Kaiser Permanente Research Paper

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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).

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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…

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…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….....

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