Kaiser Permanente

Introduction
Kaiser Permanente represents the biggest not-for-profit integrated healthcare network in the US, having a membership of more than 11.8 million within Washington D.C. and 8 other states. Instituted in the year 1945, Kaiser Permanente -California covers Southern and Northern California. It is a triple-entity pre-paid holistic system; the 3 entities, which are distinct though interlinked, are: a healthcare scheme which covers insurance risk, a system of hospitals, and clinical physician groups. The monetary incentive is offering reasonably-priced, superior-quality patient care and engaging in population health management instead of creating a large quantity of compensable facilities. The physician group as well as the health scheme are in line with one another and answerable to an international budget. They directly contract with each other solely for delivering healthcare services. Each entity has a common objective of maintaining patient health whilst simultaneously ensuring optimal utilization, as reflected within Kaiser Permanente’s capitated system of making payments. Such an alignment proves critical to the company’s attempts at maintaining affordability for members and buyers (Wheatley, 2013).
Target Market
The Cosmetic Services of Kaiser Permanente can be accessed by anyone. Irrespective of membership status, individuals are allowed to visit Kaiser Permanente providers and have cosmetic procedures administered. Indeed, the present cosmetic patients of the organization are non-members with referrals from kith and kin who are Kaiser Permanente health coverage enrollees. Irrespective of membership status, individuals receive identical superior-quality care. Further, no pricing variations may be found between non-members and members (Varney, 2012).
Pricing Overview
Knowledge of how much a particular health service costs puts one’s mind at ease when approaching a given facility for treatment. Deductible members have to pay the complete fee for services covered till they attain their “deductible” amount, beyond which, the price reduces; subsequently, deductible members only have a co-insurance or co-pay for the remainder of the year’s services. Based on the individual’s health plan, coinsurance or co-pays might be payable for certain services without achieving the deductible. Moreover, those who reach maximum out-of-pocket expenses need not disburse services they avail of for the remainder of that year. For some services (which are few in number), patients might be required to continue paying coinsurance or co-pays despite achieving their maximum out-of-pocket level (Kaiser Permanente, 2018).
Kaiser Permanente’s sample price list and therapy fee instrument offer pricing details pertaining to specific services provided by the organization. This data is regularly updated; thus, patients need to recheck time and again for any service price modifications. The fees and services displayed aren’t grounded in any details garnered from patient health records; rather, they are the prices charged to members for services provided (Kaiser Permanente, 2018).
Owing to continuous changes in medical information, the aforementioned information may not be entirely complete or up to date. Though regular updates are made, the website’s information might end up not being reflective of all details pertaining to drug withdrawal or endorsement on the part of the United States FDA (Food & Drug Administration) or voluntary drug withdrawal on the part of pharmaceutical manufacturers. Studies reveal that Kaiser Permanente’s healthcare facilities effectively provide top-shelf, happy-hour-priced healthcare. Latest Medicare information reveals all expect one Kaiser Permanente hospital costing appreciably lower as compared to the nation’s average, corroborating the efficacy of its pricing approach. The company clearly keeps its clients’ financial power in mind when setting service prices (Varney, 2012).
Value Delivery Network
Kaiser Permanente’s Integrated Care calls for teamwork on the part of all care providers. All individuals, engaged in different care areas like pharmacy management and primary or secondary care delivery, need to focus on what their goals are for a given patient and what opportunities exist for achieving better results. That is, all team members have to address patient therapy as well as the overall care pathway. The adoption of such an integrated strategy with all patients will facilitate accomplishment of the organizational goal of improving community health on the whole, concentrating on patients one by one (Health International, 2009).
The main actor in integrated healthcare provision is an efficient information technology system. If this is lacking, one simply cannot engage in data collection and sharing, result tracking, or systematic identification of patient care improvement innovations. But a sound information technology system alone does not suffice in guaranteeing integrated care. Multidisciplinary care teams formulate care pathways through the use of evidence-based medicines; these feature among the basic means of care integration. Care pathways also clarify responsibilities and roles. For instance, the organization’s physicians are responsible for providing only some portion of healthcare. The rest is provided by other care team personnel such as nursing staff and pharmacists, who abide by pathway protocols. Kaiser Permanente’s Health Connect which encompasses clinical-decision guidance capabilities like alerts/reminders and documentation templates aids care pathways. In other words, Health Connect brings required evidence to points of care (Health International, 2009).
Kaiser Permanente regards other healthcare organizations as its partners, collaborating well with them and guaranteeing alignment of their performance and quality. It banks on partner organizations for serving members; thus, they are accountable when it comes to ensuring success. The organization, for instance, looks into whether or not they are able to do anything and aid partner healthcare organizations in meeting quality standards. Frequently, the organization is incorporated closely into partner healthcare organizational operations owing to Permanente physician-headed clinical departments. Furthermore, they track hospital expenses, daily costs, procedure expenses, and so forth, enabling the organization to negotiate fees disbursed by members and ensure proper billing (Health International, 2009).
Recommendations
Introducing responsibility and alignment with mutual saving. Healthcare organizations, emergency doctors and payers may start aligning quality improvement and cost cutting goals by establishing performance and total expenditure thresholds for particular diagnostic tests and clinical procedures. If doctors, and consequently, hospitals, can decrease expenses in relation to preset thresholds, a part of the savings may be returned to the doctors in the form of bonuses (and to the healthcare organization in the form of greater facility fees). Also, quality measures may be adopted for guaranteeing patient safety, besides ensuring compliance with clinical standards (Pines et al, 2015).
Increasing alignment with partial capitation aspects. With time payers, doctors and healthcare centers may start increasing their savings potential and rewards through making a move from serviced-based payment to community/individual level payment. Additionally, such payments may encompass components of mutual savings, according doctors and the healthcare organization clinical flexibility as well as rewarding them for better quality and efficacy; for instance, capitated outpatient service rate for a particular treatment or diagnostic test coordination, or a group-based facility price. This strategically aligns practitioners, payers, and other entities towards shared objectives (Pines et al, 2015).
Patient involvement for disrupting emergency department demand. Emergency doctors and healthcare organizations are well aware of the fact that the major part of emergency service demand is of an exogenous nature (i.e., it lies outside both parties’ control). But collaborating with healthcare schemes as well as across practitioners, internally as well as externally, for developing client-focused instruments may be a valuable upfront investment. While Kaiser Permanente’s OnCall or a similar system would need considerable investment, emergency departments and healthcare organizations ought to consider partnerships with medical homes and practices at the local level for augmenting telephonic 24/7 “on call” facilities, incenting primary care providers to offer secure e-mail access to patients, and coming up with clinical outreach initiatives for high-risk patient groups (for instance, congestive heart failure patients). This may pre-empt, to a certain degree, emergency room visit requirement, in addition to shifting several emergency department services to areas that are more clinically apt. With any luck, this can relieve a certain amount of the growing emergency department demand, and be highly appreciated by the high-risk patient population (Pines et al, 2015).






References
Health International. (2009). What Health Systems Can Learn from Kaiser Permanente: An Interview With Hal Wolf.
Kaiser Permanente. (2018). Kaiser Permanente 2019 Sample Fee List. Kaiser Permanente 2018 Review.
Pines, J., Selevan, J., McStay, F., George, M., & McClellan, M. (2015). Kaiser Permanente–California: a model for integrated care for the ill and injured. The Brookings Institution) Available at http://www. brookings. edu/~/media/Research/Files/Papers/2015/05/04-emergency-medicine/050415EmerMedCaseStudyKaiser. pdf.
Varney, S. (2012, June 25). Could Kaiser Permanente's Low-Cost Health Care Be Even Cheaper? Retrieved February 22, 2019, from https://khn.org/news/kaiser-permanente-health-care-costs/
Wheatley B. (2013). Transforming care delivery through health information technology. The Permanente journal, 17(1), 81-6.