Kaiser Foundation Health Plans : An Overarching Agenda For Achieving Excellence

Today, health care is one of the most the important subjects in United States. There are many Private and nonprofitmaking organization dedicated to health care. This paper discusses the readiness of Kaiser Permanente as a health care organization to respond the future health care needs of citizens. This paper also contains its strategic plan that addresses issues relating to network growth, nurse staffing, resource management and patient satisfaction.

Reinvest current net income into interest accounts for future variable health care costs for years to come

The health care system must change to improve our nation’s health and takes strong steps to address the unsustainable growth of health care costs in America. We still have a long way to go before our health system become effective. We still have population that do not have insurance, have difficulties accessing their health care, or their needs are not met within the healthcare system. It is an investment in prevention and wellness and increasing access to primary care physician.

Patient-Centered Medical Homes (PCMH) are growing in popularity as the right thing to do improve patient care. PCMH are growing in popularity, as there is early evidence of their effectiveness (Egge, M. 2012). The PCMH concept has been widely promoted as a way to enhance primary care and deliver better care to patients with chronic conditions. This model of care has stimulated the attention of payers, Medicaid policy makers, physicians, and patient advocates, as it has the potential to address several of the limitations of the current healthcare system (Wang, J. et al 2014). Currently, primary care in the United States is focused on acute and episodic illness, it inadvertently limits comprehensive, coordinated, preventive and chronic care (Bleser, W. et al 2014). The PCMH address these limitations through organizing patient care, emphasizing team work, and coordinating data tracking (Bleser, W. et al 2014). A PCMH and HMO have some similarities but are markedly different.

The American Health Care system needs to be constantly improved to keep up with the demands of America’s health care system. In order for the American Health Care system to improve policies must be constantly reviewed. Congress still plays a powerful role in public policy making (Morone, Litman, & Robins, 2008). A health care policy is put in place to reach a desired health outcome, which may have a meaningful effect on people. People in position of authority advocates for a new policy for the group they have special interest in helping. The Health care system is formed by the health care policy making process (Abood, 2007). There are public, institutional, and business policies related to health care developed by hospitals, accrediting organizations, or managed care organizations (Abood, 2007). A policy is implemented to improve the health among people in the United States. Some policies

Health care spending grew 3.7 percent in 2012 and the traditional way medicine was practiced had to change (Edlin, Goldman & Leive, 2014). The Affordable Care Act and Population Health was designed based on the concept of “The Triple Aim” to foster change in patient care by providing better care for individuals, better health for populations and decrease the cost of health through improved care (Perez, 2014). As a result, population management has moved to the front by linking services, reducing hospital admission, risk stratification, pursing preventive medicine, ensuring medication review and lowering health care cost. Several organizations have follow in the pursuit of population management by forming Accountable Care Organizations

Our healthcare system needs major restructuring. Major improvements needs to begin with "all health care organizations, professional groups, and private and public purchasers should adopt as their explicit purpose to continually reduce the burden of illness, injury, and disability, and to improve the health and functioning of the people of the United States", (Crossing the ……, 2001).

One way to see Kaiser is as both the health insurance and the healthcare provider. Kaiser has been cited as the face of the future of healthcare. In fact, its model, a combination of a nonprofit health insurance plan with its own physicians, medical offices and hospitals, has been mentioned and used by President Obama when creating healthcare reform (Abelson, 2013). As an open system, Kaiser Permanente is affected by many external factors, such as Medicare, the National Committee for Quality Assurance (NCQA), the Division of Insurance and laws like the Healthcare Reform.

Success Of Kaiser Permanente Health Care Model And The Group Health Cooperative Model Of Health Care Compared To Other Initiatives In Health Care “Kaiser Permanente is America's leading integrated health care organization. Founded in 1945, it is a nonprofit, group-practice health maintenance organization (HMO) with headquarters in Oakland, California. Kaiser Permanente serves the health care needs of members in 9 states and the District of Columbia.” Today, it encompasses Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals, and the Permanente Medical Groups, as well as affiliation with Group Health Cooperative based in Seattle, Washington. Kaiser Permanente aspires to be the world leader in improving health through high-quality, affordable, integrated health care. We will be distinguished by our strong social purpose, physician responsibility for clinical care, and an enduring partnership between our Health Plan and our medical groups. Kaiser Permanente provides coverage programs for thousands of uninsured children and adults who are ineligible for existing state or private programs due to family income or immigration status. The organization also partners with community-based clinics to provide expertise, clinical guidelines, and other support for these safety-net providers. Through its research centers across the country, “Kaiser Permanente conducts more research, over 1,000 studies annually, than any other non-academic institution in the U.S.” The

A health care system that achieves major gains in these six areas would be far better at meeting patient needs. Patients would experience care that is safer, more reliable, more responsive to their needs, more integrated, and more available, and they could count on receiving the full array of preventive, acute, and chronic services that are likely to prove beneficial. Clinicians and other health workers also would benefit through their increased satisfaction at being better able to do their jobs and thereby bring improved health, greater longevity, less pain and suffering, and increased personal productivity to those who receive their care.

Despite the nation 's significant investment in health care, the US ranks last overall in health care to other industrialized nations. To help better health in the US, the Triple Aim was launched in October 2007 and was designed to help health care organizations improve the health of populations and the care they receive by focusing attention on three different aims that were developed to improve the experience of care, health of populations, and to reduce per capita costs of healthcare (Berwick, Nolan, & Whittington, 2008). In order to have better health in the US, all three of these components must be addressed and balanced in order to reach the goal of Triple Aim in optimizing our health care system.

If health care systems wish to remain profitable and competitive in the new value-based economy, they must become proactive and not just measure outcomes but understand what led to the desired (or undesired) outcomes in order to actually adjust.

Kaiser Permanente offers a holistic health care system by combining a nonprofit insurance plan with its own hospitals and clinics. Additionally, since the plan pays a fixed amount for medical care per member, there is a considerable financial incentive to keep people healthy and out of the hospital. Kaiser oversees, administers and provides a comprehensive care for patients, ranging from providing screening and diagnosis to filling a prescription to running a hospital where the patients undergo surgery. This strategy of integration is at least 10 percent less expensive than other providers’ services (Abelson, 2013).

Improvement Stories, Across the Chasm: Six aims for changing the health care system (2012). Institute for Healthcare Improvement.

As part of a growing trend many countries, including our own, have been using the Triple Aim approach to improve healthcare. The Triple Aim is to improve a patient’s experience of care, to advance population/ community health and to lower per capita cost. It is no secret that health care expenditure is rising. Healthcare cost per capita in the United States is twice or more than the average of other developed countries. In this cost is what many healthcare providers find to be avoidable expenditure