TOPIC selected Kaiser Permanente as the managed healthcare organization for our research.
Background
This section will cover the historical background of how closed-panel HMOS came to be. We will discuss how they differ from other HMOs and PPO plans. This element will be addressed by presenting the relevant information from scholarly sources about managed healthcare organizations and Kaiser Permanente and setting the research context. In addition, this section will cover the specific objectives the project aims to achieve
Problem statement
For cost, quality, and equity in healthcare to be achieved, there need to be fewer restrictions on insurance plans, better efficiency, and more cost transparency. Kaiser HMO prides itself on being lean and efficient, however, closed panel HMOs restrict access and utilization due to the oversight and smaller set of resources. This element will be addressed by highlighting where and when the issue of managed healthcare organizations arises, who it affects, and previous attempts to address their research question.
Kaiser Permanente is one of America’s leading healthcare providers and nonprofit health plans. Our health plan finances the care delivered by the more than 24,605 physicians of the Permanente Medical Groups, 73,618 nurses, and 75,000 allied health professionals in our 40 hospitals and 616 medical facilities. We serve 12.5 million people in California, Colorado, the District of Columbia, Georgia, Hawaii, Maryland, Oregon, Virginia, and Washington.
We serve our members using a unique business model that combines health coverage and care delivery into one coordinated experience. Unlike a traditional insurance company, we are a membership-based, prepaid, direct health care system. That means our members — whether they come to us through employer-sponsored or individual coverage, Medicare, or Medicaid — pay dues to access care and services that are coordinated across inpatient and outpatient settings, pharmacy, lab, imaging, and other ancillary services.
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