10% of what creates health has to do with medical care services and 30% is genetic and our biological inheritance. It means that 60% of what creates health has to do with behaviors in the context of the socioeconomic environment in our communities. In other words, health care is an intervention. It does not create health. Healthy communities and economic opportunity, education, access to food, access to mobility, access to a living wage job, that's what actually contributes to health. So if we're at risk for population health and frankly we think that the health care sector ought to be at risk for producing health, not just more services, we need to invest in what creates health in the first place and it has to do with a much broader array of issues. So what we've learned in our significant investments, about $2 billion a year worth of community benefit is that doing two and three and four, five year grants and 10,000 here and 100,000 here and a million there, it does not create a healthy community. You find bright spots, we do interesting things, but it doesn't scale unless we go all in with everything we have. So our model has been moving from not only how do we just do good grant making and all that, but how do we use literally every asset of our organization to improve health? So back to the whole idea of procurement, right? We do a billion and a half dollars with women and minority owned firms, that's out of $15 billion of total procurement. And what we're saying is, we not only want to get the best deal to manage costs, but how can we use that purchasing to drive the local economy so that by spending money with local companies who invest that money locally rather than it being exported to Wall Street actually drives the flywheel of the local economy which is a health producing factor. So that's one part of it with our procurement, with our HR, for example, we're expanding right now in Baltimore. We're moving into Freddie Gray's neighborhood. We can't just come in there and put in a medical facility and put some grants. We need to grow the workforce and the people who we need to hire, some of the skills are missing in that community. So we're partnering with the high schools and the community colleges and the workforce investment boards to grow the workforce skills, which again, not only helps meet the care needs, but particularly to grow the determinants of health through building local wealth creation. And then increasingly, we're using our investment portfolio. My colleague Liz Rocket is here from KP Ventures to be able to make investments. So for example, if we're trying to scale access to healthy food, we can make grants, we can do multi-year contracts with smaller companies that it's bankable to buy a truck or refrigerator or pasteurizing, and we can make capital available to actually scale food. And we can do that with mobility, home care and other areas. So we're saying in order for us to have the impact we want, we need to be all in with everything we have and we need to have partnership because clearly, and as you look out at this room and who's at SoCAP, so much of the skillsets and technologies and approaches and relationships that are needed to deliver on this, we don't have. We may be big, we may be able to do a lot with this kind of resource, but we have to partner with, frankly, everybody in this room to be able to deliver on that equation, not only with our friendly competitors who we work with very closely. We can compete on cost and quality, but when it comes to health, we need to be all in with our competitors and with the diversity of the innovators in a community to actually produce that kind of an outcome. So investing and buying local is it and we have to do much more. That makes a lot of sense. So how do you measure your impact and what's the impact that you've measured that you're most proud of? So just to, first of all, we measure everything and I don't have my smartphone here with me, but we have 10 million members and everybody can get their electronic medical record on their phone, email their doctor, see their labs, see their tests, it's coordinated. So we actually have a tremendous amount of data that we're able to use to improve the quality of care and manage costs, which is what makes us a great health plan and make a great system. But we also measure underneath clinical quality and cost, we're also measuring the determinants of health. We do community health needs assessments every three years and in fact, it's a very much of an ongoing quality process. So we can correlate cost and quality with the outcomes of population health. How are we reducing diabetes rates? Do people have access to fresh food? What are education rates in the community? What is the rate of people living with living wage? What are education attainments? In Oakland where my new adopted community, the high school graduation rate for young black men is in the 30% range. That's not okay. We're focused on that with everything we have in Oakland Unified Schools because we know that's upstream. So we measure what traditionally hospitals measure but we're also measuring all the determinants of health. And then with health, the PWC right now, we're actually looking at how we measure all of our impacts, the social impacts, the environmental economic and economic impacts so that we have a baseline on intended and unintended, beneficial and not beneficial, what are we really doing so that we have a very deliberate way to make sure that everything we do is adding up socially, economically, environmentally as well as then producing health as a byproduct of that rather than thinking about health as an intervention of a medical care system. So if you go back to our business model, the reason that it's important that we measure all that is that for us to deliver the best care at the best cost, we need to be able to invest in communities in a way that certainly provides care for people who need it like we were talking about with your family earlier but that reduces the preventable demand that reduces the demand on the system which is actually preventable that's driven by inadequate investments in communities of color, the lack of health equity, disparities, and our community struggling economically through disinvestment and the kind of things that Gar and Angela and all were talking about yesterday. That's why we're all in for that. Things we're proud of, for example, are we just invested a billion dollars to meet 50% of our total energy use through wind and solar. That's creating green jobs here in Alameda County through the wind farms in Dan and Riverside County through the solar there that is a 20 year investment that's helping build the market for wind and solar for large folks. So that's the kind of thing we're measuring and tracking about what we wanna hold ourselves accountable to since we're not accountable to Wall Street, we're accountable to our members and Main Street. That's great, more power to you. So both the mission of Kaiser Permanente and the work that you do, it really supports the notion that healthcare is a human right and not a privilege for those who can afford it. Can you talk a little bit about healthcare and equity? My vision of the American dream does not include rationing healthcare by wealth. So I think morally we have a responsibility to everyone in this country to make sure they get care for themselves and their families and their children at the right place, at the right time, et cetera. That's a moral value of ours and it matches what Henry Kaiser thought when he founded the company and gave the health plan a way to become a nonprofit rather than make it a for-profit. But there's an economic case too, it just does not make sense to not provide preventive care, to not invest in what creates for the health in the first place, to have people miss work, have their families struggle. You know, all the things that we go through and we're sick, ourselves are going through and then have people end up in the emergency department at five times the cost and pay for that. Why don't we invest in creating healthy food and access to physical activity and supports in the first place rather than just reimbursing for more diabetes care? And I think that's really what we're saying is there's a lot of money to be made in sick care and we're trying to make sure we're making it out of what's creating health in the first place and that's really the mission. Yeah. Beautiful. And that's where equity makes it really important and I don't mean cash equity, I'm talking about equity of opportunity for everybody in our country, yeah. I'd love to hear a little bit more about what call to action you have for this community, the SOCAP community, the mission-driven business community, the impact investing community. I invite you to challenge us a little bit and share what we can do together. I've been at this work of trying to create healthy communities for a long time and I'm humbled by it. It is not easy, it takes a tremendous amount of time, it takes the kind of time and patience that it does to raise a family and I think we need to be thinking generationally about this, not how do we make a quick product or app and flip it out in the next year? Of course our companies need to grow but how do we make these longer term investments in what creates health in the first place? So there's a lot that we can do but really I want to make an invitation to folks in the room and Liz and I here from Kaiser Permanente and our team basically want to make an invitation because we know that if we want to look at the totality of what creates health and kind of address that we need to scale access to healthy fresh food so everybody has access to healthy, fresh, affordable foods. If we want to make sure that people live in safe neighborhoods where there is mobility that there are transportation and transit systems that are available, that every young person has the opportunity to reach her or his potential, that we actually look at potentiation for everybody. We need to partner with our community organizations to help make that happen and that those social, environmental and behavior needs around home care and meeting people's, I mean we can provide the best care in the world which I think we do but if we then put somebody back out into a toxic community, what the heck? That's not quality. That may be clinical quality. It's not total quality. So to be successful, we need your partnership and that doesn't mean your pitch to our venture group or hey, we ought to give a grant for this or that. That means we need to understand what can urban strategies bring and how do we work with you? How can we work with impact investors like Kresge and others that we're working with impact capital like we are in the California Fresh Works Fund to actually bring capital to bear on those things that address the underlying needs that drive health and that meet the social and non-medical needs of patients. So what I'm saying I think is that as I look out at this room, I mean, look around, just yourself for a minute, look around. I mean, really. This is some of the most extraordinarily open hearts, bright people whose missions are to do something really good. Of course, many of you are building ventures, you're raising money, trying to bring home the bake. Good for you, go after it. But let's go back to what Gar said and the panel said yesterday. It's not about projectism and let's not ever let this be some flea market of one company that's cooler than the next. We have an opportunity right now to take a look at what really is underneath prosperity, not only in this country, but in all the countries that we represent. This is a global opportunity. And so basically I'll miss you in an invitation. Come meet with us and talk with us about here's what you're trying to scale, here's what you're learning. Not like some pitch, but here's what we might do together. And I think in the context of SoCAP, social venture network, Bolly, the democracy collaborative and the local partnerships on the ground, not to mention the investors and innovators and grassroots leaders on the ground that are really touching what matters most. We can actually have an impact that creates the dream that I believe we're capable of in this country and around the world and that this group is capable of doing it. So join with us and let's do something that is worthy of our lives. That's a beautiful invitation. Thank you, Tyler. I just wanna thank you, Tyler. And I invite you all to take him up on his invitation. Please come see him and Liz Rocket. Come see me after this session. We're gonna be joining you in a minute and share your ideas on how we can connect the dots, how we can all expand our impact together. Thank you all for being here. Thank you, Tyler. Thank you, Dad.