How Kaiser Permanente built some of the nation's highest-quality health plans

Kaiser Permanente's health plans often top lists for quality rankings. 

The Oakland, Calif.-based payer-provider plans took the top spot for Medicaid, Medicare and commercial plan ratings from the National Committee for Quality Assurance in 2022.  

What's behind Kaiser's consistent high marks? An integrated model, easy access to preventive care, and a focus on improving outcomes and reducing health inequities. 

Andy Bindman, MD, executive vice president and chief medical officer at Kaiser Permanente, shared his insights with Becker's on how the organization maintains its quality ratings

Payer-provider structure sets plans up for success 

Dr. Bindman said Kaiser Permanente's model as a payer-provider organization sets its health plans up for success. 

Kaiser members pay the organization, which is then responsible for their care. Dr. Bindman said this incentivizes prevention, health promotion and maintenance and management of acute and chronic conditions. 

Kaiser Permanente's physicians are salaried, rather than paid through fee-for-service, a feature Dr. Bindman said leads to better health outcomes. 

"Integrating evidence-based care and coverage the way we do drives the coordination of care across all settings and care teams," Dr. Bindman said. "Care coordination ensures that our members receive the right care, at the right time in the right setting." 

A focus on preventive care 

Dr. Bindman said Kaiser Permanente plans are leaders in the percentage of members receiving mammograms — leading to a lower mortality rate compared to plans with lower benchmarks. 

A team in its Mid-Atlantic region, which includes Virginia, Maryland and Washington, D.C., launched a program that often provides members with mammogram results in an hour or less, he said.

"If mammogram findings are suspicious, follow-up diagnostic breast imaging and biopsy can often be completed the same day — reducing stress for the member and connecting them more quickly to treatment options," Dr. Bindman said.

Kaiser's integrated EHR system flags if members are overdue for screenings, alerting staff to get them scheduled while they are in for another appointment, Dr. Bindman said. 

Confronting pandemic challenges 

Dr. Bindman said quality standards, particularly around chronic disease management and preventive screening, were difficult to maintain during COVID-19 surges. 

"With the ebbing of the pandemic, we are already seeing a steady climb in preventive screenings and increased demand for care that had been delayed," he said. "While we're glad to see our members returning for needed care, this presents new challenges for a workforce still reeling from the impacts of COVID-19." 

Kaiser Permanente is actively hiring and training new staff to meet increased demand and incorporating telehealth and 24/7 virtual care for urgent needs. 

"It's a challenging time for the healthcare system, but we're confident that our renewed capacity for quality improvement, coupled with the many learnings we have from the pandemic, will enable us to not just fully recover, but surpass our pre-pandemic excellence," Dr. Bindman said. 

Improving health equity 

As Kaiser Permanente looks at continuing to improve quality, Dr. Bindman said, the organization focused on the things most meaningful to members: outcomes and equity. 

Some of these actions include adding systems to create meaningful quality measures and developing capacity to examine health outcomes among Kaiser Permanente members by race and ethnicity. 

When the data shows disparities, Dr. Bindman said Kaiser Permanente will develop a comprehensive plan to address it. 

"Through this work, we're helping to reimagine the long-standing model of how to create accountability around quality and quality improvement, and how to make equity a critical part of how we define quality outcomes moving forward," Dr. Bindman said. 

"We recognize that this represents a shift but an important one for the field," he added. "We hope to bring other health systems, payers, regulators and policymakers along with us on this journey of transformation that most everyone recognizes is overdue."

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