Community Oriented Primary Care A Practical Assessment, Vol. 2: Case Studies (1984) / Chapter Skim
Currently Skimming:
Kaiser-Permanente Medical Care Program of Oregon
Kaiser-Permanente Medical Care Program of Oregon
Pages 93-114
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From page 93... ...
lathe Kaiser/Oregon program includes a health services research center established in 1964 specif ically to study the potential of a prepaid group practice as an important innovation in the organization of health care. The innovative programs developed make Xaiser/Oregon a particular ly good case study for demonstrating the manner in which an TO can embody the ma jar pr inciples of COPC by addressing the health needs of its enrolled population.
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From page 94... ...
Currently, the Kaiser/Oregon program is experimenting with a greatly expanded benef it package for Medicare eligible patients, including a variety of health and social services not previously offered within a prepaid medical plan. Kaiser/Oregon's success as a co~nmunity-oriented primary care program can be attributed to a number of factors not the least of which is the foresight on the part of a number of individuals in key positions in the organization.
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From page 95... ...
of which the development of health maintenance organization represented. The stated goals of the MSRC are to study: the impact of providing new health care Services to an existing, identif iable population in an established medical care system the impact of providing services to populations new to a medical care system the impact of implementing new methods and new personnel for the provision of exist ing services in a medical care system the theoretical conceptual issues of medical care utilization resee rch .
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From page 96... ...
Anne Department of Community Medicine is currently engaged in a var iety of health promotion activities for its general membership. It is also shar ing i ts expertise with nonmembers through a number of programs it conducts at work sites, and for the general public through a television program called replanning for Health.
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From page 97... ...
The research data system has been maintained since 1966 on a randomly selected f ive percent of -embers in addition to all or an augmented sample of members enrolled in special programs such as the orginal OEO neighborhood health center program and the more recent Medicare Plus. Although not including the entire enrolled community, this data base has been carefully developed to ref lect the patterns of health and utilization of the general population of members.
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From page 98... ...
supplemental revenues of 6-9 percent that include payments by plan member s outs ~ ret either as deductible or as a form of coinsurance when their particular benef it plan does not pay the entire amount of the service, and payment by liable thi Ed parties · Medicare parts A and B (11-13 percent) with what Raiser/Oregon has a special f inancial arrangement for providing medical care to Medicare beneficiaries who are Faiser/Oregon enrollees · nonplan and industrial funds (5-6 percent)
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From page 99... ...
61 61 All other 0. 4% 11 1% 1% 21 These revenues are generated by the Health Services Research Center f rom sources outside Xaiser/Oregon.
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From page 100... ...
The demographic characteristics of the membership are almost identical to the Portland area, a continuing trend that is conf i rmed by surreys conducted annually by the Medical Economics Department and by the Health Services Research Center every three years. Despite the propensity for HMOs to nerve a predominantly employed population, the various Medicare and Medicaid arrangements developed at Raiser/Oregon balance its membership to consistently reflect the socioeconomic characteristics of the Portland ares, including age, sex, health status, and employment status.
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From page 101... ...
Another source of input from the general community of Portland comes in the form of special requests from various community agencies. The Kaiser/Oregon Program has high visibility as a health maintenance organization in the Portland area and consequently is called upon f requently to conduct programs and participate in community health care events.
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From page 102... ...
In 1980, Kaiser/Oregon, with funding f ram the Health Care Financing Administration (HCFA) , developed a workable prospective payment system known as Medicare Plus, which is attractive to Medicare beneficiaries because it offers them either a premium saving or an expanded benef its package .
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From page 103... ...
The program known as Medicare Plus lI proposes to offer social services (e.g., adult day care, homemaking, medical transportaton) and long-tern care (e.g ., 100 additional days of intermediate or skilled nursing care, increased home health care)
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From page 104... ...
The recent formation of the Community Medicine Department incorporates a number of foci of activity in industrial health, employee health, and health promotion. These ef forts are f i rmly based on a view of the entire community at risk as a denominator upon which all intervention ef forts are founded .
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From page 105... ...
for example, Kaiser/Oregon is currently engaged in a fairly broad effort to develop health promotion activities in the work place. It responds to frequent request by employers to conduct seminars, to initiate health promotion activities in their workplace and to do f itnese assessments.
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From page 106... ...
In both organizations there is not only a professional but also a clear economic incentive to identify remediable health problems within their community. The Functions of COPC Def ining and Character izing the Community line Medical Economics Department routinely performs a number of studies that serve to maintain an accurate and current prof ile of the enrolled community.
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From page 107... ...
Certainly, the examples cited in address ing the health problems of the medically underserved and the Medicare eligible population demonstrate a clear attainment of stage IV in the developmen~c of this function. The identif ication of sudden infant death syndrome was based on cononunity-specif ic data and is character istic of stage II I .
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From page 108... ...
In contrast, the effort to address sudden inf ant death syndrome {SIDS ~ was monitored in a way that accounted for differential impact among the risk group, and is therefore of stage IV. Env i Comments 1 Inf luences The Common ity Me community for which the Xaiser/Oregon program has ass~ed responsibility is defined by membership in one of the Raiser/Oregon health plans.
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From page 109... ...
First, with the responsibility to provide or assure a full range of outpatient and inpatient services , there is the strong economic incentive to provide effective primary care services to its entire community in order to decrease the costs of relatively expensive secondary and tertiary care. Second, success in preventing the need for expensive tert iary care f rees resources (at least theoretically)
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From page 110... ...
The Xaiser/Oregon program is also unique bang the study sites in the way in which it develops program modifications through altering the configuration of benefits within its different health plans. Many of the developments for carrying out the functions of COPC, while particularly well developed in the Kaiser/Oregon program, can be found in many of the older } - Os.
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From page 111... ...
Although many such people are within the Bealth Services Research Center, there is a very large number among the practitioner staff as well. Several important innovations including the emergency diagnosistic unit any number of special efforts in health promotion and health in the work place, were conceived and developed by the practitioners within the program (Raiser/Portland, 1979)
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From page 112... ...
O., Health Promotion Consultant Joy Gray, Health Educator Don Gallagher, Manager, unity Medicine Department Allan Weiland, M.D., Phyetcian-in~Charge, Vancouver Medical Office Margaret O'M~lley, R.N., Director, Have Health Agency Matt Stieffel, Director, Medical Economic Department
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From page 113... ...
1981. Client satisfaction in a health maintenance Organization: Providers' perceptions compared to clients' report.
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From page 114... ...
1983. Raiser-Permanente's Medicare Plus pro ject: A successful Medicare prospective payment demonstration.
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