Kaiser and physician Sidney Garfield. Kaiser Permanente is made up of three distinct but interdependent groups of entities: the Kaiser Foundation Health Plan, Inc. Kaiser Permanente is one of the largest nonprofit healthcare plans in the United States, with over 12 million members.

KP's quality of care has been highly rated and attributed to a strong emphasis on preventive care, its doctors being salaried rather than paid on a fee-for-service basis, and an attempt to minimize the time patients spend in high-cost hospitals by carefully planning their stay. However, Kaiser has had disputes with its employees' unions, repeatedly faced civil and criminal charges for falsification of records and patient dumpingfaced action by regulators over the quality of care it provided, especially to patients with mental health issues, and has faced criticism from activists and action from regulators over the size of its cash reserves.

Kaiser Permanente provides care throughout eight regions in the United States. Two or three four, in the case of California distinct but interdependent legal entities form the Kaiser system within each region. This structure was adopted by Kaiser Permanente Compayn and leaders in Each entity of Kaiser Permanente has its own management and governance structure, although all of the structures are interdependent and cooperative to a great extent. There are multiple affiliated non-profits registered with the U.

Internal Revenue Service. According to Form governance questions, Kaiser Foundation Hospitals and Kaiser Foundation Health Plan do not have members with the power to appoint or elect board members, meaning that the board itself nominates and appoints new members. On November 5,the board of directors announced that Bernard J. TysonKaiser's president and chief operating officer for the last two years, would replace Halvorson, [5]marking the first time an African American was appointed as chairman.

As ofKaiser Permanente had In addition, Kaiser Foundation Hospitals operates medical centers in California, Oregon, Washington and Hawaii, and outpatient facilities in the remaining Kaiser Permanente regions.

The hospital foundations are not-for-profit and Xolo Cell Phone Company on the Kaiser Foundation Health Plans for funding. They also provide infrastructure and facilities that benefit the for-profit medical groups. Kaiser Permanente is administered through eight regions, including one parent and six subordinate health plan entities, one hospital entity, and nine separate, affiliated medical groups:. Copmany addition to the regional entities, inthe then-twelve Permanente Medical Groups Kakser The Permanente Federation LLCa separate entity, which focuses on standardizing patient care and performance under one name and system of policies.

The history of Kaiser Permanente dates to and Kaise tiny hospital in the town of Desert Center, California. At that time, Henry J. Kaiser and several other large construction contractors had formed an insurance Kaiser Company called Industrial Indemnity to meet their workers' compensation obligations. Soon Cpmpany, Garfield's new hospital was in a precarious financial state with mounting debt and the staff of three going unpaiddue in part to Garfield's desire to treat all patients regardless of ability to pay, as well as his insistence on equipping the hospital adequately so that critically injured patients could be stabilized for the long journey to full-service hospitals in Los Angeles.

It was Hatch who proposed to Garfield the specific solution that would lead to the creation of Kaiser Permanente: Industrial Indemnity would prepay Later, Garfield also credited Ordway with coming up with the general idea of prepayment for industrial healthcare, and explained that he did not know much at the time about other similar health plans except for the Ross-Loos Medical Group.

Hatch's solution enabled Garfield to bring Compamy budget back into the positive, and to experiment with providing a broader range of services to the workers besides pure emergency care. However, in MarchConsolidated Industries a consortium led by the Kaiser Company initiated work on a contract for the upper half of the Grand Coulee Dam in Washington state, and took over responsibility for the thousands of workers who had worked for a different construction consortium on the first half of the dam.

Edgar Kaiser, Henry's son, was in charge of the project. To smooth over relations with the workers who Kaiset been treated poorly by their earlier employerHatch and Ordway persuaded Edgar to meet Kakser Garfield, and in turn Edgar persuaded Garfield to tour the Grand Coulee site.

Garfield subsequently agreed to reproduce at Indiana Uniform Company Coulee Dam what he had done on the Colorado River Aqueduct project. Unlike the workers on Garfield's first project, many workers at Grand Coulee Dam had brought dependents with them. The unions soon forced the Kaiser Company to expand its plan to cover dependents, which resulted in a dramatic shift Roofing Company Escondido industrial medicine into family practice and enabled Garfield to formulate some of the basic principles of Kaiser Permanente.

It was also during this time that Henry Kaiser personally became acquainted with Garfield and forged a friendship which lasted until Kaiser's death. Inthe Kaiser Company began work on several huge shipbuilding contracts in Oakland, and by the end of would control four major shipyards on the West Coast.

Duringthe expansion of the American defense-industrial complex in preparation for entrance into World War II resulted in a massive increase in the number of employees at the Richmond shipyard. On March 1, Compaby, Sidney R. In July, the Permanente Foundation formed to operate Northern California hospitals that would be linked to the outpatient health plansfollowed shortly thereafter by the creation of Northern Permanente Foundation for Oregon and Washington and Southern Permanente Foundation for California.

Kaiser's first wife, Bess Fosburgh, liked the name. An abandoned Oakland facility was modernized as the bed Permanente Hospital opened on August 1, Three weeks later, the bed Richmond Field Hospital opened. Six first aid stations were set up in the shipyards to treat industrial accidents and minor illness. Each first aid station had an ambulance ready to rush patients to the surgical field hospital if required.

Stabilized patients could be moved to the larger hospital for recuperative care. These physicians established California Physicians Service to offer similar health coverage to the families of shipyard workers. Meanwhile, during the war years, the American Medical Association AMA which opposed managed care organizations from their very beginning tried to defuse demand for managed care by promoting the rapid expansion of the Zaful Company Review Cross and Compsny Shield preferred provider organization networks.

InKaiser established the Henry J. Membership bottomed out at 17, for the entire system but then surged back to 26, within six months as Garfield aggressively marketed his plan to the public.

Kaiser Permanente membership soared toin, in, in, inandin From onward, both Kaiser Permanente and Garfield fought numerous attacks from the AMA and various state and local medical societies. Henry Kaiser came to the defense of oCmpany Garfield and the health plans he had created. Inthe organization acquired its current name when Henry Kaiser unilaterally directed the trustees of the health plans, hospital foundations, and medical groups to add his name before Permanente.

That same year, Kaiser Permanente also Kiaser experiments with large-scale multiphasic screening to identify unknown conditions and to facilitate treatment of known ones. Henry Kaiser became fascinated with the healthcare system created for him by Garfield and began to directly manage Kaiser Permanente and Garfield. This resulted in a financial disaster when Kaiser splurged on the new Walnut Creek hospital; his constant intermeddling led to significant friction at every level of the organization.

The situation was not helped by Kaiser's marriage to Garfield's head administrative nurse who had helped care for Kaiser's first wife on her deathbedconvincing Garfield to marry the sister of that nurse, and then having Garfield move in next door to him.

Clifford Keene who would eventually serve as president of Kaiser Permanente later recalled that this arrangement resulted in a rather dysfunctional and combative family in charge of Kaiser Permanente. Keene was an experienced Permanente physician whom Garfield had personally hired in During he had been trying to get a job at U.

Steelbut on the morning of December 5,with internal Clmpany worsening day by day, Garfield met with Keene at the Mark Hopkins Hotel in San Francisco and asked him to turn around the organization.

It took Keene 15 years to realize that Kaiser had forced Garfield to ask Keene to become his replacement. Due to the chaos on the board, Keene at first took control with the vague title of Executive Associate, but it soon became clear to everyone that he was actually in charge and Garfield was to become a lobbyist and "ambassador" for the HMO concept.

However, even with Garfield relieved of day-to-day management duties, the underlying problem of Henry Kaiser's authoritarian management style continued to persist. After several tense confrontations between Kaiser and Permanente Medical Group physicians, the doctors met with Kaiser's top adviser, Eugene Trefethen, at Kaiser's personal estate near Lake Tahoe on July 12, Trefethen came up with the idea of a contract between the medical groups and the health plans and hospital foundations which would set out roles, responsibilities, Fad Company financial distribution.

While Keene and Trefethen struggled to fix the damage from Kaiser's micromanagement and Garfield's ineffectual management, Henry Kaiser moved to Oahu in and insisted on expanding Kaiser Permanente into Hawaii in He quickly ruined what should have been a simple project, and only a last-minute intervention by Keene and Trefethen in August prevented the total disintegration of the Hawaii organization. Having overseen Kaiser Permanente's successful transformation from Henry Kaiser's healthcare experiment into a large-scale self-sustaining enterprise, Kaiser Company retired in Inall six of Kaiser Permanente's regions had become federally qualified health maintenance organizations.

Historians [who? InKaiser Permanente expanded to Georgia. ByKaiser Permanente provided coverage for about a third of the population of the cities of San Francisco and Oakland; total Northern California membership was over 2. Elsewhere, Kaiser Permanente did not do as well, and its geographic footprint changed significantly in the s.

The organization spun off or closed outposts in TexasNorth Carolinaand the Northeast. InKaiser Permanente sold its Texas operations, where reported problems had become so severe that the organization directed its lawyers to attempt to block the release of a Texas Department of Insurance report. This prompted the state attorney general to threaten to revoke the organization's license.

The organization also sold its unprofitable Northeast division in The Ohio division was sold to Catholic Health Partners in InKaiser Permanente celebrated its fiftieth anniversary as a public health plan. Two Kaieer later, national membership reached nine million. Inthe organization established an agreement with the AFL-CIO to explore a new approach to the relationship between management and laborknown as the Kaise Management Partnership.

Going into the new millennium, competition in the managed care market increased dramatically, Comapny new concerns. The Southern California Permanente Medical Group saw declining rates of new members as other managed care groups flourished.

This information technology failure led to major changes in the organization's approach to digital records. Under George Halvorson's direction, Kaiser looked closely at two medical software vendors, Cerner and Epic Systemsultimately selecting Epic as the primary vendor for a new system, branded KP HealthConnect. Although Kaiser's approach shifted to "buy, not build," the project was unprecedented for Cpmpany civilian system in size and scope.

Early in the 21st century the NHS and UK Department of Health became impressed with some aspects of the Kaiser operation, and initiated a series of studies involving several healthcare organizations in England.

The management of hospital bed-occupancy by KP, by means of integrated management in and out of hospital and monitoring progress against care pathways has given rise to trials of similar techniques in eight areas of the UK. Ina controversial study by California-based academics published in the British Medical Journal compared Kaiser to the British National Health Servicefinding Kaiser to be superior in several respects.

Second, its doctors are salaried rather than paid per service, which removes the main incentive for doctors to perform unnecessary procedures. Thirdly, KP attempts to minimize the time patients spend in high-cost hospitals by carefully planning their stay and by shifting care to outpatient clinics. Alleged violations of California's timely access laws included failures to accurately track wait times and track doctor availability Compwny evidence of inconsistent electronic and paper records.

It was also found by the DMHC that patients Fargo Cattle Company Zebulon written materials circulated by Kaiser dissuading them from seeking care, a violation of state and federal laws.

DMHC also issued a cease and desist order for Kaiser to end the practices. The report found Kaiser had put systems in place to better track how patients were being cared for, but still had not addressed problems with actually providing mental health care that complied with state and federal laws.

It also issued a statement which denied much of the wrongdoing. In Kaiser settled five cases for alleged Compamy dumping —the delivery of homeless hospitalized patients to other agencies or Compan in order to avoid expensive medical care—between and Los Angeles city officials Compaby filed civil Kaisser criminal legal action against Kaiser Permanente for patient dumping, which was the first action of its kind that the city had taken. At the time that the complaint was filed, city officials said that 10 other hospitals were under investigation for similar Cimpany.

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