Kaiser Permanente Integration Model Has Pros, Cons (Part 1 of 2)

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We’ve written before about the leadership Kaiser Permanente has shown in pioneering an integrated model of healthcare, one that has become even more relevant under reform.

As admired as Kaiser’s innovations are, however, Reed Abelson of The New York Times provides an in-depth look at some of the complexities behind the Kaiser model, including the most glaring complexity of all—its failure to significantly lower costs.

Although Kaiser is concentrated in California, its influence is felt nationwide through its 37-hospital system and its nearly 9.1 million members. Thanks to healthcare reform, Kaiser’s integrated model of care has become popular as systems seek to fall into line with PPACA’s demands.

Abelson notes, “Hospitals across the country are buying physician practices or partnering with doctors and health insurers to form accountable care organizations, or ACOs, as a way of controlling more aspects of patient care. Doctors are also creating so-called medical homes, where patient care is better coordinated.”

In many ways, Kaiser pioneered the trends and discussions that occupy the headlines of healthcare news in 2013. Philip Fasano, Kaiser’s chief information officer, explains, “We have all the pieces. Anything a patient needs you get in the four walls of our offices.”

For all of its contributions, Kaiser’s failure to lower its cost of care is the open wound on which critics focus. One of these critics candidly observed, “They have not translated some of their strengths into better prices.”

This failure has led other critics to have major doubts about the nationwide efficacy of the Kaiser model. Abelson explains that many experts wonder if “an all-encompassing system like Kaiser’s can really be replicated and whether the limits it places on where patients can seek care will be accepted by enough people to make a difference. Or whether, as the nation’s flirtation with health maintenance organizations, or HMOs, in the 1990s showed — people will balk at the concept of not being able to go to any doctor or hospital of their choice.”

Furthermore, managing a patient’s care across its system becomes problematic “outside of California,” Abelson adds, “where Kaiser operations are less concentrated.” One Virginia member had to drive an hour and a half for her post-surgical IV antibiotics, and Kaiser has come under fire from a California state agency over its wait times for mental-health services.

Still, for any of its flaws, the system has plenty to offer the country. We’ll take a look at this aspect of Abelson’s article in our next post.

-by Pete Fernbaugh

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