Updated: April 2022
Drew E. Altman, Ph.D., Founding President and Chief Executive Officer of the modern day KFF. Follow Dr. Altman on Twitter: @DrewAltman
This essay discusses the choices we have made about our mission and operating style.
Of course, I believe deeply in what we are doing at KFF, but I offer this with the caveat that our choices are not necessarily the right ones for others. Every organization has a different set of opportunities by virtue of its history, financing, size, geographic location, its board, CEO and staff, and other factors. I have always believed that our society is best served by having a wide range of us doing different things — a truly independent sector. Organizations also evolve and change (and should). And those of us in health care should be very humble about what we can achieve in a four trillion-dollar health system dominated by money and politics. That should not stop us from asking how we can have the biggest impact, and from making sometimes tough strategic choices in crafting our mission and program strategies.
KFF is an endowed, nonprofit organization filling the need for trusted, independent information on national health issues. Legally we are a public charity — not a foundation — and as I hope you know, we are an independent national organization, headquartered in San Francisco, without any connection to Kaiser Permanente.
We are an information organization, and we accomplish our mission through policy analysis, polling, journalism, and social impact media campaigns — the core components of KFF which enable us to play our national role. We do two things well, policy and media; there’s a lot in health care we are not the experts on, and we leave to others who are. We don’t think better information is the answer to everything that ails our country or our health system; we do believe it can be a counterweight to the money, politics, and misinformation that often dominates health policy and that through it we can be a voice for people who often don’t have one. It’s the role we have chosen to play and the niche we have chosen to fill.
The hallmark of KFF is our focus on how policy affects people. Our work deals with the intricacies of financing and with policy and public programs. We are experts on Medicaid, Medicare, the ACA, problems like the uninsured or employer health coverage, and many more similar issues. The work is often quite technical. But almost everything we do, no matter how arcane, is at its core also about inequality and economic security, racism and racial equity, and the future of our diverse society. These larger issues that animate and sometimes divide our society lie behind the technical work we do and motivate us. COVID-19, with its disproportionate impact on communities of color and profound economic consequences, is the perfect example of a health issue that surfaces every one of these larger challenges. I am proud of how our organization has pivoted to devote all of our capabilities to the pandemic.
We believe in the importance of evidence and facts – these are core values for us – but we also approach our job with respect for diverse views about health and social policy and more than a little humility about the role we or any one organization can play in our giant health care system. We cannot change what’s broken in the American political system by ourselves, but we can and do try to be a constructive force in it. We are a voice for people, we want to hold both government and the health system accountable for its failures, but we never try to achieve any particular outcome, or take positions or advocate for policies or programs. We want to ensure that debate is informed by credible and timely information — whether it’s an analysis, a poll, a Kaiser Health News (KHN) story or investigation, or a COVID-19 information campaign on vaccines.
I had an opportunity to come to California and build the current day organization with this mission in my head, when the board of the Henry J. Kaiser Family Foundation made a decision around 1990 to start over after what were then contentious times at the organization. We established the new mission, recruited staff, developed programs, became an operating foundation, and then later, a public charity, choosing the legal status that fit us best and most honestly represented what we are. Nowadays we simply refer to ourselves as KFF. Special gratitude is owed to the first board who empowered me to conduct such a crazy experiment, especially the late Hale Champion, my first board chair and early co-conspirator, Congresswoman Barbara Jordan, and my friend Secretary Joseph Califano.
We have a Board of Trustees of up to 14 — including myself — with backgrounds in public service, academia, nonprofits, health care, and media. They serve two, five-year terms. Ours is a true governing board that exercises ultimate authority over everything at KFF and is very engaged, but it is not a board involved in program or operations, funding KFF, or fundraising, as is the case in some nonprofits. Our current Chair is the former senator from the great state of Maine, Olympia Snowe. As a student of these things, I can say that no nonprofit organization enjoys a healthier partnership between its staff and board, and no board operates more effectively or with better chemistry or more democratically. The relationship between the CEO and board at KFF, and the commitment everyone involved with KFF has to our mission, has been an essential ingredient to our success over many years and one of the things that has made this job so enjoyable.
We made a fundamental decision to remain a California-based organization. However, with our core audiences partly in D.C., we have maintained a substantial presence there, constructing a building in 2000 with our Barbara Jordan Conference Center and basing a large staff contingent there as well. We moved our headquarters from the Silicon Valley — where we had long owned a nine-building office complex full of venture capitalists — to San Francisco in 2018, feeling the city would offer a stronger future for our organization. We are thrilled with our new location even as we have not been in it much during the pandemic. We have a strong brand well established in health policy and we have not changed the legal name of our non-profit trust — the Henry J. Kaiser Family Foundation, although it can cause occasional confusion out in the country because we are neither a foundation, a family foundation, nor are we associated with Kaiser Permanente. We have, however, legally changed our business operating name to KFF, which we hope will modestly dispel confusion.
Our expert staff is our principal organizational asset. They conduct the analyses you see us produce, our KFF polls and surveys, and produce the great journalism distributed by KHN and run our media campaigns on HIV and COVID-19. Each part of KFF makes a slightly different contribution to our overall role as an information organization and we are strongest when we can deploy all of our assets together as we have done on health equity, the ACA, and COVID-19, as examples. We try to balance policy debate with facts and new information through our policy analysis, working in real time, or as close to it as we can. We try to give people a voice with our gold-standard polling, maintaining the highest methodological standards in a changing polling industry. We try to decode and dissect health policy and hold government and the health system accountable through in-depth reporting from KHN.
There are some other dimensions of our work we are proud of, all of which are also about producing information. For over 20 years we have operated Emmy and Peabody Award-winning, very targeted information campaigns aimed at the groups most at risk of HIV. You can check out the Greater Than AIDS website to learn more. When COVID-19 hit we added a new campaign called Greater Than COVID, featuring THE CONVERSATION, which deploys trusted messengers to reach critical audiences and counteract disinformation.
Our fastest-growing program is Kaiser Health News, which I started in 2009. The idea was to establish a nonprofit national news service inside KFF dedicated to in-depth reporting on complex health policy issues, unencumbered by the incentives that sometimes affect commercial news organizations or destination websites. KHN would produce original, in-depth coverage of complex national health issues and bring it to the American people. To do that we built KHN on a distribution — not destination — website model. KHN is a core line item in our operating budget. It is also editorially independent with regard to story ideas and content, but otherwise operates like all of our other programs with its mission, budget, and personnel decisions made as they are for all programs, by me and ultimately our Board. KHN is now the largest health policy newsroom in the country, producing a wide range of journalism for print, radio, and TV, from explanatory stories to features and deep investigations. These we focus on systemic problems not busting bad actors in health care or government. We now operate several regional bureaus and are standing up a southern bureau to lead our reporting across the South and fill the need for health journalism there. Our ambitious goal, ultimately, is to have a presence in every southern state.
We are the little engine that could, all told producing about two thousand products a year. Almost every product, except our editorially independent KHN stories which are vetted through the KHN editorial process, is an organizational product that runs through our internal review gauntlet ending with me, and often includes contributions from experts from multiple teams.
Next up for us will likely be a new permanent program focusing on disinformation in health. The impact of mis and disinformation is now pervasive. It distorts policy debate, further polarizes the country, and as we saw with disinformation about COVID vaccines, can even kill. It is now not enough for us to be in the business of producing good information, we also have to actively counter disinformation in health and we are designing a program to do that.
As this new program demonstrates we are always changing and adapting at KFF. That is true as well as we now return to the office after two years of COVID-19 hibernation and adapt to our own new hybrid work model. As the saying goes, no plan survives contact with reality and we and others will adapt further as we see how hybrid work actually works. In a mission driven organization that needs to work together across programs to be maximally effective it is vital for folks to spend meaningful time working face to face in the office together. It is also more fun.
Several years ago, we lowered the rate at which we spend from our endowment to about 5.5% annually in order to maintain the real value of our spending power and assets over time. We spent at a much higher rate while we were building a new organization and now want to sustain what we have built. Our assets are about a billion dollars.
When we lowered our payout rate to a more typical level, we changed our financing model. Overall, we now support ourselves about 70% from our endowment (just shy of a billion dollars) and 30% from external funds, which mostly come from foundations and some individual donors, including recently a major gift from MacKenzie Scott to expand our work across KFF on health equity. We use external funds chiefly for the incremental costs of mission-critical projects we could not otherwise undertake. We greatly value our funders, without whom we could not do vital work, but maintain full, independent control of everything we do in our funding relationships.
That’s us in a nutshell. An information organization trying to play a special role on the national health care scene, with no delusions about how hard that is to do. We keep changing and evolving as an organization and would rather make mistakes than stand pat. Since we operate our own programs, if something isn’t working as planned, we can adapt and fix it. We change and adapt constantly to try to be more effective – changing our financing model to bring in external funds, changing our legal status twice, building a DC building, moving to San Francisco, starting our news service KHN with much more to come. We love the work, and along the way we have created a family of colleagues who truly enjoy working together and are devoted to our unique mission.