By Patricia Lynch
The US may have its problems, but certain health plans stand out as models of excellence. Patricia Lynch, Vice President, State Government Relations, presents some of the reasons for Kaiser Permanente's success. —Report from a presentation at the 2008 conference of the MUHC-ISAI
What is Kaiser Permanente?
Kaiser Permanente is an integrated health care delivery system financed by enrollees’ prepaid dues. It operates in nine states and the District of Columbia. Kaiser Permanente serves approximately 8.7 million enrollees and operates 32 licensed hospitals. In 2007, Kaiser Permanente had $38 billion in operating revenue. Kaiser Foundation Hospitals and Kaiser Foundation Health Plan are separate, non-profit entities. In each state where Kaiser Permanente operates, Kaiser Foundation Health Plan exclusively contracts with a Permanente Medical Group to provide medical services to Kaiser Permanente enrollees. Approximately 14,000 physicians are members of Permanente Medical Groups nationally. Kaiser Permanente hospitals primarily serve Kaiser Permanente enrollees, but they are open to all members of the community through their emergency rooms regardless of a person’s ability to pay.
The benefits package to employer purchasers is very comprehensive, including all medically necessary in-patient and ambulatory care, mental health, in some regions dentistry, occupational therapy, speech therapy. Kaiser Permanente also sells insurance directly to individuals and is actively involved in government-sponsored programs such as Medicare, Medicaid and the Child Health Insurance program.
Through contracts with physicians and hospitals, Kaiser Permanente has aligned incentives to integrate in-patient and out-patient care, minimize unnecessary visits and provide care in the most appropriate setting. Specialists and generalists work together, so it is not unusual for a patient whose GP finds something that needs further investigation to walk down the hall and see a specialist in the same visit.
Prevention, diagnosis and care are integrated because people need to understand that they themselves can do much to preserve and maintain their health. Kaiser Permanente has made a significant investment in prevention of chronic disease, tobacco cessation, obesity treatment, optimal care for kids with asthma and patients with diabetes.
A $3 billion investment in health information technology systems provides both clinical support for physicians and support for the individual patient.
About 10 years ago, Kaiser Permanente committed to a 10-year program to implement national guidelines for hyperlipidemia, chronic heart failure, acute coronary syndromes and cardiac rehabilitation across its national program. In those 10 years, there has been a 15% decrease in the death rate from chronic heart failure amongst members. Across the 32 hospitals, there has been a decrease in hospital mortality rates of between 50 and 85% after age and sex adjustment. In Northern California, Kaiser Permanente members are 30% less likely to die from heart disease than non Kaiser Permanente members.