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Encyclopedia > Kaiser Permanente
Kaiser Permanente
Type Nonprofit
Founded 1945
Founder Henry J. Kaiser
Sidney R. Garfield
Headquarters Oakland, California
Key people George C. Halvorson,
Health Plan CEO
Francis J. Crosson,
Federation Executive Director
see section below
Industry Healthcare
Revenue $31.1 billion USD (2005)[1]
Employees 161,763 (2006)
Website kp.org

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. 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. Image File history File links Kaiser_Permanente. ... A nonprofit organization (sometimes abbreviated to not-for-profit, non-profit, or NPO) is an organization whose primary objective is to support some issue or matter of private interest or public concern for non-commercial purposes. ... Year 1945 (MCMXLV) was a common year starting on Monday (link will display the full calendar). ... For the sequel to the computer game Entrepreneur, which has no article of its own, see The Corporate Machine. ... Henry J. Kaiser perches above Hawaii Kai in April 1963, his suburban development in Honolulu. ... Sidney R. Garfield (1906-1984). ... This article needs additional references or sources for verification. ... Health care or healthcare is one of the worlds largest and fastest growing professions. ... For the tax agency in the United Kingdom of the same name, see HM Revenue and Customs. ... Image File history File links No higher resolution available. ... The United States dollar is the official currency of the United States. ... For the album by the Kaiser Chiefs see Employment (album) 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) is a collection of Web pages, images, videos and other digital assets that is hosted on one or several Web server(s), usually accessible via the Internet, cell phone or a LAN. A Web page is a document, typically written in HTML... Managed care is a concept in U.S. health care. ... This article needs additional references or sources for verification. ... Henry J. Kaiser perches above Hawaii Kai in April 1963, his suburban development in Honolulu. ... Sidney R. Garfield (1906-1984). ...


As of 2006, Kaiser Permanente operates in nine states and Washington, D.C., and is the largest not-for-profit managed care organization in the United States. Kaiser Permanente has 8.5 million health plan members, 148,884 employees, 12,879 physicians, 37 medical centers, 400 medical offices, and $31.1 billion in annual operating revenues. 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. Nickname: Motto: Justitia Omnibus (Justice for All) Location of Washington, D.C., in relation to the states Maryland and Virginia Coordinates: , Country United States Federal District District of Columbia Government  - Mayor Adrian M. Fenty (D)  - D.C. Council Chairperson: Vincent C. Gray (D) Ward 1: Jim Graham (D) Ward 2... A nonprofit organization (sometimes abbreviated to not-for-profit, non-profit, or NPO) is an organization whose primary objective is to support some issue or matter of private interest or public concern for non-commercial purposes. ... Managed care is a concept in U.S. health care. ...

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. Image File history File links Size of this preview: 800 × 600 pixelsFull resolution (1536 × 1152 pixel, file size: 480 KB, MIME type: image/jpeg) The Ordway Building, One Kaiser Plaza, Oakland, California. ... Image File history File links Size of this preview: 800 × 600 pixelsFull resolution (1536 × 1152 pixel, file size: 480 KB, MIME type: image/jpeg) The Ordway Building, One Kaiser Plaza, Oakland, California. ... Image File history File links Size of this preview: 732 × 599 pixelsFull resolution (904 × 740 pixel, file size: 159 KB, MIME type: image/jpeg) A office building with the Kaiser Permanente logo in downtown Oakland, California. ... Image File history File links Size of this preview: 732 × 599 pixelsFull resolution (904 × 740 pixel, file size: 159 KB, MIME type: image/jpeg) A office building with the Kaiser Permanente logo in downtown Oakland, California. ...


National structure

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

  • Kaiser Foundation Health Plans work with employers, employees, and individual members to offer prepaid health plans. The health plans are not-for-profit and provide infrastructure for and invest in Kaiser Foundation Hospitals and for-profit medical groups.
  • Permanente Medical Groups are physician-owned organizations, which provide and arrange for medical care for Kaiser Foundation Health Plan members in each respective region. The medical groups are for-profit partnerships or professional corporations and receive funding from Kaiser Foundation Health Plans. The first medical group, The Permanente Medical Group, formed in 1948 in Northern California.

In addition, Kaiser Foundation Hospitals operates medical centers in California, Oregon, and Hawaii, and outpatient facilities throughout the Kaiser Permanente regions. 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. A hospital today is an institution for professional health care provided in part by physicians and nurses. ...


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:

  • Northern California
    • Kaiser Foundation Health Plan, Inc. (KFHP)
    • Kaiser Foundation Hospitals (KFH)
    • The Permanente Medical Group, Inc. (TPMG)
  • Southern California
    • Kaiser Foundation Health Plan, Inc. (KFHP)
    • Kaiser Foundation Hospitals (KFH)
    • Southern California Permanente Medical Group (SCPMG)
  • Colorado
    • Kaiser Foundation Health Plan of Colorado (KFHPCO)
    • Colorado Permanente Medical Group, P.C. (CPMG)
  • Georgia
    • Kaiser Foundation Health Plan of Georgia, Inc. (KFHPGA)
    • The Southeast Permanente Medical Group, Inc. (TSPMG)
  • Hawaii
    • Kaiser Foundation Health Plan, Inc. (KFHP)
    • Kaiser Foundation Hospitals (KFH)
    • Hawaii Permanente Medical Group, Inc. (HPMG)
  • Mid-Atlantic (vicinity of Washington, D.C., including Maryland and Virginia)
    • Kaiser Foundation Health Plan of the Mid-Atlantic States Inc. (KFHPMA)
    • Mid-Atlantic Permanente Medical Group, P.C. (MAPMG)
  • Northwest (Northwest Oregon and Southwest Washington)
    • Kaiser Foundation Health Plan of the Northwest (KFHPNW)
    • Northwest Permanente, P.C. Physicians and Surgeons (NWP)
  • Ohio
    • Kaiser Foundation Health Plan of Ohio (KFHPOH)
    • Ohio Permanente Medical Group, Inc. (OPMG)

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.[2] One of the most successful ventures of the Permanente Company is Kaiser Permanente Ventures, a venture capital firm that invests in emerging medical technologies. [3] Northern California, sometimes referred to as NorCal, is the northern portion of the U.S. state of California. ... For the urban complex straddling the United States-Mexico border, see Bajalta California. ... Official language(s) English Capital Denver Largest city Denver Largest metro area Denver-Aurora Metro Area Area  Ranked 8th  - Total 104,185 sq mi (269,837 km²)  - Width 280 miles (451 km)  - Length 380 miles (612 km)  - % water 0. ... Official language(s) English, Hawaiian Capital Honolulu Largest city Honolulu Area  Ranked 43rd  - Total 10,931 sq mi (29,311 km²)  - Width n/a miles (n/a km)  - Length 1,522 miles (2,450 km)  - % water 41. ... It has been suggested that Middle Atlantic States be merged into this article or section. ... Nickname: Motto: Justitia Omnibus (Justice for All) Location of Washington, D.C., in relation to the states Maryland and Virginia Coordinates: , Country United States Federal District District of Columbia Government  - Mayor Adrian M. Fenty (D)  - D.C. Council Chairperson: Vincent C. Gray (D) Ward 1: Jim Graham (D) Ward 2... Official language(s) None (English, de facto) Capital Annapolis Largest city Baltimore Area  Ranked 42nd  - Total 12,407 sq mi (32,133 km²)  - Width 90 miles (145 km)  - Length 249 miles (400 km)  - % water 21  - Latitude 37° 53′ N to 39° 43′ N  - Longitude 75° 03′ W to 79° 29... Official language(s) English Capital Richmond Largest city Virginia Beach Area  Ranked 35th  - Total 42,774 sq mi (110,785 km²)  - Width 200 miles (320 km)  - Length 430 miles (690 km)  - % water 7. ... The Pacific Northwest from space This page is about the region that includes parts of Canada and the United States. ... Official language(s) (none)[1] Capital Salem Largest city Portland Area  Ranked 9th  - Total 98,466 sq mi (255,026 km²)  - Width 260 miles (420 km)  - Length 360 miles (580 km)  - % water 2. ... Official language(s) English Capital Olympia Largest city Seattle Area  Ranked 18th  - Total 71,342 sq mi (184,827 km²)  - Width 240 miles (385 km)  - Length 360 miles (580 km)  - % water 6. ... Official language(s) None Capital Columbus Largest city Columbus Largest metro area Cleveland Area  Ranked 34th  - Total 44,825 sq mi (116,096 km²)  - Width 220 miles (355 km)  - Length 220 miles (355 km)  - % water 8. ...


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.[4]


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 Francis Crosson, 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 Francis J. Crosson, 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. 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. 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. 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. In Oklahoma, Dr. Michael Shadid recruited local farmers around Elk City, Oklahoma into a small consumer healthcare cooperative. 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.[5] There are two Los Angeles Aqueducts--the original Los Angeles Aqueduct was designed by William Mulholland (an Irish immigrant who became a self-taught engineer and head of the Los Angeles Department of Water and Power) and completed in 1913 to deliver water from the Owens River to the city... The Great Depression was a dramatic, worldwide economic downturn beginning in some countries as early as 1928. ... Baylor University is a private, Baptist-affiliated research university located in Waco, Texas. ... For the UK animal charity, see The Blue Cross. ... Elk City is a city in Beckham County, Oklahoma, United States. ...


As for Kaiser Permanente, its history dates back to the year 1933 and a tiny hospital in a little town called Desert Center, California. At that time, Kaiser and several other large construction contractors had formed an insurance consortium called Industrial Indemnity to meet their workers' compensation obligations. 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. 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.[6] Desert Center is a small town (population 962) located in the Colorado Desert of Southern California, between the cities of Indio and Blythe at the junction of Interstate 10 and State Highway 177. ... Workers compensation (colloquially known as workers comp in North American English or compo in Australian English) is a form of insurance that provides medical care and compensation for employees who are injured in the course of employment in abrogating the employees right to sue their employer for the tort... Los Angeles County-USC Medical Center (also known as County USC) is an 800-bed teaching hospital located in East Los Angeles in the Boyle Heights neighborhood of Los Angeles, California. ... Colorado River Aqueduct 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. ...


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.[7]


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.[8]


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. 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.[9] For the town, see Coulee Dam, Washington. ...


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.[10]


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. 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.[11] 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.[12] Combatants Allied powers: China France Great Britain Soviet Union United States and others Axis powers: Germany Italy Japan and others Commanders Chiang Kai-shek Charles de Gaulle Winston Churchill Joseph Stalin Franklin Roosevelt Adolf Hitler Benito Mussolini Hideki Tōjō Casualties Military dead: 17,000,000 Civilian dead: 33,000...


On March 1, 1942, Sidney R. 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.[13] From the beginning, Kaiser Permanente strongly supported preventive medicine and attempted to educate its members about maintaining their own health.[14] is the 60th day of the year (61st in leap years) in the Gregorian calendar. ... Year 1942 (MCMXLII) was a common year starting on Thursday (the link will display the full 1942 calendar) of the Gregorian calendar. ... June 1 is the 152nd day of the year (153rd in leap years) in the Gregorian calendar. ... A 1930 Soviet poster propagating breast care. ...


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 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. 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.[15] In 1944 Kaiser decided to continue the program after the war and to open it up to the general public.[16] is the 213th day of the year (214th in leap years) in the Gregorian calendar. ... Nickname: Motto: A colorful past, a bright future Location in Washington Coordinates: , Country United States State Washington County Clark County Founded 1825 Incorporated 1857 Government  - Mayor Royce Pollard Area  - City  46. ...


Meanwhile, during the war years, the American Medical Association (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.[17] For the UK animal charity, see The Blue Cross. ... The Blue Shield concept was developed at the beginning of the twentieth century by employers in lumber and mining camps of the Pacific Northwest to provide medical care by paying monthly fees to medical service bureaus composed of groups of physicians. ... In health insurance, a preferred provider organization (or PPO) is a managed care organization of medical doctors, hospitals, and other health care providers who have covenanted with an insurer or a third-party administrator to provide health care at reduced rates to the insurers or administrators clients. ...


Courage to Heal, a novel by KP Historical Society President, Paul Bernstein, MD, is based on the dramatic 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.[18] Sidney Garfield & Associates had been a sole proprietorship, but in 1948, it was reorganized into a partnership, Permanente Medical Group.[19] A sole proprietorship, or simply proprietorship, is a type of business entity which legally has no separate existence from its owner. ...


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.[20]


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.[21]


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.[22] 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.[23] 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.[24]


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.[25]


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. 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.[26] The United States Steel Corporation (NYSE: X) is an integrated steel producer with major production operations in the United States and Central Europe. ... December 5 is the 339th day (340th in leap years) of the year in the Gregorian calendar. ... Year 1953 (MCMLIII) was a common year starting on Thursday (link will display full calendar) of the Gregorian calendar. ... An editor has expressed a concern that the subject of the article does not satisfy the notability guideline or one of the following guidelines for inclusion on Wikipedia: Biographies, Books, Companies, Fiction, Music, Neologisms, Numbers, Web content, or several proposals for new guidelines. ...


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. 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.[27] is the 193rd day of the year (194th in leap years) in the Gregorian calendar. ... Year 1955 (MCMLV) was a common year starting on Saturday (link displays the 1955 Gregorian calendar). ...


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. 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.[28] By that year, Kaiser membership had grown to 808,000.[29] OÊ»ahu (usually Oahu outside Hawaiian and Hawaiian English), the Gathering Place, is the third largest of the Hawaiian Islands and most populous island in the State of HawaiÊ»i. ... Official language(s) English, Hawaiian Capital Honolulu Largest city Honolulu Area  Ranked 43rd  - Total 10,931 sq mi (29,311 km²)  - Width n/a miles (n/a km)  - Length 1,522 miles (2,450 km)  - % water 41. ...


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.[30] By 1976, membership reached three million. In 1977, all six of Kaiser Permanente's regions had become federally qualified health maintenance organizations. 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.[31] 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. A health maintenance organization (HMO) is a prepaid health plan. ... Richard Milhous Nixon (January 9, 1913 – April 22, 1994) was the 37th President of the United States, serving from 1969 to 1974. ... The Health Maintenance Organization Act of 1973, also known as the HMO Act of 1973, is a law passed by the Congress of the United States that resulted from discussions Paul Ellwood had with what is today the Department of Health and Human Services. ... The Oval Office from above in 2003, during the administration of George W. Bush. ...


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.[32]


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. 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. 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[citation needed]. Kaiser Permanente closed health plans in Charlotte and Raleigh-Durham in North Carolina four years later. The organization also sold its unprofitable Northeast division in 2000. A spin-off (or spinoff) is a new organization or entity formed by a split from a larger one such as a new company formed from a university research group. ... Official language(s) No official language See languages of Texas Capital Austin Largest city Houston Largest metro area Dallas–Fort Worth Metroplex Area  Ranked 2nd  - Total 261,797 sq mi (678,051 km²)  - Width 773 miles (1,244 km)  - Length 790 miles (1,270 km)  - % water 2. ... Official language(s) English Capital Raleigh Largest city Charlotte Area  Ranked 28th  - Total 53,865 sq mi (139,509 km²)  - Width 150 miles (240 km)  - Length 560[1] miles (901 km)  - % water 9. ... Regional definitions vary from source to source. ... Official language(s) No official language See languages of Texas Capital Austin Largest city Houston Largest metro area Dallas–Fort Worth Metroplex Area  Ranked 2nd  - Total 261,797 sq mi (678,051 km²)  - Width 773 miles (1,244 km)  - Length 790 miles (1,270 km)  - % water 2. ... Official language(s) English Capital Raleigh Largest city Charlotte Area  Ranked 28th  - Total 53,865 sq mi (139,509 km²)  - Width 150 miles (240 km)  - Length 560[1] miles (901 km)  - % water 9. ... American Federation of Labor and Congress of Industrial Organizations, commonly AFL-CIO, is a national trade union center, the largest federation of unions in the United States, made up of 54 national and international unions (including Canadian), together representing more than 10 million workers. ...


In 1995, Kaiser Permanente celebrated its fiftieth anniversary as a public health plan. 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.


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.[33][34] 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.[35] 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. The National Health Service (NHS) is the publicly-funded healthcare system of the United Kingdom. ... The British Medical Journal (BMJ) is a medical journal published weekly in the United Kingdom by the British Medical Association (BMA). ...

Marketing

During the 1990s, the organization hired public relations firm Bain and Associates to position their brand in Washington, D.C. The organization also hired Strategic Partnerships LLC to secure[citation needed] tax incentives and a special hearing for government grants. Public relations (PR): Building sustainable relations with all publics in order to create a postive brand image. ... Raymone Bain is a spokesperson from the public relations firm Davis, Bain & Associates Inc. ...


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 campaign, which focuses on the theme of preventative care, was the first since Kaiser Permanente's In the Hands of Doctors campaign. Allison Janney is the company's advertising spokesperson. The Interpublic Group of Companies, Inc. ... A 1930 Soviet poster propagating breast care. ... Allison Brooks Janney (born November 19, 1959) is an Emmy-winning American actress, perhaps best known for her portrayal of C. J. Cregg on the American television series The West Wing and of Prudy on the 2007 film adaption of the musical Hairspray . ...


Quality of care

U.S. News and World Report, in its 2005 annual ranking of US commercial health plans, listed Kaiser Permanente Hawaii as 45th (out of 257 health plans), Kaiser Permanente Colorado as 55th, Kaiser Permanente Northern California as 58th, Kaiser Permanente Mid-Atlantic as 73rd, Kaiser Permanente Georgia as 81st, and Kaiser Permanente Southern California as 88th.[36] U.S. News & World Report is a weekly newsmagazine. ... Motto: (Out Of Many, One) (traditional) In God We Trust (1956 to date) Anthem: The Star-Spangled Banner Capital Washington D.C. Largest city New York City None at federal level (English de facto) Government Federal constitutional republic  - President George Walker Bush (R)  - Vice President Dick Cheney (R) Independence from...


A 2004 Consumer Reports survey of planholders ranked Kaiser Permanente overall as average or better. 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.[37] Consumer Reports, an American magazine published monthly by Consumers Union, publishes reviews and comparisons of consumer products and services based on reporting and results from its in-house testing laboratory. ...


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.[38]


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[39]. The National Health Service (NHS) is the publicly-funded healthcare system of the United Kingdom. ...


Interoperability

From a clinical perspective, KP wants medical devices that function well in a hospital setting. Physician efficiency could be greatly improved if hospital technology were easier to use. One change that KP desires is a single sign-on system that would prevent doctors from having to waste time logging on to multiple machines separately. KP is also seeking systems with better patient-ID binding and with greater data recoverability in the event of a system failure. // European Definition COUNCIL DIRECTIVE 93/42/EEC of 14 June 1993 concerning medical devices defines a ‘medical device’ as: any instrument, apparatus, appliance, material or other article, whether used alone or in combination, including the software necessary for its proper application intended by the manufacturer to be used for human...


From a technical perspective, KP wants products that are easy to install and easy to connect to the rest of its system. KP also wants products that can be monitored and maintained remotely. Hiring a large number of technical experts is very expensive, so KP would like to employ a central team that could efficiently serve all its hospitals.


KP has great leverage in the industry for biomedical devices because it buys in such bulk. As of yet, however, it has chosen to set its own standards for interoperability and does not endorse any general standards. KP simply requires that its vendors prove that their products will work with KP’s in-house system. The company feels that general standards for interoperability are still immature. Interoperability is connecting people, data and diverse systems. ... A vendor is one who sells something. ...

Operational Cost Planning

Maintaining so many facilities and employing so many people, KP constantly seeks to keep its cost low; and over the past years, it has struggled to contend with rising infrastructure costs related to rising steel and cement prices. KP actively promotes wellness initiatives designed to prevent its customers from needing to go to the hospital. KP also has a strong interest in interoperability, and its size gives it great bargaining power. Interoperability is connecting people, data and diverse systems. ...

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. ...


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. 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[40] who ascribed it to an administrative oversight. Los Angeles County is a county in California and is the most populous county in the United States. ... The Johns Hopkins University, founded in 1876, is a private institution of higher learning located in Baltimore, Maryland, United States. ... The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is recognized as the leading United States agency for protecting the public health and safety of people. ...


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,[41] and rated the health plan as superior on preventive care.


Federal regulation of managed care

The organization is mentioned in an Oval Office discussion about the initiation[42] of the Health Maintenance Organization Act of 1973. By 1977, all six of Kaiser's regions had become federally qualified HMOs. The Oval Office from above in 2003, during the administration of George W. Bush. ... The Health Maintenance Organization Act of 1973, also known as the HMO Act of 1973, is a law passed by the Congress of the United States that resulted from discussions Paul Ellwood had with what is today the Department of Health and Human Services. ...


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. This has triggered some discussion and dissent.[43] Some cases proceed to court and one argument is over whether the requirement to go through dispute resolution is enforceable[citation needed]. For other uses, see Malpractice (disambiguation). ...


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.[44]


Wilfredo Engalla is a notable case. In 1991, Engalla died of lung cancer nearly five months after submitting a written demand for arbitration. The California Supreme Court found[45] 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 Foundation for Taxpayer & Consumer Rights contends that Kaiser continues to oppose HMO arbitration reform[46] Lung cancer is the malignant transformation and expansion of lung tissue, and is the most lethal of all cancers worldwide, responsible for 1. ... The Supreme Court of California is the state supreme court in California. ...


Patients and consumer interest groups sporadically attempt to bring lawsuits against Kaiser. 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. 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.[47][48][49] In the United States, an Inspector General is a type of investigator charged with examining the actions of a government agency or military organization as a general auditor of their operations to ensure they are operating in compliance with general established policies of the government, to audit the effectiveness of...


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 care, as reported by National Public Radio's All Things Considered. “NPR” redirects here. ... 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.[50]


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). Upon opening the transplant center, Kaiser required that members who are transplant candidates in Northern California obtain services through their transplant center. An organ transplant is the transplantation of an organ (or part of one) from one body to another, for the purpose of replacing the recipients damaged or failing organ with a working one from the donor. ... The University of California, San Francisco (UCSF) is a public university located in San Francisco, California. ... The University of California, Davis, commonly abbreviated to UC Davis or UCD is one of the ten University of California campuses. ...


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.[51] 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. is the 123rd day of the year (124th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday (link displays full 2006 calendar) of the Gregorian calendar. ... This just IN !!!:paris hiltons new dog. ...


On May 13, 2006 and after less than two years of operation, Northern California Kaiser announced that it would discontinue the kidney transplant program. 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.[52][53] is the 133rd day of the year (134th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday (link displays full 2006 calendar) of the Gregorian calendar. ...


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.[54]


References

  1. ^ http://www.bizjournals.com/portland/stories/2006/02/13/daily42.html?from_rss=1 Portland Business Journal story on KP revenue
  2. ^ http://xnet.kp.org/permanentejournal/fall97pj/history.html Permanente Journal story on the formation of The Permanente Federation
  3. ^ http://www.kpventures.com/ http://www.kpventures.com/ Kaiser Permanente Ventures
  4. ^ Board of Directors
  5. ^ Rickey Hendricks, A Model for National Health Care: The History of Kaiser Permanente (New Brunswick, NJ: Rutgers University Press, 1993), 13-17
  6. ^ Hendricks, 19-26
  7. ^ Hendricks, 26-27
  8. ^ Hendricks, 28
  9. ^ Hendricks, 28-35
  10. ^ Hendricks, 36-38
  11. ^ Hendricks, 40-47
  12. ^ Hendricks, 63
  13. ^ Hendricks, 49
  14. ^ Hendricks, 58
  15. ^ Hendricks, 49-50
  16. ^ Hendricks, 63
  17. ^ Hendricks, 79
  18. ^ Hendricks, 65
  19. ^ Hendricks, 185
  20. ^ Hendricks, 66-75
  21. ^ Hendricks, 96-101, 142-150
  22. ^ Hendricks, 111
  23. ^ Hendricks, 123-124
  24. ^ Hendricks, 133
  25. ^ Hendricks, 165-167
  26. ^ Hendricks, 174-180
  27. ^ Hendricks, 189-190
  28. ^ Hendricks, 199-203
  29. ^ Hendricks, 209
  30. ^ Hendricks, 205
  31. ^ Transcript of taped conversation between President Richard Nixon and John D. Ehrlichman
  32. ^ Hendricks, 209, 215
  33. ^ UK NHS reports and briefings on the mode of operation of Kaiser and its effectiveness
  34. ^ BBC article on UK evaluation of KP
  35. ^ 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. 
  36. ^ US News Health Insurance rankings
  37. ^ Consumer Reports HMO ratings
  38. ^ Kaiser Permanente leads in California HMO report card
  39. ^ Economist.com Survey of Health-Care Finance, Jul 15th 2004
  40. ^ New Scientist article on vaccine project
  41. ^ Califonia regulatory body report card for 2005 on HMOs operating in the state
  42. ^ : Transcript of taped conversation between President Richard Nixon and John D. Ehrlichman
  43. ^ Chris Rauber. "Kaiser fires back in arbitration suit." San Francisco Business Times. February 20, 1998.
  44. ^ The Foundation for Taxpayer & Consumer Rights. "'Independent' Administrator Of Kaiser Arbitration System Is Rep For Corporate Lobby" News Release. January 8, 2003.
  45. ^ Full opinion of the California Supreme Court in the case of Engalla v. Permanente Medical Group, Inc.
  46. ^ 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.
  47. ^ List of Office of Inspector General fines for patient dumping
  48. ^ Federal Patient Dumping act applied in these fines
  49. ^ ABC news coverages of patient dumping allegations
  50. ^ "Kaiser Faces Charges for Dumping Homeless Patient" November 16, 2006.National Public Radio, with contribution from Associated Press. Story includes video footage.
  51. ^ Los Angeles Times coverage of kidney transplant program
  52. ^ SF Gate account of closure of kidney transplant program (2006 May 13 viewed May 19)
  53. ^ MSNBC account of closure of kidney transplant program (2006 May 21 viewed May 29)
  54. ^ Statement regarding further litigation in kidney transplant program

External links

  • Kaiser Permanente
  • Department of Managed Health Care reports
  • Nightly News with Brian Williams Report on successful Kaiser Permanente initiatives
  • Health Administration Responsibility Project Group scrutinizing managed care and its failures
  • CIMIT - Center For Integration of Medicine And Innovative Technology - KP & Interoperability Resource

  Results from FactBites:
 
Kaiser Permanente Jobs - Employment Opportunities at Monster.com (1395 words)
Kaiser Permanente in Northern California was one of the few HMOs in California to earn the top rating of "Excellent," which means that we satisfied or surpassed NCQA's strict evaluation criteria in areas such as preventive care, member services, physician credentialing, and improvements in care delivery.
Kaiser Permanente's philosophy of preventive care, pioneered nearly 60 years ago, has helped to change the way medicine is practiced today.
Kaiser Permanente is making an important contribution to the treatment of chronic conditions, which account for nearly 60 percent of all medical costs in the United States.
  More results at FactBites »

 
 

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