What insurers can learn from Kaiser's successful integrated healthcare model


Kaiser Permanente has so successfully executed its integrated healthcare model that other insurers could benefit from following its lead as health reform is pushes the industry toward further collaboration with providers.

Kaiser's streamlined, integrated care puts an emphasis on prevention, wellness and electronic health records and has allowed the company to provide care that's up to 20 percent below market average costs. Insuring 5.5 million commercial members while also operating 35 hospitals throughout California, Kaiser earns almost $24 billion in premiums each year, the Sacramento Bee reported, and owns 40 percent of the state's commercial and individual markets.

In one initiative aimed at reducing emergency room visits, Kaiser found that most ER users have chronic and mental health issues requiring closer coordination between primary doctors, nurses and pharmacies. By calling members who routinely frequent ERs to a meeting with the primary doctor, a chemical-dependency counselor and a pharmacist, Kaiser has seen members with an average of 30 ER trips a year drop to below six visits a year, FierceHealthPayer previously reported.

"Broadly speaking, Kaiser is aligned with healthcare reform," Micah Weinberg, health policy analyst with the nonprofit economic advocacy group Bay Area Council, told the Bee. "In a lot of ways, the world of healthcare is seeing the need to become more like Kaiser."

The California insurance company has even found supporters in the unlikeliest of places--including famed industry critic Wendell Potter. "What we're going to see is that our healthcare system is always going to evolve," said Potter, senior analyst, industry watchdog and author of the book Deadly Spin.

"I do think that the Kaiser model is the right model. It's not perfect, but it's one of the best models of integration of care, the most effective way to improve costs and safety," he told the Bee.

It was Kaiser that began "breaking down the silos protecting and separating the self-interests of insurance companies, doctors and hospitals," Potter added. "It's where we need to go. And we need to work to get to where integration of care is seamless."

To learn more:
- read the Sacramento Bee article

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