Kaiser Permanente discusses Open Season options

Friday - 11/12/2010, 4:34pm EST

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Open Season continues for federal employees, and so does For Your Benefit's look at the various health care providers. This week, hosts Bob Leins and Tammy Flanagan were joined by John Patrick, Director of Sales and Account Management for FEHB, Jeff Goldman, Executive Director of Government Programs, and Dr. Jaewon Ryu, Associate Medical Director for the Mid-Atlantic States Region for a discussion all things Kaiser Permanente.

Open Season is "a really critical time for federal employees, it's about more than just choosing your benefits. Federal employees have a chance to choose what's right for them and how they receive their health care," Goldman said.

Kaiser Permanente is making many changes to their health care options for federal employees in the coming year, but the decision started with a history lesson: Henry Kaiser, the company's founder, was an industrialist working in California who hired a physician and built hospital near his worksite to provide health care coverage for his workers and for their families if they opted in. From there, the integrated health care approach grew. Kaiser still maintains a large presence in California, but has since then expanded. Their local region headquarters is in Rockville, and includes many FEHB enrollees.

Kaiser has over 120,000 patients through FEHB, and 10 percent of all federal employees receive coverage through Kaiser. In California, nearly 45 percent of employees and retirees have Kaiser

So among the changes Kaiser is making is to expand products and services, including increased hours for radiology/imaging services, labs, pharmacy and urgent care services.

In addition, Kaiser will be opening five new HUB facilities in the coming years.

  • Capitol Hill--opening in early 2011
  • Gaithersburg--expected to open in 2012
  • Tyson's Corner--expected to open in 2012
  • Largo--expected opening in 2013
  • Baltimore-area--TBD
These larger facilities include primary care, specialty care, ambulatory surgery, out patient suites, 24-hour clinical decision units and many other services, all in one building.

"It's in the interest of expanding where we do things and increasing our capabilities to do more thing in one place," Ryu said.

At these facilities, patients can hypothetically walk in for a cough or runny nose, and also receive a mammogram in the same visit, or seek treatment for pain in their elbow and get colonoscopy done as well.

"These are all things that are the bread-and-butter Kaiser Permanente-style of health care delivery," Ryu said.

The process is further simplified through their new E-Consult service, which Ryu explains as smashing together the referral and booking process. When one office makes a referral, they can then further check ahead for appointment openings at the other office for the patient.

"People have sort of this pre-conceived notion about HMOs. First of all, the HMO piece is really about the insurance side of the house, not necessarily the care delivery, and I think that's really what separates Kaiser Permanente is the care deliver," Goldman said.

When patients join Kaiser, they are enrolled in Primary Care right away, Ryu said, so that they have a "quarterback" for complete care; someone to keep an eye on every facet of their health care delivery. General health care is good at making specialists available, but "the patient is the one that's got to navigate that process, whereas within Kaiser we have that primary care doctor to do that for them," Ryu said.

Also in an integrated health care plan, Goldman elaborated, patients don't need to take their health care records with them from doctor to doctor; all of the information is stored and shared in-house.

Another myth: that Kaiser only does out-patient care. But that's not really true, Ryu said.

"We have our own hospitalist doctors, our own specialists who round on our patients that happen to land in hospitals," and we work very closely with a handful of pre-selected hospitals that we have a core-partnership with and when a patient lands in those hospitals we have our own electronic medical record system, our own hospitalists, our own specialists, our own case managers, and we've even moved toward a hospital-within-a-hospital model.

At the Virginia Hospital Center, Kaiser operates its own floor for Kaiser patients admitted to the hospital.

"I think that's really a signal of what we're all about, which is trying to integrate and coordinate that care across all these different silos of the health care system," Ryu said.

But Kaiser isn't the only health care provider making changes to their coverage, and Goldman had general advice for all federal employees this Open Season.

"Take the time to go down to your federal open season fair, talk to the health plans, find out what's going on, find out what's new and different. Stuff changes every year and it's really in your best interest to know." Goldman said.