Kaiser Permanente is not an insurance plan. Kaiser Permanente is two different parts. The Kaiser Foundation Health Plan is the insurance, or administrative side. The Permanente is the Permanente Medical Group. The Permanente Medical Group is separate from the Kaiser part. The doctors are employees of the Permanente Medical Group. The group of doctors only sees Kaiser patients. Unlike traditional insurance where the doctors are independent contractors who must get approval from an insurance company before they do something, the Permanente Group physicians make all decisions regarding care themselves. They do not need permission from Kaiser, the insurance company. Because the doctors are employees, not independent contractors, they are not paid more or less because of what they do or don’t do for a patient. The doctors are paid based on outcomes in their field, and a part of their compensation is based on patient satisfaction. Because they are employees, the doctors do not have to go after an insurance company or file to Medicare and wait to get paid, and don’t feel the need to sell patients services or tests that they don’t need. They also don’t have to deal with the paperwork that can come from taking multiple insurance plans, all with different rules and different sets of paper. In many areas of the country, there are doctors waiting for the chance to work for the Permanente Group. The doctors say they came because they want to practice medicine, not run a business.
Most care is done in Kaiser owned medical centers. They only own hospitals in California. The medical centers have family doctors, specialists, laboratories, xray, MRI scans, infusion services, and a pharmacy. All of the doctors and services (including the pharmacies, x-ray and labs) are connected by an electronic medical record and telemedicine. This means all of the doctors and others who see you can see all your records, communicate real time, and work together care. The doctors also make appointments for you themselves if you need to see another doctor, and they put in the lab or x-ray orders or prescriptions right then and there into the computer. This way you can go directly to the x-ray or specialist and not have to wait for a referral or get a permission slip. Everything is in the medical record.
Because the doctors are on staff, there is no reason for doctors to not refer to a specialist. Because they own the lab, the x-ray, the MRI or CAT scan, there is no reason not to provide a test. The machine is there, the staff is there. For all the tests and scans, the information goes straight into the medical record. The doctor gets it right away, and all the other doctors can see it too, so you don’t have to get the same test or x-ray again, or go to pickup “a copy of your films” to take to the specialist. Kaiser owns their own pharmacies and buys all of their medications for over 10 million people, so they get deals on prescription drugs. If you need a special medicine that they don’t have or cover, the doctor can write why it is medically necessary and get it covered for you.
So there are several things that make Kaiser Permanente different from other health plans. Besides most of the services being “in house”, and all of the patient records being in one place where all of the providers can see them at once, The Permanente Medical group can draw on the information on prevention, treatment and success rates for over 10 million people. When the doctors make medical decisions, they do it based on real experience and evidence. They also have committees where they discuss new techniques and treatments and challenging cases, like cancers or transplants. It’s almost like a club, and the patients are called members.
I have been a Kaiser member for 18 years. My husband joined after years of watching how it worked. The best way to explain is to tell you about an experience I had with my father. Dad is 90 now, but I put him on the Kaiser Medicare plan when he was 85. It’s a long story, but here it is:
Dad said his knee hurt. We made an appointment with his Internal Medicine doctor for the next day. When we got there, they check his ID and Kaiser card, we paid $10 and he went to the nurse to have his weight and blood pressure checked and he got a lecture on getting a flu shot. When the doctor came in, I told him, “Dad needs to see an orthopedist. His knee is really bothering him.” The doctor said, “Okay. But let’s get a flu shot first. Then we can get an x-ray ”. After the flu shot and the doctor looking at his knee, we took the elevator downstairs and waited 10 minutes for his turn in x-ray. After we got him dressed again, we went back upstairs and asked the guy at the desk what to do next. He called to the medical staff and then asked us if we could wait until the doctor was done with a patient. I went to the lobby to get Dad a cup of coffee at the Starbucks. A few minutes after I got back, we went to the exam room and the doctor called up the x-ray on the screen. I asked if we could be referred to an orthopedist now. He said, “Wait a minute.” He got on the phone and asked for a doctor by name. There was a ring, and a man came on the phone. The doctor asked him to go to some computer address and asked if the other guy if he could see the screen. They talked some medical mumbo jumbo, “eroded this, osteo that.” The guy on the other end finally said, “Okay. I can take him at one.” The internal doctor said to us, “Would you like to see the rheumatologist at one?” We agreed that would work. He then suggested that Dad get some bloodwork done. May as well while we are here. Dad was pretty worn out by now, so I asked the nurse if we could use a wheelchair. She got one.
Now I take Dad to the lab and take a number. We wait for the 3 ahead of us to check in, then show the ID card and the young lady put in Dad’s information. She asked his name and his date of birth. She said his order wasn’t in the system yet. She made a call and said it might be a couple minutes. A couple minutes later, they have Dad wheeled back and they take a couple tubes of blood. We had got there to Kaiser at 10: 30 am. It was now after noon. I went back to the Starbucks place and got a muffin and sandwich. We ate lunch sitting on a sofa with a coffee table, watching the people come and go. Before going to the next doctor, I had to go look at the directory and found the Rheumatology department was on the 3rd floor. I put Dad back in a wheelchair and took him up. We checked in at the desk and paid $10 for the doctor visit. A couple minutes after one o’clock, we are taken back where the nurse again checks who Dad is and takes his blood pressure. The doctor comes in and asks Dad some questions, feels his knee, looks back at the x-ray, has him walk a little. He asks Dad to verify what medications he is taking. Dad forgets two. The doctor says, “The record says you take ____ and _____. “Oh yeah. Yes. Those too.” So the doctor says,
“I would like to give you an injection of corticosteroid, and then give you a prescription that should help ease the pain.” He looks at the screen on the computer and presses a few buttons. “ I see you just had blood work done. Judging by this, you should be okay on Celebrex. I should see you again in a month to see how you are doing. He presses some more buttons. Can you come back on the 14th?” We agree on a time. He leaves. It takes about 10 minutes before the nurse comes in with a wheeled tray. The doctor comes in and gives Dad an injection, and tells us to wait a few minutes to make sure all is okay. A few minutes later, the nurse comes in with a bunch of papers/instructions and reviews follow up care and points out the next appointment date. As I wheel Dad out the door, she says, “Don’t forget to pick up the prescription.” So we go downstairs and I go to the pharmacy on the way out and pick up his prescription, paying $15.
We left a little after 2pm. 3.5 to 3.75 hours. Dad went to take a nap. I pretty much wanted one too, but think about it…
He had an x-ray. He had lab work. He saw his doctor, who got him a second opinion. Technically he saw 2 doctors, twice. He had a flu shot and he had a steroid shot. We made a follow up appointment, and got a prescription filled. All of this cost $35, and we did not have to get referrals, find another doctor, drive to another doctor… Who knows when or where that would have been? Would any of them have noticed he didn’t have his flu shot? Find a participating x-ray place. We would have to wait for the x-ray to send the films to the doctor and make another appointment to see him/her again. The doctor then would probably send us to a lab to make sure the Celebrex was okay. We would probably have to wait a day or two for the lab work to be reported back to the doctor. Then the doctor could phone in the prescription and we would have to drive to the pharmacy to pick it up. So it might have been at least a week before Dad would have had any relief for his knee.
I cannot think of a more efficient way to get medical care. I check the ratings every year in US News and World Reports and Consumer reports and Kaiser is always on top. They even won a J.D. Power award. His Internal Medicine doctor graduated NYU and has been at Kaiser since I became a member (18 years). The rheumatologist was a department chair at Johns Hopkins before coming to Kaiser. I would not take Dad to just anyone, and I know this plan is good enough for him (and the rest of my family).