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Kaiser Permanente
Type Nonprofit
Founded 1945
Founder Henry J. Kaiser
Sidney R. Garfield
Headquarters Oakland, California, USA
Key people George C. A non-profit organization ( abbreviated "NPO" also "not-for-profit" is a legally constituted Organization whose objective is to support or engage Year 1945 ( MCMXLV) was a Common year starting on Monday (link will display the full calendar An entrepreneur is a person who has possession over a company enterprise, or Venture, and assumes significant accountability for the inherent risks and the outcome Henry John Kaiser ( May 9, 1882 — August 24, 1967) was an American Industrialist who became known as the father of modern American Sidney R Garfield (1906-1984 An American doctor who founded the Kaiser Permanente healthcare system thus a pioneer of Health maintenance organizations. Oakland (ˈoʊklənd founded in 1852 is the eighth-largest city in the U The United States of America —commonly referred to as the Halvorson,
Health Plan CEO
John H. Cochran, MD,
Federation Executive Director
see section below
Industry Healthcare
Revenue ▲ $34. For other uses of this term see Industry (disambiguation An industry (from Latin industrius, "diligent industrious" Health care is the prevention treatment and management of illness and the preservation of mental health through the services offered by the medical, Nursing In business revenue or revenues is Income that a company receives from its normal business activities usually from the sale of goods and services 4 billion USD (2006)[1]
Net income ▲ $1. The United States dollar ( sign: $; code: USD) is the unit of Currency of the United States; it has also been Net income is equal to the Income that a firm has after subtracting costs and Expenses from the total Revenue. 3 billion USD (2006)[2]
Employees 169,729 total
156,000 employees (2007)[3]
13,729 physicians (2006)[4]
Website kp.com

Kaiser Permanente is an integrated managed care organization, based in Oakland, California, founded in 1945 by industrialist Henry J. Kaiser and physician Sidney R. Garfield. The United States dollar ( sign: $; code: USD) is the unit of Currency of the United States; it has also been Employment is a Contract between two parties, one being the employer and the other being the employee. A website (alternatively web site or Web site, a back-construction from the Proper noun World Wide Web) is a collection of Web pages The term " managed care " is used to describe a variety of techniques intended to reduce the cost of providing health benefits and improve the quality of care ("managed care Oakland (ˈoʊklənd founded in 1852 is the eighth-largest city in the U Henry John Kaiser ( May 9, 1882 — August 24, 1967) was an American Industrialist who became known as the father of modern American Sidney R Garfield (1906-1984 An American doctor who founded the Kaiser Permanente healthcare system thus a pioneer of Health maintenance organizations. Kaiser Permanente is a consortium of three distinct groups of entities: the Kaiser Foundation Health Plan, Inc. and its regional operating organizations, Kaiser Foundation Hospitals, and the Permanente Medical Groups. As of 2006, Kaiser Permanente operates in nine states and Washington, D.C., and is the largest managed care organization in the United States. Washington DC ( formally the District of Columbia and commonly referred to as Washington, the District, or simply D The term " managed care " is used to describe a variety of techniques intended to reduce the cost of providing health benefits and improve the quality of care ("managed care The United States of America —commonly referred to as the Kaiser Permanente has 8. 7 million health plan members[5], 156,000 employees[6], 13,729 physicians[7], 37 medical centers, 400 medical offices, and $34. The term health insurance is generally used to describe a form of Insurance that pays for medical expenses 4 billion in annual operating revenues and $1. 3 billion in net income[8]. The Health Plan and Hospitals operate under state and federal not-for-profit tax status, while the Medical Groups operate as for-profit partnerships or professional corporations in their respective regions.

Contents

Structure and governance

Kaiser Permanente's headquarters (the Ordway Building in downtown Oakland)
Kaiser Permanente's headquarters (the Ordway Building in downtown Oakland)
One of Kaiser's many other office buildings in Oakland
One of Kaiser's many other office buildings in Oakland

Kaiser Permanente provides care throughout eight regions in the United States. Each of these regions comprise two or three (and, in one case, four) separate but interdependent legal entities. This structure has endured since Kaiser Permanente physicians and leaders agreed to this framework, known as the Tahoe Agreement, in 1955.

National structure

The two types of organizations which make up each regional entity are:

In addition, Kaiser Foundation Hospitals operates medical centers in California, Oregon, and Hawaii, and outpatient facilities throughout the Kaiser Permanente regions. A patient is any person who receives medical attention care or treatment. The hospital foundations are not-for-profit and primarily rely on the Kaiser Foundation Health Plans for funding. They also provide infrastructure and facilities that benefit for-profit medical groups.

Regional entities

Kaiser Permanente is administered through eight regions, including one parent and five subordinate health plan entities, one hospital entity, and nine separate, affiliated medical groups:

In addition to the regional entities, in 1996, the then-twelve Permanente Medical Groups created The Permanente Federation, a separate entity, which focuses on standardizing patient care and performance under one name and system of policies. Around the same time, the The Permanente Company was also chartered as a vehicle to provide investment opportunities for the for-profit Permanente Medical Groups. [9] One of the most successful ventures of the Permanente Company is Kaiser Permanente Ventures, a venture capital firm that invests in emerging medical technologies. [10]

Governance

Each entity of Kaiser Permanente has its own management and governance structure, although the structures are interdependent and cooperative to a certain degree.

Kaiser Foundation Health Plan and Hospitals

Kaiser Foundation Health Plan and Hospitals has a single Board of Directors which is the ultimate governing body. George C. Halvorson is the chairman of the Board and the chief executive officer of Kaiser Foundation Health Plan and Hospitals. In this capacity, Mr. Halvorson is sometimes referred to as the chairman and CEO of Kaiser Permanente, although he is not a director for any of the Permanente Medical Group boards or an officer of any of those organizations. Halvorson leads a national leadership team that manages health plan and hospital operations across all the Kaiser Permanente regions. Each region is headed by a regional president, who all report to a member of the national leadership team. The Kaiser Foundation Health Plan and Hospital Board of Directors consists of fourteen members including Mr. Halvorson. The other thirteen members of the Kaiser Foundation Health Plan and Hospital board are Christine K. Cassel, MD, Thomas W. Chapman, EdD, Daniel P. Garcia, William R. Graber, J. Eugene Grigsby III, PhD, Judith A. Johansen, Kim J. Kaiser, Philip A. Marineau, Jenny J. Ming, Edward Pei, J. Neal Purcell, Cynthia A. Telles, PhD, and Sandra P. Thompkins. [11]

Permanente Medical Groups

The Permanente Medical Groups all have varying organizational structures, but all are led by a physician executive (called the executive director or executive medical director) who reports to a board of directors made up of the physician-owners of the medical group. The executive director or executive medical director in each region partners with the health plan and hospitals regional president to provide direction to operations in that region. On a national level there is a subordinate entity representing the regional Permanente Medical Groups called the Permanente Federation. Its executive director is John H. Cochran, MD. The Federation is accountable to an Executive Committee, and is made up of four of the nine regional Permanente Medical Group chiefs, along with the executive director of the Permanente Federation. The current Executive Committee is made up of Permanente Federation executive director John H. Cochran, MD, TPMG executive director and CEO Robert Pearl, MD, SCPMG medical director and chairman Jeffrey A. Weisz, MD, TSPMG medical director and chairman Bruce Perry, MD, and OPMG president and medical director Ronald Copeland, MD. Dr. Copeland also serves as chairman of the Permanente Federation Executive Committee.

History

Early years

Though it has since become the largest organization of its kind, Kaiser was not the first HMO. "HMO" redirects here For other uses see HMO (disambiguation. In its modern form, the HMO combines a large group practice, contracts with employers to care for a group of workers, and a prepayment plan for both hospitals and group practices. "HMO" redirects here For other uses see HMO (disambiguation. The first "contract doctor" system in the West was orchestrated by Dr. Raymond G. Taylor, who created a temporary healthcare system from 1908 to 1912 on behalf of the Los Angeles Board of Public Works to care for the 10,000 workers on the Los Angeles Aqueduct project. There are two Los Angeles Aqueducts, the First Los Angeles Aqueduct (or the Owens Valley aqueduct) (completed 1913 and the Second Los Angeles Aqueduct The first group prepayment plans appeared in 1929 in response to the onset of the Great Depression. That year, Baylor University started a hospital prepayment plan, the first of several which would ultimately join together to become the Blue Cross insurance network. Baylor University is a private, Baptist -affiliated Research University located in Waco Texas. Blue Cross redirects here For other uses see Blue Cross (disambiguation The Blue Cross Blue Shield In Oklahoma, Dr. Michael Shadid recruited local farmers around Elk City, Oklahoma into a small consumer healthcare cooperative. Elk City is a city in Beckham County, Oklahoma, United States. And in Los Angeles, Dr. Donald Ross and Dr. H. Clifford Loos founded the Ross-Loos Clinic to care for City of Los Angeles public utilities workers. [12]

As for Kaiser Permanente, its history dates back to the year 1933 and a tiny hospital in a little town called Desert Center, California. Desert Center, in Riverside County California, is an unincorporated town (pop At that time, Kaiser and several other large construction contractors had formed an insurance consortium called Industrial Indemnity to meet their workers' compensation obligations. Workers' compensation (colloquially known as workers' comp in North America or compo in Australia) a form of Insurance that provides Garfield had just finished his residency at Los Angeles County-USC Medical Center at a time when jobs were scarce; fortunately, he was able to secure a contract with Industrial Indemnity to care for 5,000 construction workers building the Colorado River Aqueduct in the Mojave Desert. Los Angeles County-USC Medical Center (also known as County General) is an 800-bed Teaching hospital located in the Boyle Heights neighborhood of The Colorado River Aqueduct is a 242-mi (392 km water conveyance in southern California in the United States. For the indigenous American tribe see Mohave. The Mojave Desert (moʊˈhɑːvi or /məˈhɑːvi/ ( Hayikwiir Mat'aar in Mojave Soon enough, Garfield's new hospital was in a precarious financial state (with mounting debt and the staff of three going unpaid), due in part to Garfield's desire to treat all patients regardless of ability to pay, as well as his insistence on equipping the hospital adequately so that critically injured patients could be stabilized for the long journey to full-service hospitals in Los Angeles. [13]

However, Garfield's dedication and competence won over two Industrial Indemnity executives, Harold Hatch and Alonzo B. Ordway. It was Hatch who proposed to Garfield the specific solution that would lead to the creation of Kaiser Permanente: Industrial Indemnity would prepay 17. 5% of premiums, or $1. 50 per worker per month, to cover work-related injuries, while the workers would each contribute five cents per day to cover non-work-related injuries. Later, Garfield also credited Ordway with coming up with the general idea of prepayment for industrial healthcare. Garfield also later explained that he did not know much at the time about other similar health plans except for Ross-Loos. The term health insurance is generally used to describe a form of Insurance that pays for medical expenses [14]

Hatch's solution enabled Garfield to bring his budget back into the positive, and to experiment with providing a broader range of services to the workers besides pure emergency care. By the time work on the aqueduct concluded and the project was wrapped up, Garfield had paid off all his debts, was supervising ten physicians at three hospitals, and controlled a healthy financial reserve of $150,000. [15]

Garfield returned to Los Angeles for further study at County-USC with the intent of entering private practice. However, in March 1938, Consolidated Industries (a consortium led by the Kaiser Company) initiated work on a contract for the upper half of the Grand Coulee Dam in Washington state, and took over responsibility for the thousands of workers who had worked for a different construction consortium on the first half of the dam. Grand Coulee Dam is a Hydroelectric Gravity dam on the Columbia River in the U Edgar Kaiser, Henry's son, was in charge of the project. To smooth over relations with the workers (who had been badly treated by their earlier employer), Hatch and Ordway persuaded Edgar to meet with Garfield, and in turn Edgar persuaded Garfield to tour the Grand Coulee site. Garfield subsequently agreed to reproduce at Grand Coulee Dam what he had done on the Colorado River Aqueduct project. He immediately spent $100,000 on renovating the decrepit Mason City Hospital and hired seven physicians. [16]

Unlike the workers on Garfield's first project, many workers at Grand Coulee Dam had brought dependents with them. The unions soon forced the Kaiser Company to expand its plan to cover dependents, which resulted in a dramatic shift from industrial medicine into family practice and enabled Garfield to formulate some of the basic principles of Kaiser Permanente. It was also during this time that Henry Kaiser personally became acquainted with Garfield and forged a friendship which lasted until Kaiser's death. [17]

In 1939, the Kaiser Company began working on several huge shipbuilding contracts in Oakland, and by the end of 1941 would control four major shipyards on the West Coast. During 1940, the expansion of the American defense-industrial complex in preparation for entrance into World War II resulted in a massive increase in the number of employees at the Richmond shipyard. World War II, or the Second World War, (often abbreviated WWII) was a global military conflict which involved a majority of the world's nations, including In January of 1941, Henry Kaiser asked Garfield to set up an insurance plan for the Richmond workers (this was merely contract negotiation with insurance companies), and a year later Kaiser asked Garfield to duplicate at Richmond what he had done at Desert Center and Mason City. [18] Unlike the two other projects, the resulting entity lived on after the construction project that gave birth to it, and it is the direct ancestor of today's Kaiser Permanente. [19]

On March 1, 1942, Sidney R. Events 86 BC - Lucius Cornelius Sulla, at the head of a Roman Republic army enters in Athens, removing the Tyrant Year 1942 ( MCMXLII) was a Common year starting on Thursday (the link will display the full 1942 calendar of the Gregorian calendar. Garfield & Associates opened its offices in Oakland to provide care to 20,000 workers, followed by the opening of the Permanente Health Plan on June 1. Events 193 - Roman Emperor Didius Julianus is Assassinated 987 - Hugh Capet is elected [20] From the beginning, Kaiser Permanente strongly supported preventive medicine and attempted to educate its members about maintaining their own health. Generally speaking preventive medicine is the part of Medicine engaged with preventing Disease rather than curing it [21]

In July the Permanente Foundation was formed to operate Northern California hospitals that would be linked to the outpatient health plans, followed shortly thereafter by the creation of Northern Permanente Foundation for Oregon and Washington and Southern Permanente Foundation for Southern California. The term health insurance is generally used to describe a form of Insurance that pays for medical expenses The name Permanente came from Permanente Creek, which ran by Henry Kaiser's first cement plant; Kaiser's first wife, Bess Fosburgh, liked the name. The first Permanente Hospital opened in Oakland on August 1. Events 30 BC - Octavian (later known as Augustus enters Alexandria, Egypt, bringing it under the control of the Roman Three weeks later, the Richmond Field Hospital opened, and the Northern Permanente Hospital opened two weeks later to serve workers at the Kaiser shipyard in Vancouver, Washington. Vancouver is a city on the north bank of the Columbia River in the U [22] In 1944 Kaiser decided to continue the program after the war and to open it up to the general public. [23]

Meanwhile, during the war years, the American Medical Association (AMA) (which opposed managed care organizations from their very beginning) tried to defuse demand for managed care by promoting the rapid expansion of the Blue Cross and Blue Shield preferred provider organization networks. The American Medical Association (AMA founded in 1847 and incorporated 1897 is the largest association of Physicians and Medical students in the United States Blue Cross redirects here For other uses see Blue Cross (disambiguation The Blue Cross Blue Shield In Health insurance, a preferred provider organization (or "PPO" sometimes referred to as a participating provider organization) is a Managed [24]

Courage to Heal, a novel by KP Historical Society President, Paul Bernstein, MD, is based on the story of Garfield's life, his struggles with the AMA, and the origins of Kaiser Permanente.

Postwar growth

The end of World War II brought about a huge plunge in Kaiser Permanente membership; for example, 50,000 workers had left the Northern California yards by July 1945. Membership bottomed out at 17,000 for the entire system but then surged back to 26,000 within six months as Garfield aggressively marketed his plan to the public. [25] Sidney Garfield & Associates had been a sole proprietorship, but in 1948, it was reorganized into a partnership, Permanente Medical Group. A sole proprietorship, or simply proprietorship ( Benjamen Clark [26]

During this period, a substantial amount of growth came from union members; the unions saw Kaiser Permanente care as more affordable and comprehensive than what was available at the time from private physicians under the fee-for-service system. For example, Fortune magazine had reported in 1944 that 90% of the U. S. population could not afford fee-for-service healthcare. Kaiser Permanente membership soared to 154,000 in 1950, 283,000 in 1952, 470,000 in 1954, 556,000 in 1956, and 618,000 in 1958. [27]

From 1944 onward, both Kaiser Permanente and Garfield fought off numerous attacks from the AMA and various state and local medical societies. Fortunately, Henry Kaiser came to the defense of both Garfield and the health plans he had created. The term health insurance is generally used to describe a form of Insurance that pays for medical expenses [28]

In 1951 the organization acquired its current name when Henry Kaiser unilaterally directed the trustees of the health plans, hospital foundations, and medical groups to add his name before Permanente. [29] However, the physicians in the Permanente Medical Group deeply resented the implication that they were directly controlled by Kaiser, and successfully forced him to back off with respect to their part of the organization. That same year, Kaiser Permanente also began experiments with large-scale multiphasic screening to identify unknown conditions and to facilitate treatment of known ones. [30] Simultaneously, although no one questioned his medical competence, Garfield's deficiencies as an executive were becoming apparent as the organization expanded far beyond his ability to manage it properly. [31]

Even worse, Henry Kaiser became fascinated with the healthcare system created for him by Garfield and began to directly micromanage Kaiser Permanente and Garfield. This resulted in a financial disaster when Kaiser splurged on the new Walnut Creek hospital; his constant intermeddling led to significant friction at every level of the organization. The situation was not helped by Kaiser's marriage to Garfield's head administrative nurse (who had helped care for Kaiser's first wife on her deathbed), convincing Garfield to marry the sister of that nurse, and then having Garfield move in next door to him. Clifford Keene (who would eventually serve as president of Kaiser Permanente) later recalled that this arrangement resulted in a rather dysfunctional and combative family in charge of Kaiser Permanente. [32]

Keene was an experienced Permanente physician whom Garfield had personally hired in 1946. During 1953 he had been trying to get a job at U.S. Steel, but on the morning of December 5, 1953, with internal tensions worsening day by day, Garfield met with Keene at the Mark Hopkins Hotel in San Francisco and asked him to turn around the organization. The United States Steel Corporation ( is an integrated Steel producer with major production operations in the United States, Canada, and Central Europe Events 63 BC - Cicero reads the last of his Catiline Orations. Year 1953 ( MCMLIII) was a Common year starting on Thursday (link will display full calendar of the Gregorian calendar. Mark Hopkins Hotel, is a 19 story luxury hotel located at Number One Nob Hill & 999 California Street San Francisco California, United States. It took Keene 15 years to realize that Kaiser had forced Garfield to ask Keene to become his replacement. Due to the chaos on the board, Keene at first took control with the vague title of Executive Associate, but it soon became clear to everyone that he was actually in charge and Garfield was to become a lobbyist and "ambassador" for the HMO concept. "HMO" redirects here For other uses see HMO (disambiguation. [33]

However, even with Garfield relieved of day-to-day management duties, the underlying problem of Henry Kaiser's authoritarian management style continued to persist. After several tense confrontations between Kaiser and Permanente Medical Group physicians, the doctors met with Kaiser's top adviser, Eugene Trefethen, at Kaiser's personal estate near Lake Tahoe on July 12, 1955. Events 1191 - Saladin 's garrison surrenders ending the two-year Siege of Acre. Year 1955 ( MCMLV) was a Common year starting on Saturday (link displays the 1955 Gregorian calendar) Trefethen came up with the idea of a contract between the medical groups and the health plans and hospital foundations which would set out roles, responsibilities, and financial distribution. The term health insurance is generally used to describe a form of Insurance that pays for medical expenses [34]

While Keene and Trefethen struggled to fix the damage from Kaiser's micromanagement and Garfield's ineffectual management, Henry Kaiser moved to Oahu in 1956 and then insisted on expanding Kaiser Permanente into Hawaii in 1958. Oahu (usually Oahu outside Hawaiian and Hawaiian English) known as ''"The Gathering Place", is the third largest of the The State of Hawaii ( or həˈwaɪʔiː Hawaiian: Mokuāina o Hawaii) is a state in the United States located on an Archipelago in the He promptly ruined what should have been a simple project, and only a last-minute intervention by Keene and Trefethen in August 1960 prevented the total disintegration of the Hawaii organization. [35] By that year, Kaiser membership had grown to 808,000. [36]

Managed care era

Having overseen Kaiser Permanente's successful transformation from Henry Kaiser's healthcare experiment into a large-scale self-sustaining enterprise, Keene retired in 1975. [37] By 1976, membership reached three million. In 1977, all six of Kaiser Permanente's regions had become federally qualified health maintenance organizations. "HMO" redirects here For other uses see HMO (disambiguation. Some believe then-President Richard Nixon specifically had Kaiser Permanente in mind when he signed the Health Maintenance Organization Act of 1973, as the organization was mentioned in an Oval Office discussion of the Act. The Health Maintenance Organization Act of 1973 (Public Law 93-222 also known as the HMO Act of 1973, 42 U | |-| |-| |- | |-| |-| |-| |-| |} The Oval Office is the official office of the President of the United States. [38] In 1980, Kaiser acquired a non-profit group practice to create its Mid-Atlantic region, encompassing the District of Columbia, Maryland, and Virginia. In 1985, Kaiser Permanente expanded to Georgia.

Regional evolution

By 1990, Kaiser Permanente provided coverage for about a third of the population of the cities of San Francisco and Oakland; total Northern California membership was over 2. 4 million. [39]

Elsewhere, Kaiser Permanente did not do as well, and its geographic footprint changed significantly in the 1990s. The organization spun off or closed outposts in Texas, North Carolina, and the Northeast. A spin-off (or spinoff) is a new Organization or Entity formed by a split from a larger one such as a Television series based on a pre-existing Texas ( is a state geographically located in the South Central United States and is also known as the Lone Star State. North Carolina ( is a state located on the Atlantic Seaboard in the southeastern United States The Northeast is a region of the United States. As defined by the U In 1998, Kaiser Permanente sold its Texas operations, where reported problems had become so severe that the organization directed its lawyers to attempt to block the release of a Texas Department of Insurance report. Texas ( is a state geographically located in the South Central United States and is also known as the Lone Star State. This prompted the state attorney general to threaten to revoke the organization's license. In North Carolina, the Industrial Union Department of the AFL-CIO issued a 1996 report critical of the quality of the care the organization provided. North Carolina ( is a state located on the Atlantic Seaboard in the southeastern United States American Federation of Labor and Congress of Industrial Organizations, commonly AFL-CIO, is a National trade union center, the largest federation of Kaiser Permanente closed health plans in Charlotte and Raleigh-Durham in North Carolina four years later. The term health insurance is generally used to describe a form of Insurance that pays for medical expenses The organization also sold its unprofitable Northeast division in 2000.

In 1995, Kaiser Permanente celebrated its fiftieth anniversary as a public health plan. The term health insurance is generally used to describe a form of Insurance that pays for medical expenses Two years later, national membership reached nine million. In 1997, the organization established an agreement with the AFL-CIO to explore a new approach to the relationship between management and labor, known as the Labor Management Partnership. A trade union or labour union is an organization of workers who have banded together to achieve common goals in key areas such as wages hours and working conditions forming

International reputation

Early in the 21st century the NHS and UK department of health became impressed with some aspects of the Kaiser operation, and initiated a series of studies involving several healthcare organisations in England. [40][41] Visits occurred and suggestions of adopting some KP policies are currently active. The management of hospital bed-occupancy by KP, by means of integrated management in and out of hospital and monitoring progress against care pathways has been admired, and given rise to trials of similar techniques in eight areas of the UK. In 2005 a controversial British Medical Journal editorial reported a study by California-based academics which compared Kaiser to the British National Health Service. The National Health Service ( NHS) is the publicly funded healthcare system in England. [42] The editorial in the BMJ suggested that KP managed comparable costs to the NHS, but this generated argument mainly that American costs were in fact higher than NHS, and it was generally accepted that the NHS was cheaper and more efficient whereas Kaiser may be more rapid.

Marketing

During the 1990s, the organization hired public relations firm Bain and Associates to position their brand in Washington, D. Public relations (PR is the practice of managing the flow of Information between an Organization and its Publics Public relations - often referred Raymone Bain is a spokeswoman from the public relations firm Davis Bain & Associates Inc C. The organization also hired Strategic Partnerships LLC to secure tax incentives and a special hearing for government grants.

In 1999, a number of groups successfully sued Kaiser Permanente in regard to its In the Hands of Doctors advertising campaign. The lawsuit revealed that doctors at the organization were not fully in control of decision-making and that there may have been persuasion to limit care with financial bonuses. In 2004, the organization retained Campbell-Ewald to develop a $40-million-dollar ad campaign called Thrive. The Interpublic Group of Companies Inc (IPG ( is one of the big four global advertising holding companies (the others being Omnicom, WPP and Publicis The campaign, which focuses on the theme of preventative care, was the first since Kaiser Permanente's In the Hands of Doctors campaign. Generally speaking preventive medicine is the part of Medicine engaged with preventing Disease rather than curing it Allison Janney is the company's advertising spokesperson. Allison Brooks Janney (born November 19, 1959) is an Emmy Award -winning American actress, best known for playing C

Quality of care

U.S. News and World Report, in its 2006 annual ranking of US commercial health plans, ranked Kaiser Foundation Health Plans as follows, out of 246 rated plans[43]:

A 2004 Consumer Reports survey of planholders ranked Kaiser Permanente overall as average or better. Consumer Reports is an American Magazine published monthly by Consumers Union. It showed below average ratings in the Colorado and Mid-Atlantic regions for two measures of quality of care: 'care from doctors', and the 'quality of their primary care physician'. The same survey ranked Kaiser Permanente's Northern California region as the best HMO overall among rated plans. "HMO" redirects here For other uses see HMO (disambiguation. [44]

In the 2006 California Healthcare Quality Report Card, Kaiser Permanente's Northern California and Southern California regions led the rankings, with each scoring six out of eight possible stars. [45] Kaiser's rankings in the 2007 report were lower; Kaiser scored 3 out of 4 possible stars, tied for first place with 3 other firms. [46]

KP's performance has been attributed to three practices: First, KP places a strong emphasis on preventative care, reducing costs later on. Second, its doctors are salaried rather than paid per service, which removes any incentive for doctors to perform unnecessary procedures. Thirdly, KP attempts to minimize the time patients spend in high-cost hospitals by carefully planning their stay and by providing cares in clinics. This practice results in cost savings for KP and greater doctor attention to patients. A comparison to the UK's National Health Service found that patients spend 2-5 times as much time in NHS hospitals as compared to KP hospitals[47]. The National Health Service ( NHS) is the publicly funded healthcare system in England.

Research

Kaiser doctors and others carry out research publishing in peer-reviewed journals and in the organization's own journal Permanente Journal. A variety of Medical journals exist for each specialty The list of journals can also be organized by specialty and further into "leading" journals and "other" journals

Kaiser operates a Division of Research which in 2006 declared around 200 active studies in progress. Kaiser's bias toward prevention is reflected in the areas of interest—vaccine and genetic studies are prominent.

Measles vaccine project participation

Between June 1990 and October 1991, Kaiser, along with the Los Angeles County Department of Health, Johns Hopkins University and the CDC carried out a clinical trial of the Edmonton strain of Measles vaccine. Los Angeles County is a county in California and is by far the most populous county in the United States. The Centers for Disease Control and Prevention (or CDC) is an agency of the United States Department of Health and Human Services based in unincorporated Measles (rubeola is a Disease caused by a virus specifically a Paramyxovirus of the genus Morbillivirus. The Los Angeles arm of the trial involved 1500 (900 receiving the study treatment) mostly black and Latino babies. Other arms ran in Haiti and several African countries. The aim was to induce immunity to Measles earlier, as cases in young children had been causing alarm. The trial was ended early when increased mortality appeared in other countries. Inadequate consent had been obtained, in that parents were not informed that the vaccine, licenced in other countries and registered with the FDA as a trial medication, was unlicensed in the U. S. This raised concerns over US government department ethics, and occasioned an apology by the CDC[48] who ascribed it to an administrative oversight.

Regulation

In California, the Department of Managed Health Care is the state regulatory agency which oversees managed care insurers and providers. In 2005, the Department of Managed Health Care ranked Kaiser Permanente near the top of the list of California managed care insurers,[49] and rated the health plan as superior on preventive care. The term health insurance is generally used to describe a form of Insurance that pays for medical expenses

Federal regulation of managed care

The organization is mentioned in an Oval Office discussion about the initiation[50] of the Health Maintenance Organization Act of 1973. | |-| |-| |- | |-| |-| |-| |-| |} The Oval Office is the official office of the President of the United States. The Health Maintenance Organization Act of 1973 (Public Law 93-222 also known as the HMO Act of 1973, 42 U By 1977, all six of Kaiser's regions had become federally qualified HMOs. "HMO" redirects here For other uses see HMO (disambiguation.

Concerns and violations

As the largest not-for-profit health plan in the United States, Kaiser Permanente is a target of both praise and criticism. In recent years, however, the organization has come under intensive scrutiny for a series of management, patient care, financial, and technology issues, primarily in its Northern and Southern California regions.

Mandatory arbitration

In order to contain costs, Kaiser requires agreement by planholders to submit patient malpractice claims to arbitration rather than litigating through the court system. In Law, malpractice is a type of negligence in which the Misfeasance, Malfeasance or Nonfeasance of a Professional, under a duty This has triggered some discussion and dissent. [51] Some cases proceed to court and one argument is over whether the requirement to go through dispute resolution is enforceable.

Kaiser established an Office of Independent Administrators (OIA) in 1999 to oversee the arbitration process. The degree to which this is independent has been questioned. [52]

Wilfredo Engalla is a notable case. In 1991, Engalla died of lung cancer nearly five months after submitting a written demand for arbitration. Lung cancer is a Disease of uncontrolled Cell growth in tissues of the Lung. The California Supreme Court found[53] that Kaiser had a financial incentive to wait until after Engalla died; his spouse could recover $500,000 from Kaiser if the case was arbitrated while he was alive, but only $250,000 after he died. The Supreme Court of California is the State supreme court in California. The Foundation for Taxpayer & Consumer Rights contends that Kaiser continues to oppose HMO arbitration reform[54]

Patients and consumer interest groups sporadically attempt to bring lawsuits against Kaiser Permanente. Recent lawsuits include Gary Rushford's attempt to use proof of a physician lie to overturn an Arbitration decision.

Homeless patient treatment

Kaiser has settled three cases for alleged patient dumping since 2002. The Emergency Medical Treatment and Active Labor Act ( EMTALA) is a United States Act of Congress passed in 1986 as part of the Consolidated Omnibus During that same period, the Office of the Inspector General settled 102 cases against US Hospitals which resulted in a monetary payment to the agency. Office of the Inspector General ( OIG) is a sub-agency that is part of Cabinet departments and independent agencies of the United States federal government [55][56][57]

On November 16, 2006, Los Angeles city officials filed civil and criminal legal action against Kaiser Permanente for "patient dumping"--the delivery of homeless hospitalized patients to other agencies or organizations in order to avoid expensive medical careas reported by National Public Radio's All Things Considered. All Things Considered (ATC is a news radio program in the United States broadcast on the National Public Radio network

The legal filings are intended to punish hospitals for releasing homeless hospital patients (often via taxis) on the sidewalk near relief shelters instead of accepting responsibility for releasing hospital patients into the care of a relative, or of a recognized agency.

The city's decision to charge Kaiser Permanente reportedly was influenced by security camera footage, allegedly showing a 63-year-old patient, dressed in hospital gown and slippers, wandering toward a mission on Skid Row, as outlined in a 20-page complaint. City officials say that as many as 10 other area hospitals are under investigation for possible future action for this practice. [58]

Kidney transplant program

In 2004 Northern California Kaiser Permanente initiated an in-house program for kidney transplantation. Prior to opening the transplant center, Northern California Kaiser patients would generally receive transplants at medical centers associated with the University of California (UC San Francisco and UC Davis). The University of California San Francisco ( UCSF) is one of the world's leading centers of Health sciences research Patient care, and education The University of California Davis, commonly known as UC Davis, or just UCD, is a public coeducational university located in the city of Davis, Upon opening the transplant center, Kaiser required that members who are transplant candidates in Northern California obtain services through their transplant center.

On May 3, 2006, the Los Angeles Times published an investigative report which accused the transplant program of mismanagement which resulted in delays for patients awaiting kidneys. Events 1491 - Kongo monarch Nkuwu Nzinga is baptised by Portuguese missionaries adopting the baptismal name of João Year 2006 ( MMVI) was a Common year starting on Sunday of the Gregorian calendar. The Los Angeles Times (also known as the LA Times) is a daily Newspaper published in Los Angeles California and distributed [59] According to the report, Northern California Kaiser performed 56 transplants in 2005 and twice that many patients died waiting for a kidney. At other California transplant centers, more than twice as many people received kidneys than died during the same period.

On May 13, 2006, after less than two years of operation, Northern California Kaiser announced that it would discontinue the kidney transplant program. Events 1497 - Pope Alexander VI excommunicates Girolamo Savonarola. Year 2006 ( MMVI) was a Common year starting on Sunday of the Gregorian calendar. As before, Northern California Kaiser now pays for pre-transplant care and transplants at outside hospitals, as do all other Kaiser Permanente regions. This change affected approximately 2,000 patients. [60][61]

Two patients have filed personal injury lawsuits against Kaiser and the widow of a patient who died has filed a wrongful death claim. According to the lawyer representing the three plaintiffs, more lawsuits are planned. [62]

See also

References

  1. ^ Colliver, Victoria. Kaiser earnings are up 30% San Francisco Chronicle. The San Francisco Chronicle was founded in 1865 as The Daily Dramatic Chronicle by teenage brothers Charles de Young and Michael H February 16, 2007.
  2. ^ Colliver, Victoria. Kaiser earnings are up 30% San Francisco Chronicle. The San Francisco Chronicle was founded in 1865 as The Daily Dramatic Chronicle by teenage brothers Charles de Young and Michael H February 16, 2007.
  3. ^ Kaiser Permanente – Group Health Study Shows Depression Worsens HIV Treatment Kaiser Permanente (see boilerplate for employee statistics). December 2007.
  4. ^ Kaiser Permanente National Statistics Kaiser Permanente. December 2006.
  5. ^ Kaiser Permanente National Statistics Kaiser Permanente. May 2007.
  6. ^ Kaiser Permanente – Group Health Study Shows Depression Worsens HIV Treatment Kaiser Permanente (see boilerplate for employee statistics). December 2007.
  7. ^ Kaiser Permanente National Statistics Kaiser Permanente. December 2006.
  8. ^ Colliver, Victoria. Kaiser earnings are up 30% San Francisco Chronicle. The San Francisco Chronicle was founded in 1865 as The Daily Dramatic Chronicle by teenage brothers Charles de Young and Michael H February 16, 2007.
  9. ^ Permanente Journal story on the formation of The Permanente Federation
  10. ^ http://www.kpventures.com/ http://www.kpventures.com/ Kaiser Permanente Ventures
  11. ^ Board of Directors
  12. ^ Rickey Hendricks, A Model for National Health Care: The History of Kaiser Permanente (New Brunswick, NJ: Rutgers University Press, 1993), 13-17
  13. ^ Hendricks, 19-26
  14. ^ Hendricks, 26-27
  15. ^ Hendricks, 28
  16. ^ Hendricks, 28-35
  17. ^ Hendricks, 36-38
  18. ^ Hendricks, 40-47
  19. ^ Hendricks, 63
  20. ^ Hendricks, 49
  21. ^ Hendricks, 58
  22. ^ Hendricks, 49-50
  23. ^ Hendricks, 63
  24. ^ Hendricks, 79
  25. ^ Hendricks, 65
  26. ^ Hendricks, 185
  27. ^ Hendricks, 66-75
  28. ^ Hendricks, 96-101, 142-150
  29. ^ Hendricks, 111
  30. ^ Hendricks, 123-124
  31. ^ Hendricks, 133
  32. ^ Hendricks, 165-167
  33. ^ Hendricks, 174-180
  34. ^ Hendricks, 189-190
  35. ^ Hendricks, 199-203
  36. ^ Hendricks, 209
  37. ^ Hendricks, 205
  38. ^ Transcript of taped conversation between President Richard Nixon and John D. Ehrlichman
  39. ^ Hendricks, 209, 215
  40. ^ UK NHS reports and briefings on the mode of operation of Kaiser and its effectiveness
  41. ^ BBC article on UK evaluation of KP
  42. ^ Feachem RG, Sekhri NK, White KL (2002). "Getting more for their dollar: a comparison of the NHS with California's Kaiser Permanente". BMJ 324: 135-41. PMID 11799029.  
  43. ^ Best Health Plans 2006. Retrieved on 2007-09-11. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 9 - The Battle of the Teutoburg Forest ends 506 - The Bishops of Visigothic Gaul
  44. ^ Consumer Reports HMO ratings
  45. ^ Kaiser Permanente leads in California HMO report card
  46. ^ State of California - 2007 Health Care Quality Report Card
  47. ^ Economist.com Survey of Health-Care Finance, Jul 15th 2004
  48. ^ New Scientist article on vaccine project
  49. ^ California regulatory body report card for 2005 on HMOs operating in the state
  50. ^ : Transcript of taped conversation between President Richard Nixon and John D. Ehrlichman
  51. ^ Chris Rauber. "Kaiser fires back in arbitration suit." San Francisco Business Times. February 20, 1998.
  52. ^ The Foundation for Taxpayer & Consumer Rights. "'Independent' Administrator Of Kaiser Arbitration System Is Rep For Corporate Lobby" News Release. January 8, 2003.
  53. ^ Full opinion of the California Supreme Court in the case of Engalla v. Permanente Medical Group, Inc.
  54. ^ The Foundation for Taxpayer & Consumer Rights. "A Placebo Kaiser Arbitration Bill Killed In Senate Committee: Kaiser's 'Independent' Arbitration System Administrator Lobbies For Kaiser." News Release. April 26, 2000.
  55. ^ List of Office of Inspector General fines for patient dumping
  56. ^ Federal Patient Dumping act applied in these fines
  57. ^ ABC news coverages of patient dumping allegations
  58. ^ "Kaiser Faces Charges for Dumping Homeless Patient" November 16, 2006.National Public Radio, with contribution from Associated Press. Story includes video footage.
  59. ^ Los Angeles Times coverage of kidney transplant program
  60. ^ SF Gate account of closure of kidney transplant program (2006 May 13 viewed May 19)
  61. ^ MSNBC account of closure of kidney transplant program (2006 May 21 viewed May 29)
  62. ^ Statement regarding further litigation in kidney transplant program
  63. ^ Democracy Now! | An Hour with Michael Moore on "SiCKO," his Trip to Cuba with 9/11 Rescue Workers, the Removal of Private Healthcare Companies & Clinton's Ties to Insurance Companies: "They're into Her Pocket and She'

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