Kaiser Permanente National MCO Analyzer 2011

Analyst: Paula Wade

Report Summary:
With 9 million members, nonprofit health insurer Kaiser Permanente has a structure unlike any other national carrier. With commercial populations in nine states, Californians make up 75 percent of its membership. Kaiser is investing heavily in new medical offices and medical centers throughout its footprint, and particularly in its underperforming markets of the Mid-Atlantic and Georgia. Kaiser's integrated structure is complemented by its HealthConnect electronic medical records system, and is years ahead of its competitors in its ability to track members' care. It now offers PPOs, POS plans and self-insured plans as those models gained favor among Americans, but most Kaiser members remain sold on the HMO.

Questions Answered In This Report: 
Kaiser's HealthConnect allows all HMO patients to have a medical home at any Kaiser office or affiliate hospital and adds benefits of e-mail access to physicians. How has its electronic health record improved adherence and member health? How does the integrated structure bring clinical pharmacists into patient care? 

Kaiser touts impressive quality measures including having four of its Medicare Advantage plans earning coveted five-star status. How has its sweep of the Medicare Advantage quality rankings changed the game for Medicare plans in the western states? How are competitors fighting back?

Kaiser is building new medical offices and hospitals in several of its smaller markets. Will the building boom result in new members? Is it a sign Kaiser plans to pursue new business more aggressively? How will the new construction prepare Kaiser for the new members when healthcare reforms' coverage mandates go into effect in 2014?

Primary research: Documents and research from HealthLeaders-InterStudy, Kaiser Permanente, the Kaiser Family Foundation, Centers for Medicare & Medicaid Services 

Companies Mentioned In This Report:

• Avivia Health
• Epic
• Kaiser Foundation Hospitals and Health Plans
• Kaiser Medical Group
• Kaiser Permanente