Kaiser California Medical Insurance Plans

Kaiser Permanente, offered by BenefitsCafe.com

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Kaiser Permanente is the largest insurer in the state by enrollment, covering over 6.1 million Californians.  Kaiser is unique among California insurance companies in that the doctors, hospitals and insurance company are all one entity.  They share common incentives which is to keep patients healthy vs. other, decentralized systems where each person who treats a patient may try to maximize their profit in a visit.  In the Kaiser system, the doctors share medical information in a cutting edge, multi-billion dollar electronic medical record system.  This enables doctors to collaborate and consult on patient care and it eliminates the need for duplicate tests.  Because Kaiser is a “comprehensive health care delivery system” it offers rich benefit plans at extremely low rates.

People feel passionately about Kaiser: they seem to either love it or they hate it. Regardless of your personal feelings, as someone considering benefits for your employees, you should take a close look at Kaiser. Also, Kaiser has made massive changes over the last decade; built dozens of hospitals and medical facilities; and it is a different company from what you may have known or heard from people who used the system years ago.

The Brookings Institution has an excellent overview of Kaiser, in its report, Kaiser Permanente – California: A Model for Integrated Care for the Ill and Injured. The short report begins with this description:

Kaiser Permanente (KP) is the nation’s largest nonprofit integrated health care system with over 9.6 million members (nationwide). KP-California consists of the Northern and Southern California Regions. KP is a pre-paid integrated system consisting of three distinctly separate, but related entities: a health plan that bears insurance risk, medical groups of physicians, and a hospital system. The financial incentive is to provide high quality, affordable care and manage population health rather than generating high volume of compensable services. Both the health plan and the medical group are aligned and accountable for a global budget, and only contract directly with one another for the provision of medical services. All three entities share in the goal, reflected in the organization’s capitated payment system, of keeping patients healthy while optimizing utilization. This alignment is crucial in KP’s effort to maintain affordability for their purchasers and members.

Love it or hate it, you should be glad that Kaiser is an option in California. Their rates are less than other HMO plans and they put downward pressure on the rates of other insurance companies.

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