SONNET Newsletter Summer 2024: Feature Story
'Compassion is the through line’: A reflection on SONNET’s evolution and future
Retiring SONNET Program Director Andrea Paolino shares thoughts on the network’s role in advancing social health at Kaiser Permanente and beyond
Q&A with Andrea Paolino, MA, SONNET program director and senior research operations manager at the Kaiser Permanente Colorado Institute for Health Research
A lot has changed since the Kaiser Permanente Office of Community Health established the Social Needs Network for Evaluation and Translation (SONNET) in 2017. But one thing has stayed the same: Andrea Paolino, MA, has been at the helm of SONNET’s Coordinating Center — expertly leading the daily operations of a growing network of researchers and evaluators committed to helping Kaiser Permanente improve members’ social health.
As SONNET’s founding program manager, Andrea worked alongside the duo that launched the network: Loel Solomon, PhD, MPP, Kaiser Permanente’s vice president of Community Health at the time, and John Steiner, MD, MPH, a senior clinician investigator at Kaiser Permanente Colorado’s Institute for Health Research (IHR). A longtime research operations manager at IHR, Andrea was pivotal in helping realize Loel and John’s vision for using research and evaluation to inform Kaiser Permanente’s social health strategy. More recently, as SONNET’s program director, she has guided SONNET through leadership transitions and significant growth in scope and influence.
Now, as Andrea retires after 21 years of service to Kaiser Permanente, we wanted to honor her contributions to SONNET — and take one last opportunity to learn from her experience as one of Kaiser Permanente’s early champions for social health. In this Q&A, she talks about how SONNET evolved, what she’s most proud of, and her hopes for SONNET’s future.
What was Kaiser Permanente’s impetus for creating SONNET in 2017?
It started in 2015 with the “Challenge Possible” initiative launched by Bernard Tyson, who was CEO of Kaiser Permanente from 2013 until he passed away suddenly in 2019. Bernard was a visionary, and he wanted to do more to help our members with their social, economic, and behavioral needs — or what we called “SEBN” back then. He asked everyone across the enterprise to think big: What would it look like if Kaiser Permanente helped address members’ needs beyond health care? What could our role be in helping them with essential things that impact health, such as meeting their social needs?
John Steiner, my longtime colleague at IHR, came back from the “Challenge Possible” focus groups with an idea he cooked up with Loel Solomon: Let’s provide scientific evidence to inform what Kaiser Permanente does next. Loel found support to conduct a food insecurity survey among Kaiser Permanente members with Medicare coverage in Colorado and learned that 6% of these older adult members were food insecure.
It was like this hidden population with social needs was suddenly revealed: Even among people who were insured, day-to-day challenges like having enough food were a very real issue.
That research was really the birth of SONNET because it provided proof that our members have social needs that we can document. Loel and John then launched SONNET as a Kaiser Permanente research network to connect and learn from social health initiatives across the enterprise. To highlight social needs work happening across Kaiser Permanente, John worked with Loel and the editor of The Permanente Journal to develop a special supplement in 2018: Addressing Basic Resource Needs in Health Care Settings: From Clinic to Community.
How has SONNET grown and evolved since then?
Like many research networks, SONNET has navigated changes in leadership, funding, and scope. Our original Steering Committee included research and evaluation partners from several Kaiser Permanente regions. And knowing that we needed to stay connected to the larger social health research landscape, we were fortunate to engage Laura Gottlieb, MD, MPH, from the Social Interventions Research and Evaluation Network (SIREN), who has been a key SONNET partner from the beginning.
Today, that original group of SONNET partners has evolved into our current Evaluation and Research Committee (ERC), which includes researchers and evaluators from all 8 Kaiser Permanente regions — along with the Kaiser Permanente Bernard J. Tyson School of Medicine, the Kaiser Permanente Community Health Evaluation & Measurement team, and SIREN. SONNET’s structure has fluctuated a bit to stay aligned with the resources available. But we’ve always focused on providing specific areas of expertise, such as survey methodology and advanced analytics, to provide evidence that helps guide Kaiser Permanente’s social health strategy.
In 2019 when Loel moved on to become a professor at the Bernard J. Tyson School of Medicine, we were very fortunate that SONNET’s new sponsor, Kaiser Permanente Vice President for Social Health Anand Shah, MD, MS, recognized the value of SONNET and what its researchers and evaluators could contribute to Kaiser Permanente’s social health strategy. In another good turn of events, when John stepped down as SONNET director in 2020, Cara Lewis, PhD, a senior investigator at Kaiser Permanente Washington Health Research Institute (KPWHRI) was selected to become SONNET’s next codirector alongside Katie Coleman, MSPH, who co-leads KPWHRI’s Center for Accelerating Care Transformation (ACT Center).
At that point, I think SONNET naturally entered another phase of thinking big. Working with our growing ERC, SONNET supported more than a dozen research and evaluation projects across Kaiser Permanente regions over the last few years — on topics ranging from the impact of loneliness on health to the link between social needs and health care utilization in older adults to understanding strategies for addressing missing race and ethnicity data in electronic health records.
Among all those projects, what are you most proud of?
Being part of SONNET has always made me proud to work at Kaiser Permanente. Especially in the early days, it was rare for a health system to prioritize using research and evaluation to learn how we can do a better job of helping our members, and I’m really pleased with how we’ve continued to build on our early accomplishments.
The best examples are Kaiser Permanente’s National Social Health Surveys in 2020 and 2022, which were designed based on what we learned from a survey in Southern California that Cara led in 2019. These larger, nationally representative surveys showed us that more than 60% of Kaiser Permanente members across all 8 regions experience at least 1 social need. They also provided valuable data that enabled subsequent analyses on issues like the links between social risks and acute health care utilization, racial differences in chronic illness outcomes, and exposure to COVID-19.
Having social needs data that is representative of an insured population is rare in social health research, so I’m thankful that Anand recognized the importance of supporting the surveys and our efforts to share what we learn in journals and at conferences — and, most importantly, with our social health colleagues across Kaiser Permanente. In the last couple years, Anand has really helped SONNET deepen our connections with Kaiser Permanente’s Social Health Practice Team so that we can quickly respond to their research and evaluation needs. Our social health colleagues across the enterprise know they can reach out to SONNET when they have a research question and that we’ll give them an evidence-based answer they can trust.
I’m also proud of how the SONNET team has adapted to changes along the way. When Cara moved on to the National Institutes of Health in early 2023, SONNET ERC member Meagan Brown, PhD, MPH, an assistant investigator at KPWHRI, stepped up to become SONNET’s new associate director. She took the 2022 National Social Health Survey across the finish line while continuing to lead other important SONNET projects — such as developing a Kaiser Permanente-wide social health training for care teams and a set of priorities for learning and action informed by feedback from hundreds of social health partners across the enterprise.
What are your hopes for SONNET’s future?
I hope we continue to provide evidence that helps Kaiser Permanente focus limited resources on what works to improve social health for our members. SONNET has always been committed to sharing what we learn in the public domain, and I hope we continue to prioritize this so that our research can also benefit communities served by other health systems.
As an example, the SIREN 2025 National Research Meeting, “Advancing the Science of Social Care,” will be an opportunity for SONNET to share findings from Kaiser Permanente projects and to learn from social health research happening across the nation. Gatherings at conferences like this are among my favorite SONNET memories, so I hope many of our ERC members will be able to attend and spend time together.
I think compassion is the through line in all of this. The social health leaders, researchers, and evaluators I’ve worked with through SONNET are compassionate people. At the end of the day, they want our members to feel that Kaiser Permanente cares about them as a whole person. That’s the beating heart of SONNET, and I hope that never changes.
Acknowledgments
In addition to SONNET’s founders and current and former directors, Andrea would like to express gratitude to:
- Executive sponsors Anand Shah (also SONNET’s accountable executive), Beth McGlynn, and Wendee Gozansky
- SONNET’s Evaluation and Research Committee
- SONNET Coordinating Center team members Carolyn Bain, Susan Bennett, and Jessica Ridpath
- Kaiser Permanente partners Pam Schwartz, Cheryl Kelly, and many others on the Social Health Practice Team
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