TEXAS
ARTICLES(10)
New York
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Massachusetts - Connecticut - Vermont (8)
North
Carolina
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News Stories
About Kaiser Permanente From Areas
that Kaiser was kicked out of!
Did you know
that Kaiser had a total of 124,000 enrollees,
Kaiser Texas
"We basically said to the doctors, `If you value your job, you won't
say anything about hospitalization.' All you'll say is, `I think you
need
further evaluation..."The first thing that ever comes out of a Kaiser
CEO
now is what's the bottom line," Vogt said on a videotape of his speech.
"Anytime you have to balance the budget, how do you do it? You cut
utilization,
drop referral rates, and drop your hospitalization."
"The
reason we're revising that protocol now is
because our utilization
exploded" Vogt said. "The cost of dropping it to only one missed heart
attack was tripling our hospital days."
https://kaiserpapers.com/news/texasbadheart.html
Fort Worth
Star-Telegram - Thursday, March 27, 1997
AUSTIN - Attorney General Dan Morales has chided
the Kaiser Permanente health maintenance organization for trying to
"harass and intimidate state officials and public employees" in its
battle with insurance regulators.
Read full article at: https://kaiserpapers.com/news/attorney-general-texas-kaiser.html
1997 - DALLAS --
An HMO has agreed to pay $5.35 million to a family
who claimed that medical cost-cutting led to a man's death from
untreated
heart disease.
Lawyers for
the family of Ronald Henderson alleged that
a plan by Kaiser Permanente's North Texas HMO to cut hospital expenses
by 45 percent, plus an HMO official's speech that stressed putting
``the
bottom line'' first, led to the 56-year-old man's death.
https://kaiserpapers.com/horror/heart/corpuscristi.html
Fines and
related articles
https://kaiserpapers.com/fines/#Texas
DALLAS
-- Kaiser Permanente - An HMO has agreed to pay $5.35 million to a
family
who claimed that medical cost-cutting led to a man's death from
untreated
heart disease.
Lawyers for the family of Ronald Henderson alleged
that
a plan by Kaiser Permanente's North Texas HMO to cut hospital expenses
by 45 percent, plus an HMO official's speech that stressed putting
``the
bottom line'' first, led to the 56-year-old man's death.
The
HMO agreed to the settlement Tuesday after a test
jury in a novel nonbinding minitrial said it would have awarded the
family
more than 10 times that amount if the case had gone to an actual trial.
https://kaiserpapers.com/horror/heart/tex2116.html
Managed Care Insurer Liability : The Texas
Law
Explanations
on how the state of Texas has handled HMO issues more productively,
more fairly, for proactively for the patient than other areas.
Care Versus
Cost
Nation’s
Wealthiest HMO Leaves Jury Outraged
Feb. 13,
1998
FORREST SAWYER
It begins
with a malpractice lawsuit in Texas, a family claiming the negligence
of the country’s largest HMO,
Kaiser Permanente, left their loved one dead. During the trial,
startling
evidence emerged, an internal speech by a Kaiser
administrator. The administrator painted a picture of a company that
appeared willing
to risk placing profit above patient welfare. Together with the rest of
the
evidence, the speech stunned jurors and helped drive Kaiser to settle
the
lawsuit for
millions.
https://kaiserpapers.com/horror/drophospitalization.html
HOW
KAISER'S COST-SLASHING NICKED ITS IMAGE - Texas
SHUTTERED HOSPITALS.
Meanwhile, Texas State
Attorney General Dan Morales says there are
''sufficient grounds and
justification'' for
the state to yank Kaiser's HMO license.
October 31,
1998 Sierra
Health
Subsidiary Completes Purchase of Kaiser Southwest; Texas Health Choice
Will Be New Name
https://kaiserpapers.com/news/texsierra.html
Kaiser
Permanente and TDI Settle Dispute
April 18,
1997
Return to
Index
Kaiser
Foundation Health Plan of Texas agreed today to drop its lawsuit
against the Texas Department of Insurance, pay a $1 million fine and
take
specific steps to assure high-quality patient care for its 124,000
enrollees.
https://kaiserpapers.com/news/kaisergiveuptexas.html
Kaiser New
York - Kaiser Massachusetts
- Kaiser Connecticut
- Kaiser Vermont
[Kaiser Permanente/Community Health Plan of New York (enrollment codes
PW and QB) will be
acquired and administered by Capital District Physicians Health Plan
(CDPHP), enrollment code
SG.
CDPHP applied for and received approval for all counties within Kaiser
Permanente/Community Health Plan’s service area. The state of New York
approved all of those counties except Clinton and Sullivan (PW)
Counties, and Putnam (QB) County. CDPHP is therefore not authorized to
operate a health plan in those counties.]
https://kaiserpapers.com/pdfs/dec-11-1999.pdf
Spring, 1999
HMO FOUND NOT RESPONSIBLE FOR CLERK’S LEAK OF
PATIENT INFORMATION
In a recent court decision in New York, Kaiser
Permanente/Community
Health Plan was found not responsible for violation of a patient’s
confidential
information by one of its file clerks (Melissa Grace, “State judge
rejects
claim against CHP,” Albany Times Union, April 14, 1999). The clerk had
told people at a party that the patient was a lesbian, which she had
learned
from the records of a Kaiser social worker who was counseling the
patient.
Kaiser was off the hook legally because Kaiser had provided training to
its employees about the need to protect patient information in
confidential
files at the HMO. Further, according to New York law employers are not
liable for their employees’ conduct unless the conduct was in
furtherance
of the employers’ interests , and the clerk was not acting within the
scope
of her duties. The decision is being appealed.
CCEMHC takes the position that such information,
obtained in the
process
of mental health care, should not be in patient-identifiable records at
HMOs in the first place. Nor should clerks have access to the
information.
May 13, 1999 - The
New York state attorney general's office is investigating some
managed-care plans for possibly violating a state law by telling
patients and doctors that patients must first get approval from their
primarycare doctor to be covered for an emergency-room visit.
The HMOs, which include Oxford Health Plans Inc.,
Cigna Corp.'s Cigna HealthCare unit and Kaiser
Permanente's
Northeast health plan, have received subpoenas, the attorney general's
office said. The office is seeking materials that it believes would
show violations of the socalled "prudent layperson" standard of a 1996
state patient's rights law.
https://kaiserpapers.com/news/subpoena-in-new-york.html
http://www.health.ny.gov/press/releases/1999/kaiser.htm
Statement on Decision of Kaiser Permanente to Leave New York and Its
Northeast Market
Albany, June 18 – The New York State Department of Health has been
notified by Kaiser Permanente, a managed care organization licensed
under Article 43 of New York State Insurance Law and Article 44 of New
York State Public Health Law, that it intends to cease operation in New
York and three neighboring states by December 31, 1999.
The Department was notified yesterday by the company of its decision.
The State Health Department will work with Kaiser Permanente to effect
a smooth transition for the plan's 285,000 enrollees in New York State,
and to ensure that they continue to have access to care. Ideally,
Kaiser's provider network will continue to be available to Kaiser
members after the transition period, through provider contracts with
other insurers or acquisition of the company's provider network by
another health plan.
Kaiser Pemanente has been a quality provider of managed care in New
York State, and we expect that the company's commitment to its members
will continue through the transition period. Currently, Kaiser is
working with the providers who staff its health clinics to form
independent provider groups which will be able to contract with other
health plans.
The State Health Department, along with the State Insurance Department,
must approve any proposed transaction for transfer of Kaiser
Permanente's New York assets to another managed care organization.
Among the factors the Department will review before approving a sale is
whether there would continue to be sufficient provider network capacity
for current Kaiser enrollees under the new health plan.
6/18/99-63 OPA
Kaiser is leaving not just Vermont,
but all of New England 100,000 customers here are a small piece of the
puzzle. That said, Kaiser lost millions of dollars
in
Vermont and was gaining a reputation for less-than-perfect customer
service. In a competitive world, those are the companies that do not
and should not survive.
https://kaiserpapers.com/news/kaiserleavesvermont.html
Rude
Awakening When Kaiser Retreats
By
the end of 1999, Kaiser Permanente is leaving western
Massachusetts, two regions in New York, parts of Connecticut and all of
Vermont.
.....The
era of having group practices exclusive to one insurer has
probably passed.
https://kaiserpapers.com/news/odato.html
Kaiser
Permanente Pulls out of Kansas City several fines and sanctions on this
web page.
https://kaiserpapers.com/news/kansascity1.html
Kaiser
vs Director of Revenue State of Missouri - Kaiser advised
that
they do have to pay sales tax and cannot get a refund.
http://tinyurl.com/2evv9z
and http://www.oa.mo.gov/ahc/case/KaiserFoundationHealthPlanOfKC01-1135RV.KAW.doc
North
Carolina
There
is lots of good
information on the entire Kaiser system, and why
they failed in so many areas in this following document from the
university
of North Carolina.
http://www.unc.edu/~danielg/research_projects/kaiser.pdf
The
Rise and Fall of a Kaiser Permanente Expansion Region
From The Insider - The
North
Carolina State Government News Service
V. 4, No.
93 Monday, May 13, 1996 18 pages
HMO LAWSUITS RAISE ISSUES: Kaiser Foundation Health Plan of North
Carolina,
the first large, out-of-state HMO to tap the N.C. market in 1985, has
grappled
with a spate of patient lawsuits in recent years.
https://kaiserpapers.com/news/morethanany.html
RALEIGH,
N.C.--(BW HealthWire)--Aug. 17, 1999--
The Carolina
Permanente Medical Group Also Signs Agreement
With PARTNERS
Enabling Members to Continue Receiving Care
From Their
Permanente Physicians After the Sale
PARTNERS
National Health Plans of North Carolina Inc. has signed a
definitive sale agreement with Kaiser Foundation Health Plan to
transfer Kaiser's employer-sponsored and Medicare membership in the
Raleigh-Durham-Chapel Hill area to PARTNERS.
PARTNERS, a
subsidiary of Novant Health Inc., is based in
Winston-Salem, N.C. The sale is expected to close on or before December
31, contingent upon regulatory and other customary approvals. Financial
terms were not disclosed.
http://findarticles.com/p/articles/mi_m0EIN/is_1999_August_17/ai_55467652
The Rise and
Fall of a Kaiser Permanente Expansion Region
The Milbank Quarterly
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690244/
..........we examine the rise and fall of the Kaiser Permanente (KP)
expansion effort in North Carolina in order to gain insight into making
prepaid group practice work. We trace and analyze the key events in the
North Carolina KP's entry and start-up, its performance and growth over
time, and its exit. We use interview data collected from former and
current KP national, regional, and local managers; North Carolina
public officials; state and national health care experts; and
supplemental analyses of enrollment, financial, and other secondary
data. We conclude that KP's failed North Carolina expansion resulted
not from an inherent flaw in the PGP model but from a complex
interaction of political, economic, and organizational factors.
Finally, we offer some policy recommendations for PGPs’ role in future
reform efforts. We believe that PGPs should still remain of special
interest to those reformers who see the health system changing through
marketplace competition.
The Origins of Kaiser Permanente's
Expansion into North Carolina
Kaiser Permanente (KP) began on
the West Coast as a company-funded and company-managed means of
providing medical care services to workers in Henry J. Kaiser's
industrial enterprises. Its corporate headquarters began and remain in
Oakland, California. By 1955, KP had a major presence in three regions
(Northern California, Southern California, and Oregon), with a growing
network of hospitals and clinics and a combined membership of 500,000.
KP expanded to Hawaii in 1958 and a decade later established regions in
Colorado (1969) and Ohio (1969). After the passage of the Health
Maintenance Organization Act in 1973, the KP plans in all six regions
became federally qualified HMOs. By the early 1980s, KP had additional
regions in Texas (1979), the greater Washington, D.C., metropolitan
area (1980), and greater Hartford, Connecticut (1982). The plan in
Texas began as a 50–50 joint venture of KP and Prudential, and in 1983
KP took over Prudential's interest. KP tried (and failed) to acquire a
plan in Chicago but eventually bought an existing plan in Kansas City.
Whereas our interview
participants described KP's earlier expansions as “opportunistic,” KP's
expansion into the Southeast appeared to be more purposeful. KP wanted
a national presence in order to compete more effectively for national
corporate accounts and to position itself more favorably in the event
of national health care reform. Accordingly, it chose to expand in
regions where it did not have a presence, namely, the South. KP
conducted comprehensive analyses of several markets in the South and
Midwest and narrowed its final expansion choices to Raleigh-Durham,
North Carolina, and Atlanta, Georgia. Because half the organization's
joint national health plan/physician leadership committee preferred one
market, and the other half preferred the other market, KP decided to
enter both markets (KP
Institute 2002).
At the same time that KP was
trying to expand regionally, elected officials and policy reformers in
North Carolina were trying to make the state an attractive operating
environment for health care delivery systems that were not
fee-for-service plans. Impressed by the cost-containment achievements
of PGPs such as Kaiser Permanente, the Group Health Cooperative of
Puget Sound, and the Health Insurance Plan of New York, Congress had
already passed the Health Maintenance Organization Act in 1973. The act
defined HMOs, provided grants and loans for the start-ups of nonprofit
HMOs, and required all employers of 25 or more employees to offer at
least one PGP and one Independent Practice Association–based HMO as
health insurance options wherever they were available and desired. This
requirement was a big boost to the development of HMOs, including PGPs,
and a spark for state-level reforms in the late 1970s and early 1980s.
Please read more at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690244/
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