Skip navigation

Roadmap History

In collaboration with Kaiser Permanente, Health Leads convened a working group of 23 visionaries in 2015 — leaders dedicated to addressing social determinants of health in hospitals, neighborhood clinics and primary care practices across the country. These inaugural meetings resulted in both a shared vision for the future of healthcare delivery in the United States and a commitment to grow the influential, aligned network needed to advance change. 

“In partnership with communities, healthcare organizations should identify and address individuals’ essential needs as an integral part of quality healthcare.” – Roadmap vision statement

In the ensuing months, the working group developed The Essential Needs Roadmap, a framework to guide fellow health and community leaders in establishing or expanding effective social needs initiatives. Today, the Roadmap also serves as a gateway to curated best practices, implementation guidance and other resources focused on building our collective wisdom to better address essential human needs as a standard part of quality care.

The Essential Needs Roadmap is firmly rooted in shared learning, and we commit to improving and strengthening the framework and underlying content over time in partnership with you. Please share your insights and ideas about the Roadmap, or recommend other resources we might share with the field.

Roadmap Contributors

Development of The Essential Needs Roadmap would not have been possible without the sustained support of the Commonwealth Fund and the following individuals and organizations:

Steering Committee

Veronica Gunn
Vice President – Population Health Management and Payment Innovation, Children’s Hospital Wisconsin
Thea James
Vice President, Mission and Associate Chief Medical Officer, Boston Medical Center
Anna Roth
CEO, Contra Costa Regional Medical Center
Loel Solomon
Vice President of Community Benefit, Kaiser Permanente
Jeff Thompson
Executive Advisor, Gundersen Health System
Kimberlydawn Wisdom
Senior Vice President of Community Health & Equity and Chief Wellness & Diversity Officer, Henry Ford Health System


Inaugural Partners

Deborah Allen
Director of the Bureau of Child, Adolescent and Family Health, Boston Public Health Commission
Christopher Barron
Executive Director – Population Health, Fort HealthCare
Ken Bertka
Chief Medical Officer, Integrated Health Network of Wisconsin
Carrie Bridges Feliz
Director, Community Health Institute, Lifespan
Pablo Bravo
Director, Community Grants & Investments, Dignity Health
John Brill
Director, Aurora Health Care
Audrey Burghardt
Children’s Hospital Wisconsin
Jennifer Christian Herman
Executive Director, Healthworks & Product Innovation, Kaiser Permanente
Jann Dorman
Vice President Clinical Operations Performance, Kaiser Permanente
Caroline Fichtenberg
Managing Director, SIREN Network
Nathan Fleming
Senior Consultant – Population Health, Gundersen Health System
Nancy Gordon
Research Investigator, Kaiser Permanente
Wendy Gozansky
Vice President and Chief Quality Officer, Colorado, Kaiser Permanente
Diane Jones
Vice President – Healthy Communities, Catholic Health Initiatives
Julie Laurin
Director of Care Coordination, Integrated Health Network of Wisconsin
Stephanie Lenzner
Vice President of Clinical Integration, Integrated Health Network of Wisconsin
Kelly Logue
Senior Director of Care Affordability, Hospital Medicine & Critical Care, HealthPartners Medical Group
Elisa Mendel
National Vice President, Kaiser Permanente
Tricia McGinnis
Vice President, Programs, Center for Healthcare Strategies
Sarita Mohan
Regional Executive Director, Medi-Cal Strategy & Operations, Kaiser Permanente
Scott Orsey
Director – Operations & Strategy, Office of Community Child Health, Connecticut Children’s Medical Center
Ranu Pandey
Principal Consultant, Kaiser Permanente
Heather Paradis
Children’s Hospital Wisconsin
Magda Peck
Founder/Principal, MP3 Group
Dan Peddycord
Director of Public Health, Contra Costa Health Services
Peter Roberts
President for Population Health and Insurance Services, Children’s Health System of Texas
Lisa Schilling
Vice President, Healthcare Performance Improvement and Execution Strategy, Kaiser Permanente
Nirav Shah
SVP & COO – Clinical Operations, Southern CA, Kaiser Permanente
Matt Stiefel
Senior Director, Population Health, Kaiser Permanente
Sara Steines
Children’s Hospital Wisconsin
Tom Walton
Interim Director – Population Health, KentuckyOne Health
Jesi Wang
Vice President of Healthcare Transformation, MetaStar
Michelle Wong
Director, Kaiser Permanente


Participating Organizations

Aurora Health Care

Baystate Health

Boston Medical Center

Boston Public Health Commission

Catholic Health Initiatives

Center for Health Care Strategies

Children’s Health

Children’s Hospital of Wisconsin

Connecticut Children’s Medical Center

Contra Costa Health Services

Dayton Children’s Hospital

Dignity Health

Fort Health Care

Gunderson Health System

Health Partners

Henry Ford Health System

Integrated Health Network of Wisconsin

Kaiser Permanente

Kentucky One Health



Mount Sinai St. Luke’s

Rainbow Babies & Children’s Hospital