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

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In our last post, we began dissecting Reed Abelson’s in-depth look in The New York Times at the Kaiser Permanente integration model and its failure to lower the cost of healthcare, a fact that Kaiser’s critics focus on.

Perhaps it would do the industry well to remember the old saying, “Pioneers take the arrows.”

For any of the Kaiser integration model’s shortcomings, there is much to learn from it, including its near-flawless “use of electronic records and technology systems for tracking patient care,” Abelson writes.

Over the course of a decade, he explains, Kaiser invested $30 billion in “sophisticated electronic records and computer systems that…have led to better-coordinated patient care.  And because [its nonprofit insurance] plan is paid a fixed amount for medical care per member, there is a strong financial incentive to keep people healthy and out of the hospital, the same goal of the hundreds of accountable care organizations now being created.”

Kaiser clinicians across its system have full access to a patient’s medical history and records. Sometimes, all it takes to move a patient’s care forward is an email to another specialist within the system. This saves “a lot of starting over,” one internist said.

Abelson adds, “In the last five or so years, Kaiser has also been using the information to identify those doctors or clinics that excel in certain areas, as well as those in need of improvement. The organization has also used the records to change how it delivers care, identifying patients at risk for developing bed sores in the hospital and then sending electronic alerts every two hours to remind the nurses to turn the patients. The percentage of patients with serious pressure ulcers, or bed sores, dropped to well under 1 percent from 3.5 percent.”

Nevertheless, the organization is well aware of its critics and well aware of its failure to lower its cost of care and continues to examine ways in which it can improve.

Chairman and chief executive George C. Halvorson told Abelson that “he and other health systems must fundamentally rethink what they do or risk having cost controls imposed on them either by the government or by employers, who are absorbing the bulk of health insurance costs.”

Halvorson believes “the future of healthcare is going to be rationing or re-engineering.”

This belief has brought Kaiser to its latest innovation. In an effort to achieve that “holy grail” of lowering the cost of healthcare, Halvorson and Kaiser are toying with the idea that healthcare needs to get away from the traditional medical environments—the hospital, the doctor’s office—and into the patient’s environment.

Albeen writes, “Kaiser is experimenting with ways to provide care at home or over the Internet, without the need for a physical office visit at all.”

What is your opinion of Kaiser Permanente? Are you skeptical of the integrated model or do you seek to emulate it within your system? What are the pros and cons of the Kaiser model from your perspective?

-by Pete Fernbaugh

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