Experts Cite Kaiser Permanente as the Model for Healthcare Reform

by webadmin on February 19, 2013

We here at HCE have had the pleasure of interviewing members of the executive team at Kaiser Permanente before. It is an outstanding organization and very progressive in its goals and aims for healthcare. In an era when everyone is trying to be cutting edge, Kaiser defines cutting edge.

This is largely because of its focus on integrated care, namely prevention, writes Cynthia H. Craft in The Sacramento Bee, something that “has helped Kaiser evolve from an HMO with a reputation for cut-rate, cookie-cutter care to the healthcare industry giant it is today.” Kaiser is now “a national model for healthcare reform.”

A $23.3-billion, 35-hospital nonprofit integrated managed-care consortium with 5.5 million commercial customers in California, Kaiser Permanente dominates “40 percent of the state’s commercial and individual markets, more than any competitor,” Craft reports.

Kaiser is so influential that its top executive was instrumental in formulating the Affordable Care Act. Basically, any hospital seeking to be an ACO will employ “Kaiser’s model of emphasizing prevention, wellness, integrated care, and use of electronic medical records.”

Ron Groepper, senior vice president for Kaiser in the greater Sacramento region, defines integrated care as “smooth coordination among the various medical professionals so there’s little delay and perhaps less hassle.”

California legislators also promote Kaiser as the model for insurers wishing to market their wares through the state’s HIE.

One health policy analyst told Craft, “Broadly speaking, Kaiser is aligned with healthcare reform. In a lot of ways, the world of healthcare is seeing the need to become more like Kaiser.”

It’s amazing, especially considering Kaiser’s roots “as a prepaid group practice covering Kaiser Industries’ workers who were building aqueducts and dams in the Mojave Desert,” Craft recalls.

Lest you’re too overwhelmed with the admiration this organization garners, it’s important to remember that Kaiser has been afflicted by many problems over the years. They were dinged by the California Department of Managed Care in 2005 and 2006 for problems with mental-health provider access and payment denials “for in-area, out-of-network emergency services.” Then, Craft writes, state regulators found that Kaiser was behind on providing autism assessments to scores of patients in 2009, and “last year, regulators probed denials of payment for emergency ambulance services.” Corrective action was ordered in each case.

Still, despite imperfections and flaws, experts such as Wendell Potter, senior analyst and industry watchdog, believe the Kaiser model is the right one and “one of the best models of integration of care, the most effective ways to improve costs and safety.” They’ve broken “down the silos protecting and separating the self-interests of insurance companies, doctors and hospitals.”

-by Pete Fernbaugh

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