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As some other people have mentioned below, the much lauded[1] vertically integrated health provider Kaiser Permanente started this way, as the health provider
by mapgrep 9y ago
As some other people have mentioned below, the much lauded[1] vertically integrated health provider Kaiser Permanente started this way, as the health provider caring for the workers of an enlightened large employer, Kaiser Steel, which at the time was a massive shipbuilder for the Navy and others headquartered in California with a major presence in the SF Bay Area.
I was briefly covered by a Kaiser plan, and have a lot of old friends who are either covered, work there, or worked there, and can say people really appreciate not only the relatively low costs but also the ability to just come to one place no matter the ailment and know you'll be able to get an appointment quickly and be taken care of, and won't have to haggle to get the care you need or deal with insurance company roadblocks. To the extent there are downsides (and of course there are) they are around not being able to have your own doctor (though I do think there is an approximation of that) and overzealous cost cutting (see the kidney center scandal).
My understanding is Kaiser has not spread much beyond California due to regulatory issues.
(Interestingly, Kaiser Steel was a major setting for Atlas Shrugged.)
[1] http://www.nytimes.com/2013/03/21/business/kaiser-permanente-is-seen-as-face-of-future-health-care.html http://www.nytimes.com/2013/03/21/business/kaiser-permanente...
- limaoscarjuliet 9y agoI love Kaiser. One stop shop for most things, easy, efficient, unified records. Highly recommended!
- aaronbrethorst 9y agoKaiser is available up and down the west coast, having completed the acquisition of Group Health last year. https://www.seattletimes.com/seattle-news/health/kaiser-permanente-wins-approval-to-buy-group-health/ https://www.seattletimes.com/seattle-news/health/kaiser-perm...
- ingsoc79 9y agoThey're mostly based in California, though they recently acquired Group Health Cooperative (largest healthcare provider in Washington State).
- hinkley 9y agoThey’ve been doing a big ad campaign in WA. Now I understand why.
- efm 9y agoKaiser is also available in Colorado.
- maxxxxx 9y agoI had Kaiser for a while and loved it. One appointment and you get two doctor visits and blood tests done the same day.
- joncrane 9y agoKaiser Permanente has a huge presence in the Washington, DC area.
- infinite8s 9y agoThey are the main healthcare provider for a large swath of federal government workers in the DC area.
- bigtones 9y agoI'm with Kaiser Permanente (switched from a PPO) and have been for two years and I absolutely agree with your comment - in SF they have brand new world class facilities in the dog patch neighborhood near me and I can book and see a doctor and orthopedic specialist and get an xray and scan in the same day and in the same building, and be about $30 out of pocket all in. That is awesome health care.
- seanwessmith 9y agoI'm new to the area and have Kaiser. Are you talking about UCSF Medical Center at Mission Bay?
- bigtones 9y agoThe Kaiser facility is very close to that UCSF facility next to the 101 on Owens street.
- all_blue_chucks 9y agoIs it an HMO? Because those can bankrupt you if you go out of network...
- dekhn 9y agoIt's a Health Plan. People go out of network in Kaiser all the time- basically, once Kaiser's default system can't handle you (complex organ transplants, advanced rare cancers, etc), they send you to a place like UCSF, and have negotiated the cost structure. There's no guarantee KP won't bankrupt you, but it seems better than most.
- cbhl 9y agoKaiser has both HMO and PPO plans, although depending on your employer you might only have access to the HMO (e.g. if they went with another insurer for the PPO).
- otterley 9y agoThus proving the inherent value of the network!
- snow_mac 9y agoThey're in Colorado
- e40 9y agoKaiser is no longer a low-cost provider. They actually are quite expensive. We go through a very large group to get a better rate but it's still much higher than many of the other options that we have in our plan. When you look at how Kaiser is structured, they should be cheaper. I think they're just pocketing the difference between the market rate and what their costs are.
- learc83 9y ago>I think they're just pocketing the difference between the market rate and what their costs are. This is baseless and not really possible. Insurers must spend 80% of premiums (85% for large group plans) on providing care for their insured.
- dv_dt 9y agoAn allowance 15-20% overhead for health insurance seems like pretty low bar for the industry...
- s73ver_ 9y agoAnd yet, it was groundbreaking when it was signed into law. People received refund checks after it went into effect.
- FireBeyond 9y agoAnd immediately after, administration costs shot up to ooh, 15-20%...
- everdev 9y agoDitched my BlueShield PPO for Kaiser and costs went down dramatically. There's tons of costs to be saved in healthcare and glad to see the private sector making an effort.
- colmvp 9y agoI tried applying to Kaiser and they rejected me for having a pre-existing condition which couldn't be helped given that I was born with it. Good for everyone else, I guess. :/ I ended up moving back home where the government covers my treatments.
- DrJaws 9y agoThey are a business not an ONG. US is a shithole country in relation to healthcare systems
- pcurve 9y agoisn't that illegal now?
- everdev 9y agoThat was my understanding as well.
- colmvp 9y agoThe incident happened before the ACA, though insurers have found clever ways around it: https://www.theguardian.com/commentisfree/2016/oct/27/obamacare-preexisting-condition-health-insurance-discrimination https://www.theguardian.com/commentisfree/2016/oct/27/obamac...
- pcurve 9y agothe tactic doesn't involve denying coverage though. The poster above said he/she was rejected.
- deleted 9y ago[deleted]
- guelo 9y agoI'm with Kaiser and my favorite thing compared to the PPOs I've been with in the past is the integrated IT health records. Any doctor, specialists, ER, can see my whole history of ailments and drugs and lab test results. When my doctor orders up a specialist or a pharmacy I don't have to re-explain anything, it's all in the system. I'm sure it helps reduce medical errors.
- briffle 9y agoThey were the first 'big' client of Epic Software. Many other hospital systems around the US now use Epic, and have similar features.
- guelo 9y agoThe difference is when you're on something like BlueCross you have a "network" of hospitals and independent doctors and labs and pharmacies that you can choose from. But those are not on all on one IT system and a lot of times they have no way of communicating with each other. With Kaiser it's all vertically integrated under one company that can impose a system-wide IT system.
- astrange 9y agoYou may be amused to hear about the programming language they use. https://thedailywtf.com/articles/A_Case_of_the_MUMPS https://thedailywtf.com/articles/A_Case_of_the_MUMPS
- _jal 9y agoI've known two people who loved Kaiser until they had a serious issue. Not privy to a ton of the details, but it appears that they Kaiser is not immune to at least a divergence of interests with their patients when the figures get big.
- amelius 9y agoHence health insurance should be strictly separate from health care. A strong insurance body could even ensure proper competition in the health care space.
- jack9 9y agoI've been with kaiser my whole life. 3 open heart surgeries from 2 to 32, ongoing medical of all kinds (psych to phys). Kaiser was 2nd in the nation for cardiac care for awhile. I have had nothing but great experiences and have transferred to their Washington state system, which is basically the same, except the facilities and staff seem less sophisticated overall.
- wahern 9y agoI've heard horror stories from all kinds of people with all kinds of insurers. For example, a neighbor of mine uses California Pacific Medical in Nob Hill. It's the hospital that caters to San Francisco elite. This past year his doctors mistook skin cancer on his eye for a sty for like 6+ months. He went back several times complaining before they caught their mistake. It's too soon to tell, but that serious issue may turn out to be a fatal one. Doctors aren't magicians, and they make plenty of mistakes. More to your point, no respectable doctor is going to ignore the cost and time element. Nor should he. There's no such thing as a cost-free diagnostic or procedure, even when money is no object. Even the very best doctor the world has ever seen is working with scarce time and resources; namely, his own. There's no avoiding conflicting interests and goals of some sort or another. At the end of the day people should be choosing healthcare based on objective criteria. More importantly, our social policies should be built around objective criteria. By objective criteria Kaiser is one of the very best hospital systems in the country. There's plenty to complain about, but it's the nature of things.
- 9y ago
- blahyawnblah 9y agoI really like the doctors at Kaiser. All very smart and caring. But their billing department is awful. I paid my bill every month but still got sent to collections multiple times. They would always recall it, but it was a giant pain in the ass.
- deleted 9y ago[deleted]
- physcab 9y agoI’ve been with Kaiser for over a year after having been on One Medical which is aiming to go in the opposite direction (many small satellite offices with good tech and more personal private care). For simple, routine needs Kaiser really does shine. Easy appointments, quick, good staff. We recently had a baby through Kaiser and pre-natal and post-partum care as well as the actual delivery was a fantastic experience. Much more so than the experiences of my peers at other non-Kaiser hospitals. Cost is all covered in employee plan. BUT as soon as you encounter specific issues, Kaiser breaks. I’ve had persistent GI issues and was never able to find consistent specialists on Kaiser. I also lost coverage to my therapist as Kaiser only does group therapy.
- propman 9y agoAgreed. Kaiser does well for the vast majority of problems and for the averafe person, but anything specific, out of the norm, or challenging Kaiser fails. You sometimes need to see someone not in network and that's the main reason for insurance. Anyone really can help treat you for common ailments, but when something unique comes it's better to have the options to see the best in the field.
- mbesto 9y agoThis happened to my family as well. My wife broke her ankle and is an avid amateur sports nut. She wanted to go see a top sports doctor (KP has none) and couldn't get KP to cover any of it. To pay out of pocket was anywhere between $20k-$30k. We ended up flying to the UK because it was cheaper and she had a trusted top tier sports injury surgeon she knew there.
- erispoe 9y agoWell that's how it works. If you want healthcare to work for everyone, you cannot expect that insurance will reimburse treatment from top doctors outside of rare conditions (where top doctors are the only doctors). Sport related injuries are extremely common. Why should an insurance reimburse an incredibly costly treatment when a normal treatment is good enough for most people? By definition, you cannot have an insurance that covers everyone but sends you to a top 1% doctor. What would the other 99% used for?
- hyperion2010 9y agoKP was in North Caronlia in the 90's and if it wheren't for boneheaded mismanagement would have been completely dominant in the market there now. One of those other futures that slipped away in the night :(.
- outworlder 9y agoKaiser is great compared to other US providers (although that's not such a high bar). The issue I see is that they are very reluctant to refer you to specialists even when the issue seems way over the GPs head. And they are somewhat fast-food-ish. Go in, do whatever it needs to be done quickly, then off you go. But still way better (and cheaper) than the competition.
- mLuby 9y agoAgree that Kaiser is great for normal cases. That said, it is terrible when traveling. It's almost as if they don't expect people to travel for more than a week at a time. What do people do during long term travel?
- thefourthchime 9y agoThat's pretty cool. I grew up with Kaiser, going to the one-stop-shop hospital in my youth. I didn't think much of it, it was icky and grey. It wasn't until adulthood and having to navigate the fragmented world we have now, I realize how nice that was. That and it was cheap(ish)!
- rdtsc 9y agoSecond that. I was covered by Kaiser for more than 10 years. It really is a great provider. You just show up to a clinic and everything is there - all the specialists, doctors, labs all under one roof. They have all the records already, everyone in the chain can see each others notes, lab results etc. Yeah with my plan I don't have access to outside doctors, so far however I didn't need them.
- dzink 9y agoKaiser is almost a monopoly in Hawaii (only a handful of providers they haven't bought). Interests can diverge when they are the sole provider for both insurance and every health need. Example: hiring practices of cheap vs competitive doctors and staff. Anecdotally every doctor and nurse I know refuses to take their family there.
- sxates 9y agoI'm also a big fan of Kaiser, and can share a couple of anecdotes to illustrate why. A few years ago when I was working for a startup and had insurance through United Healthcare, I came down with a high fever and then started seeing blood in my urine on a Saturday. My only option was to go to the ER, which I did. In the ER I had blood and urine tests, which determined that I had an infection in my kidneys. I was treated with intravenous antibiotics, and sent home a couple hours later with prescriptions for a couple more drugs to take for the next week or two. IIRC my total bill for the 2-3 hours I was there was around $6,000, of which my insurance covered about $1500 and I was left with a $4500 bill to cover out of pocket. I remember thinking at the time that such an event would be financially catastrophic for most people - I was fortunate that I could afford it. My wife has been with Kaiser for many years. Last year my wife started experiencing chest pains, which turned out to be pulmonary embolisms (blood clots in the lungs). She was admitted to the ER as well, where they ran some tests and got her on blood thinners. This was followed up with lung capacity tests and a few other things. Like me, she was in the ER for just a few hours, then sent home with appointments for follow-ups. Total cost for my wife was about $50 all-in. The magic of Kaiser is that when the insurance and the provider are both the same company, there's no dispute over pricing. There are no fights over bills, and no surprise costs that weren't covered. We have deductibles with Kaiser, but almost all services are a low fixed cost, so we don't eat into those deductibles much at all. This is not the case with other insurance companies. In my mind the Kaiser model is what the US should have as a national health care system, that's really good at covering the 95% cases at a reasonable cost, leaving people the option to go to other providers for specialty care if needed.
- LinuxBender 9y agoI was with Kaiser for a long time because I never needed a doctor. When I did, I had to fire kaiser. They nearly killed me. Talking to my coworkers, it turns out this is quite common. They hire a lot of people that received their medical degree in countries with much lower standards. It's actually quite concerning how many people I know IRL that lost friends due to misdiagnosis by Kaiser. It doesn't help that you can't (easily) sue them. You agree to a non arbitration clause. I see a lot of folks praising KP in this post and it's very concerning.
- comicjk 9y agoIf you want to convince me, show me the relevant statistics. Medical errors are not unknown from other health providers.
- LinuxBender 9y agoI am not looking to convince anyone. I know what I experienced. My friends know what they experienced. That is more than enough for me to have left KP and to warn my friends regarding my experiences. I have advised various agencies of my experiences.