Kaiser vs Blue Shield

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vv19
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Kaiser vs Blue Shield

Post by vv19 »

I am changing my job next month and the new employer has option of choosing between Kaiser and BS CA. Can anyone share their experiences with those two and help me choose the right one? FWIW, I live in Northern CA and both my wife and I are pretty healthy (haven't had a doctor's appointment for the last 3 years except for annual physicals).
billern
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Re: Kaiser vs Blue Shield

Post by billern »

I've have had good experiences with Kaiser in Sonoma County. Not everyone likes the Kaiser system.I like not having to deal with or worry about whether something is in network or not. Go to a Kaiser facility and you are guaranteed not to run into out of network issues.

When looking at insurance, there are other financial factors that are important. The monthly premium you pay, the coverage, limits, etc all should play a part in your decision.
Topic Author
vv19
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Re: Kaiser vs Blue Shield

Post by vv19 »

If I look at purely financial terms, then Kaiser is cheaper. Kaiser's deductible is 2500, Shield's is 4000. Kaiser monthly premium is also about $15 cheaper.
chaz
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Re: Kaiser vs Blue Shield

Post by chaz »

Kaiser has been very good for my family.
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jbuzolich
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Re: Kaiser vs Blue Shield

Post by jbuzolich »

Also agree, Kaiser has been very good to my family and to my parents. I guess we may have always had what would be considered platinum level coverage today but we have never paid much of anything out of pocket. A couple hundred here or there at most. We've had hospital stays, the birth of a child, and one of my medications is retail over $4k monthly. Only minor copays and that's it.
fareastwarriors
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Re: Kaiser vs Blue Shield

Post by fareastwarriors »

I heard good things about Kaiser from friends/family.
Busting Myths
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Re: Kaiser vs Blue Shield

Post by Busting Myths »

There is a foundation in California that collects data to rate different medical groups. I have not looked into it much but it may be of help to you.
http://www.calqualitycare.org/

The group above paired up with Consumer Reports to put ratings which showed Kaiser with high ratings in most California regions.
http://www.calqualitycare.org/~/media/f ... 022k14.pdf

As a personal note I had Kaiser before switching to my current employer's coverage (Health Net). I really do miss Kaiser's integration of different services and not having to worry about finding some specialist if I needed them. I am not a big fan of PPO as you have to find the right medical group first then the right primary care physician or vice versa which adds another layer of complications. My doctor works only four days of week and if I need something after hours its pretty much "go to urgent care". The Kaiser has much better hours and more physicians on hand for the routine stuff.
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JMacDonald
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Re: Kaiser vs Blue Shield

Post by JMacDonald »

I moved from Blue Shield to Kaiser in SoCal about 9 years ago. It was a good move. Kaiser is big on preventative medicine. That makes sense for both the patient and the bottom line for Kaiser. I am very happy with Kaiser and would be reluctant to move to an area without Kaiser
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Snapper
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Re: Kaiser vs Blue Shield

Post by Snapper »

My family has had Kaiser for many years. We are very happy with them. Many of the issues that once put people off are history. We have always liked the focus on wellness and the fact that there is no incentive to run unneeded tests or perform unneeded procedures to jack up fees for doctors and specialists. If you check Consumer Reports you will find satisfaction with Kaiser about the highest of any system.
Ron Ronnerson
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Re: Kaiser vs Blue Shield

Post by Ron Ronnerson »

I'm in Northern CA as well and have had both Kaiser and Blue Shield. I currently have Blue Shield through the Covered CA Exchange. Wife has Kaiser through the exchange. I always have to check as to whether a doctor, etc. is in network or not. Wife doesn't have to worry; as long as she goes to a Kaiser, everything is in-network. I plan to switch to Kaiser in the near future. Only negative is that the nearest Kaiser hospital from us can take 45 minutes to get to during busy traffic times.
DFrank
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Re: Kaiser vs Blue Shield

Post by DFrank »

Personally, I am not a fan of HMOs. Should I be unfortunate enough to have to deal with a serious illness, I would rather have the flexibility to go to the best doctor I can find for the particular health issue in question and obtain at least some level of reimbursement. With an HMO like Kaiser you either stay within Kaiser, or you pay 100% of the costs.

As a general matter, I don't think health care decisions should automatically go to the low cost option unless that's all that can be afforded in a specific instance. Sometimes you do get what you pay for.

My mother in law was covered by Kaiser. She went in to see her doctor about a persistent cough, they took chest X-Rays, and found lung cancer. They went back and reviewed the X-Rays from two years prior, and found the cancer in those as well. She was stage 4 when diagnosed. There is no way of knowing for sure whether she would have been at a more treatable stage had they read the original X-Rays correctly, but we do wonder. I know this is anecdotal information, but it's enough for me to say that I would never choose Kaiser if given another reasonable alternative.

I've been covered by Blue Shield CA for many years now, and have been quite happy with them.

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AnimalCrackers
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Re: Kaiser vs Blue Shield

Post by AnimalCrackers »

billern wrote:I like not having to deal with or worry about whether something is in network or not. Go to a Kaiser facility and you are guaranteed not to run into out of network issues.
I place a high value on avoiding costly out of network surprises, too, and my family has been happy with Kaiser for seven years.
"Everybody has a plan until they get punched in the face." -- philosopher Mike Tyson
oxothuk
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Re: Kaiser vs Blue Shield

Post by oxothuk »

DFrank wrote:Personally, I am not a fan of HMOs.
Kaiser is one thing. All of the other plans that go under the rubric "HMO" are quite another.

I've had Kaiser for 36 years and had only good experiences with them. This includes the whole range from kids' ear infections to an angiogram I had last year. I've never once felt like they held back any reasonable treatment in order to save money. YMMV.

The best strength of Kaiser, IMHO, is that their practitioners work as a team and provide continuity of care from one episode to another. I'm not constantly filling out forms to recap my medical history to some new office. Also, I don't have to worry about whether my doctor will or won't be part of their network next year.

The main weakness of Kaiser is their limited geographical coverage. Fortunately it covers where I live and visit most often.
123
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Re: Kaiser vs Blue Shield

Post by 123 »

I've used Kaiser for over 20 years while my spouse uses Blue Shield. I am baffled how anyone who had any appreciation of how well Kaiser runs would opt for Blue Shield. At Kaiser if you need a blood test you walk into a lab at one of their sites and get it done (maybe even at 7 am on a weekend morning). With its electronic integration the Kaiser lab knows why you're there. With Blue Shield each lab visit can be a separate appointment and billing adventure with an independent lab. They can't do anything without that prescription for lab work from your physician. Need a medical procedure? At Kaiser it gets on the schedule, you go in, and it gets done. With Blue Shield there can be multiple providers for the same procedure, a doctor, a facility/hospital, maybe an additional doctor or anesthesiologist, and a device provider for certain kinds of surgeries. Easily 3 or 4 different paperwork/billing steams with you in the middle. Kaiser is far more integrated. Medical records sharing is exceptionally easy at Kaiser, can be a major hurdle when your care requires multiple independent providers using Blue Shield.

Need a prescription? With Kaiser's electronic records the physician enters it and its often ready as soon as you can get to the pharmacy in the medical center. Do you like to deal with a lot of coordination issues between your physician and a pharmacy? Well, then an independent pharmacy plan along with your Blue Shield coverage may keep you busy. I have to admit though that significant strides have been made by the independent pharmacy benefit plans in recent years.
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General Disarray
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Re: Kaiser vs Blue Shield

Post by General Disarray »

Another vote for Kaiser. When I lived in Southern California, I used Blue Cross/Blue Shield (both as an HMO and PPO) and also Kaiser--all with different employers. Blue Cross/Blue Shield was a pain in the ass. It was incredibly bureaucratic and inefficient, and I used to get bills from them all the time for even routine exams that I thought were fully covered. With Kaiser, I experienced none of this. My experience with Kaiser was positive and I have yet to see this replicated anywhere: Everything was quick, easy, and painless. As a number of posters mention, having an integrated system really makes things run smoother, allowing for a happier patient experience with the health care system.
madbrain
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Re: Kaiser vs Blue Shield

Post by madbrain »

DFrank wrote:Personally, I am not a fan of HMOs. Should I be unfortunate enough to have to deal with a serious illness, I would rather have the flexibility to go to the best doctor I can find for the particular health issue in question and obtain at least some level of reimbursement. With an HMO like Kaiser you either stay within Kaiser, or you pay 100% of the costs.
I am with Kaiser in Northern California and I have had HIV for 8 years. My primary physician is also an HIV specialist, and he is a great doctor. I am very happy with Kaiser in general, in Northern California.
The premiums (employer based) are also the lowest of any of the choices we have. And the copays are very low. The only thing Kaiser is not good for in my experience is mental health services.
DFrank
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Re: Kaiser vs Blue Shield

Post by DFrank »

oxothuk wrote:
DFrank wrote:Personally, I am not a fan of HMOs.
Kaiser is one thing. All of the other plans that go under the rubric "HMO" are quite another.
Well, make no mistake about it, Kaiser is an HMO. I agree they are more integrated than other HMOs that work through a network of providers.

Regardless, they are all the same in one key respect: Either you stay within the network, or you pay 100% of your medical costs. If you find it acceptable to be limited to choosing doctors within that network in order to obtain any reimbursement of your medical costs, then an HMO may be for you. When I was young I too chose HMO coverage for the convenience, and as several have pointed out the lack of cost surprises. In my youth I had little expectation of serious medical issues.

As I've grown older and watched both my parents encounter health issues that are best dealt with by true specialists that aren't in any HMO network, my priorities have changed. I place much less priority on the ease of access for routine medical issues, and even less priority on whether my deductible is $3k or $4k. It's much more important to me to know that if I want to go to one of the top specialists in the country for a particular medical issue I can do that and get some level of reimbursement.
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craiggsean
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Re: Kaiser vs Blue Shield

Post by craiggsean »

Same here. KP has few choices of specialists. I know quite a few stories of folks who had misdiagnosis. If you can afford it, go with BCBS and you have access to more specialists and motivated physicians.
Busting Myths
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Re: Kaiser vs Blue Shield

Post by Busting Myths »

craiggsean wrote:Same here. KP has few choices of specialists. I know quite a few stories of folks who had misdiagnosis. If you can afford it, go with BCBS and you have access to more specialists and motivated physicians.
Is there any evidence suggesting KP has higher misdiagnosis rates than other health providers? I see this point come up often from the anti-Kaiser group but never any hard data to back up the claim.
craiggsean
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Re: Kaiser vs Blue Shield

Post by craiggsean »

I like your ID. :wink:
I only have anecdotes from families and friends. Enough for me.
Not anti-KP, by the way.
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Tortoise
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Re: Kaiser vs Blue Shield

Post by Tortoise »

My family uses Kaiser. Our plan, provided through our work, does not have a deductible. Our co-pays are $15 per doctor visit, although my co-pays are often waived. We have to pay a little for drugs, but it is typically on the order of $10 for a bottle of prescription meds.

We like the integration of Kaiser. Most every type of treatment is available in-house, and your medical records are available to all doctors and nurses in the centralized database. I had a Basal Cell Carcinoma on my forehead that my doctor noticed during a checkup. She sent me down the hall to see a dermatologist. The dermatologist agreed that it was a Basal Cell Carcinoma. They then made a MOHS surgery appointment for me. The Basal Cell cancer was then removed.

For treatments that are not available in-house, Kaiser will work with other providers to supply the treatment you need. Case in point: I have Multiple Myeloma, which is a cancer of the blood plasma. One of the ways to combat Myeloma is with a bone marrow stem cell transplant. Kaiser does not have the equipment to do this, but Stanford University Medical Center does. I was therefore sent to Stanford for my transplant. Kaiser paid for all treatment at Stanford.

The transplant was only marginally successful, and the Myeloma cancer came back after 4 months. I was getting chemotherapy injections at Kaiser before, and now after, the transplant. I do not pay anything for my weekly lab work and chemotherapy injections at Kaiser. I pay $10 per month for chemo pills that I also take once a week.
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davebarnes
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Kaiser

Post by davebarnes »

I really like Kaiser.
I just went through treatment for colon cancer (finished chemo on 29JUL2014).
Excellent service.
All your records are electronic and all your docs have access to them.
The docs know each other. Personally.
All my docs responded quickly to emails.

The only negative I have is that they won't send me PDFs (some sort of stupid HIPAA issue) even though I don't give a crap about privacy.
A nerd living in Denver
DFrank
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Re: Kaiser vs Blue Shield

Post by DFrank »

A number of folks have talked about some benefits of Kaiser being the sort of seamless treatment enabled by electronic medical records, ease of being referred to a specialist, prescriptions being sent to the pharmacy electronically so they are ready when you arrive there, and so on.

Those benefits are not unique to Kaiser. I am a BCBS customer, and I get all my routine medical care (which practically speaking means all my medical care to date - knock on wood) through a regional medical care company. They have a couple major hospitals in the area, a number of smaller doctor's offices, and a significant number of specialists on staff. They have electronic medical records across the company, so whether I am seeing my primary care physician in the local office, or a specialist somewhere else, they all have access to my medical record. I also have access to my complete medical record through an on-line tool which also has capabilities for HIPPA compliant private electronic communications with my doctor and/or nurse practitioners in his office. They send prescriptions to my local pharmacy, and they are often ready in the time it tales to drive from my doctor's office to the pharmacy on the way home. So, point being, many of those benefits can be obtained if you are with the right medical care company who is providing care on behalf of BCBS.

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dm200
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Re: Kaiser vs Blue Shield

Post by dm200 »

My wife and I (and our son, before he aged out) have been on Kaiser (Washington DC area) for about half of the last almost 40 years. The only reason we ever left Kaiser was due to employment change where Kaiser was not an option. I am back on Kaiser's Medicare plan - and my wife has a Kaiser ACA plan.

Kaiser plans have differences in every location, but the general structure is the same - Kaiser is both a provider and insurer. In most cases, you will receive health/medical services from a Kaiser facility. I am a huge fan of Kaiser for the following reasons (not necessarily in order of importance):
1. It is my opinion that Kaiser screens out Physicians that have low competency (or are "quacks"). I have high confidence that any Kaiser physician is competent.
2. I have never experienced Kaiser withholding tests, procedures, access to specialists, etc. that I believed were medically or health warranted. On the contrary, on several occasions, Kaiser did more than similar situations when on other plans.
3. When a specialist is needed, Kaiser finds one and makes the referral. Really easy. Once you have been referred to a Kaiser specialist by your primary care physician, you normally do not need to go back to the primary care physician for future appointments with the specialist. So, for example, when my primary care doctor referred me to dermatology for a skin cancer checkup - and the dermatologist says, "I want to see you back in a year" - you just make that appointment the next year with the dermatologist. Now, with email access - you can email all of your physicians directly.
4. I have not done this, but if you want to change to a different primary care physician - you just do it - either online or with a phone call.
5. Especially when our son was little, the advice nurse phone line was a great resource.
6. This varies by location, but here Kaiser has "Urgent care" facilities open all the time, and they can handle almost anything. The "Clinical decision unit" right there can keep parents up to 24 hours for treatment/observation. Much, much less expensive than emergency room at a hospital and they have access to all records online. For example, last year my doctor was concerned (I was not) that I might have had or be having a heart attack (or something similar). She called me at 5 pm to check in - and I spent the next 18 hours there (inside just like a hospital) - had chest X-ray, 2 or 3 blood tests, hooked up to EKG type monitor - treadmill stress test the next day with review by cardiologist - the total I paid was $60! [$30 copay checking in and $30 copay for cardiologist]. Bottom line - absolutely nothing wrong with my heart.
7. Today, I can do about half (depending on the 'details') of interaction with my primary care doctor by email (NO CHARGE) or an occasional telephone apt (NO CHARGE). I communicate with the doctor - almost never a technician, nurse, etc. I can even attach a picture with the email.
8. All records are electronic - no carrying paper to a specialist appt. Specialists do not need to run their own duplicate tests - because they can access all test results.

In evaluating the costs of Kaiser vs. BCBS - I suggest that (depending on Kaiser in your area) you try to factor in fewer "charged" appointments with doctors because with Kaiser you may be able to do much by email, etc.
chuppi
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Re: Kaiser vs Blue Shield

Post by chuppi »

I have experience with both. I have used both and currently I am with Kaiser. I prefer Kaiser here are the positives for Kaiser
- Cheaper premium as others have noted.
- Birth of my first child was with BCBS insurance and cost came to around 4-5K out of pocket. Some complication, little longer hospital stay, etc... Second child at Kaiser and total cost was 20$ copay on the first appointment.
- With the PPO, its indirect payment and so hospitals/physicians try to game the system. We had an experience where doctors called us for a second appointment just to say everything is normal. You pay copay and they bill the insurance company. With Kaiser, they would just sent an email and you can correspond with them by email if you have questions. Saves money and time.
- Emergency room visit is 35$ copay (this may be dependent on the plan) and thats it. Had to go there 3 times in the last 2 years with my young children. All the times the wait time was not more than 15-20minutes.
- Kaiser is big on preventative care. They basically want to avoid future doctor visits as much as possible and it is mutually beneficial. All vaccinations are free of cost I believe.
- Saves time. Email doctors and they respond within 24hours. No need for doctor visit. You can call the nurse 24/7 and they can consult doctors and get back to you if needed. They suggest next steps which might even be a doctor visit or emergency room visit. Usually you go to a big Kaiser hospital. All tests (x-ray, blood test, etc...) can be done in one place. They share your medical record electronically. It is so efficient. I can login to my account and check my old medical records anytime.

Whats the negative for Kaiser?
You have a primary physician and he/she is your primary contact. You can of course choose your primary physician or switch to another physician anytime. Primary Physician directs you to other Specialists when needed. Supposing they recommend that you see a cardiologist, you can choose from a few who work for Kaiser. You cannot go to that highly rated cardiologist outside of Kaiser. It does not matter to me much at this stage. Generally doctors want to help patients and thats why they get into the profession. They have a usual protocol that they follow. Sure some are more pleasant and better than others. But I feel that I will never be able to pick the right one anyway if it really were up to me.
anncatchingup
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Re: Kaiser vs Blue Shield

Post by anncatchingup »

I worked for nearly 30 years in the acute healthcare field, first as a nurse and later in the quality assurance, utilization review, and medical staff services departments. I worked in small and large community and private hospitals and saw the good, bad, and ugly in healthcare. In fact, part of my job was to help identify the bad and make sure it was addressed. In those days, my insurance was always covered by my employer and I could go to whoever I wanted to. I'm out of that field now, but I feel that my experience made me a more knowledgeable and discriminating healthcare consumer. For the past 14 years I've been covered by Kaiser in the Sacramento, California area. My husband and I are pretty fit and active, however we still have utilized their services for routine and preventive care, trauma care, acute illnesses, and several surgeries; the most recent being my husband's total hip replacement. We have never had a problem getting the care or seeing the specialists we needed in a timely manner. We are very, very happy with Kaiser. We now have Kaiser Senior Advantage and have no intention of changing.

Ann
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JMacDonald
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Re: Kaiser vs Blue Shield

Post by JMacDonald »

anncatchingup wrote:I worked for nearly 30 years in the acute healthcare field, first as a nurse and later in the quality assurance, utilization review, and medical staff services departments. I worked in small and large community and private hospitals and saw the good, bad, and ugly in healthcare. In fact, part of my job was to help identify the bad and make sure it was addressed. In those days, my insurance was always covered by my employer and I could go to whoever I wanted to. I'm out of that field now, but I feel that my experience made me a more knowledgeable and discriminating healthcare consumer. For the past 14 years I've been covered by Kaiser in the Sacramento, California area. My husband and I are pretty fit and active, however we still have utilized their services for routine and preventive care, trauma care, acute illnesses, and several surgeries; the most recent being my husband's total hip replacement. We have never had a problem getting the care or seeing the specialists we needed in a timely manner. We are very, very happy with Kaiser. We now have Kaiser Senior Advantage and have no intention of changing.

Ann
Before I moved to Kaiser about nine years ago from Blue Shield, I asked a friend of mine who had worked for Kaiser as a nurse at one time if she would recommend Kaiser. She told me yes. She said she was disappointed that her new job working for an oncologist did not have Kaiser as an option. That convince me to make the change, and I am happy I did.

Here is an article about an unusual case being handled by Kaiser: http://www.latimes.com/local/lanow/la-m ... story.html
Sacramento Kaiser hospital treating patient possibly exposed to Ebola
Best Wishes, | Joe
Scal
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Re: Kaiser vs Blue Shield

Post by Scal »

Just switched from Blue Cross to Kaiser in January, purely for cost reasons. Other posts here have talked about the upsides of Kaiser, which I largely agree with. My only major issue with Kaiser? Get used to hearing the phrase "higher than expected call volume", because you will hear that every time you call.

With BC, we could reach our doctor's office or a night nurse any time of day. That's pretty nice when your small child has symptoms and your not sure if an ER visit is necessary.

With Kaiser, you'll spend a lot of time on hold. My wife is expecting our second child, and she started bleeding last Friday night. She called the main line, and after describing her symptoms was told that she could expect a nurse to call back in an hour and a half! We ended up going to the ER, perhaps unnecessarily.

Also note that there is basically one number for everything. God help you if you accidentally get disconnected when you finally reach the person you need to talk to. Have fun waiting for another hour on hold.

On the upside, many things can be done through the web. Also, we ended up having to fight BC on almost everything. Even routine labwork. So it's nice knowing that we don't have to put up with that anymore.
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Re: Kaiser vs Blue Shield

Post by bnes »

I've been with both.

Kaiser is far better integrated. Your doctor taps a few buttons and by the time to walk to the lab for tests, they know to expect you.
Preventative care is good. You may feel like, and are, a cog in the Kaiser machine... but it's a good machine.

Blue Cross is more typical. They make money when care is denied, and I had more paperwork and paperwork hassles.
oxothuk
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Re: Kaiser vs Blue Shield

Post by oxothuk »

Scal wrote:My only major issue with Kaiser? Get used to hearing the phrase "higher than expected call volume", because you will hear that every time you call.
That may be a regional issue. I've never had to wait on hold for more than 5 minutes (in Colorado).
Colorado14
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Re: Kaiser vs Blue Shield

Post by Colorado14 »

Given a choice, I'd go with Anthem BCBS over Kaiser in a heartbeat, but that's based on my CO experiences with both. Kaiser doctors (primary care, a specialist, and even the optometrist) were all sub-par, but I'm guessing there are some good ones out there and that there is quite a bit of variation. I'm a big fan of Anthem - good doctors, great customer service via phone, clearer billing practices, and did I mention better doctors?
chuppi
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Re: Kaiser vs Blue Shield

Post by chuppi »

oxothuk wrote:
Scal wrote:My only major issue with Kaiser? Get used to hearing the phrase "higher than expected call volume", because you will hear that every time you call.
That may be a regional issue. I've never had to wait on hold for more than 5 minutes (in Colorado).
Agree. Have made dozens of phone calls in the last 2 years and the wait is no more than 5minutes.
hicabob
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Re: Kaiser vs Blue Shield

Post by hicabob »

I had Kaiser a few years ago and now have BCBS. I miss Kaiser - it's a much better way to deliver health care imo.
TheGreyingDuke
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Re: Kaiser vs Blue Shield

Post by TheGreyingDuke »

Colorado13 wrote:Given a choice, I'd go with Anthem BCBS over Kaiser and did I mention better doctors?
Not sure how you evaluated that they were "better doctors". Research has shown that individuals are not very good at assessing the quality of their clinicians; they tend to focus on bedside manner (which is relevant for sure) rather than clinical expertise.

Give me the gruff, arrogant, expert surgeon :happy rather than the kind and solicitous surgeon who botches the procedure.

BTW, I have worked in numerous medical settings, including Kaiser, and there is no doubt that systems in place make more likely superior care. For sure there are other exigencies that might make another choice superior.

And referral to non-KP specialists is routine and in my experience has worked quite well.
"Every time I see an adult on a bicycle, I no longer despair for the future of the human race." H.G. Wells
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windhog
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Re: Kaiser vs Blue Shield

Post by windhog »

I believe I have something valuable to add, but it’s possible that some might think this post is too political. I will do my best to be even-handed.

I am retired from a thirty-year career as a medical subspecialist, and have worked in a group practice, a university practice and a solo shop. In my last practice iteration I had minimal insulation from the vagaries of managed care, since my spouse was my biller and insurance company contact. ‘Nuf said?

My impression of Kaiser is limited, and I am not surprised at the number of positive responses in this thread. Kaiser is rather unique, being an organization conceptualized and built as an integrated health insurance system of both insurance and medical practice under one roof. I would suggest that it is probably the best-integrated HMO business around, with a single Electronic Medical Record (EMR) and uniformly streamlined pathways for patient access. I have no doubt it is user-friendly and generates high levels of satisfaction for people who are fundamentally healthy and whose needs are intermittent and of low complexity. I find it interesting that none of the Kaiser-favorable responders have reported on long-term disease management problems. If anyone can comment on this experience, I would be delighted to hear of it.

My first contact with Kaiser happened early in my career, when I was searching for a job. My subspecialty is one that has historically required one full-time practitioner for a service population of 125,000 covered lives. When I inquired about the staffing of the Kaiser plan in the Denver area (admittedly 30 years ago) I learned that their covered population was on the order of 250,000 lives. They had no one in my field on staff and had no interest in recruiting anyone. Hmmm.

I had no professional contact with Kaiser patients until I relocated to the west coast. I then had the opportunity to assume care of a few folks who had chronic conditions that ideally should have had at least semi-annual check-ups with the appropriate subspecialist. In fact, those patients were getting all of their routine care by non-physician extenders while covered by Kaiser. Thus, my bias, that the Kaiser system does a great job with primary and routine care and has a blind spot for the needs of the minority with serious chronic diseases. I worry most that the primary care provider will not recognize the need for a subspecialist, and that the Kaiser deck is stacked against this option.

Moving on to BC/BS, I find it hard to say anything good about the indemnity medical insurance industry, of which I consider Blue Cross/Blue Shield to be a prime example. The only plus that emerges when compared to Kaiser is the coverage to see the top-notch university guru when you really need him/her, whether the need is a one-time second opinion or life-long care.

So which option would I suggest? I would hold my nose and buy the insurance coverage you hope to never need: just like you buy life insurance, flood insurance and disability insurance. Or, you can opt for the convenient drive through and hope you never need anything more. You will probably be OK. :shock:

I hope this helps.

Paul
DFrank
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Re: Kaiser vs Blue Shield

Post by DFrank »

windhog wrote:So which option would I suggest? I would hold my nose and buy the insurance coverage you hope to never need: just like you buy life insurance, flood insurance and disability insurance. Or, you can opt for the convenient drive through and hope you never need anything more. You will probably be OK. :shock:
^ I agree with this.

Dave
Dave
oxothuk
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Re: Kaiser vs Blue Shield

Post by oxothuk »

windhog wrote:I find it interesting that none of the Kaiser-favorable responders have reported on long-term disease management problems.
I believe one of the earlier responders reported having HIV, which I would think qualifies under long-term disease management.
Minot
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Re: Kaiser vs Blue Shield

Post by Minot »

windhog wrote:I believe I have something valuable to add, but it’s possible that some might think this post is too political. I will do my best to be even-handed.

I am retired from a thirty-year career as a medical subspecialist, and have worked in a group practice, a university practice and a solo shop. In my last practice iteration I had minimal insulation from the vagaries of managed care, since my spouse was my biller and insurance company contact. ‘Nuf said?

My impression of Kaiser is limited, and I am not surprised at the number of positive responses in this thread. Kaiser is rather unique, being an organization conceptualized and built as an integrated health insurance system of both insurance and medical practice under one roof. I would suggest that it is probably the best-integrated HMO business around, with a single Electronic Medical Record (EMR) and uniformly streamlined pathways for patient access. I have no doubt it is user-friendly and generates high levels of satisfaction for people who are fundamentally healthy and whose needs are intermittent and of low complexity. I find it interesting that none of the Kaiser-favorable responders have reported on long-term disease management problems. If anyone can comment on this experience, I would be delighted to hear of it.

My first contact with Kaiser happened early in my career, when I was searching for a job. My subspecialty is one that has historically required one full-time practitioner for a service population of 125,000 covered lives. When I inquired about the staffing of the Kaiser plan in the Denver area (admittedly 30 years ago) I learned that their covered population was on the order of 250,000 lives. They had no one in my field on staff and had no interest in recruiting anyone. Hmmm.

I had no professional contact with Kaiser patients until I relocated to the west coast. I then had the opportunity to assume care of a few folks who had chronic conditions that ideally should have had at least semi-annual check-ups with the appropriate subspecialist. In fact, those patients were getting all of their routine care by non-physician extenders while covered by Kaiser. Thus, my bias, that the Kaiser system does a great job with primary and routine care and has a blind spot for the needs of the minority with serious chronic diseases. I worry most that the primary care provider will not recognize the need for a subspecialist, and that the Kaiser deck is stacked against this option.

Moving on to BC/BS, I find it hard to say anything good about the indemnity medical insurance industry, of which I consider Blue Cross/Blue Shield to be a prime example. The only plus that emerges when compared to Kaiser is the coverage to see the top-notch university guru when you really need him/her, whether the need is a one-time second opinion or life-long care.

So which option would I suggest? I would hold my nose and buy the insurance coverage you hope to never need: just like you buy life insurance, flood insurance and disability insurance. Or, you can opt for the convenient drive through and hope you never need anything more. You will probably be OK. :shock:

I hope this helps.

Paul
For another point of view:
Kaiser has had programs in place for several years managing chronically ill patients. But Kaiser's attempt to manage chronically ill patients has been the exception; most plans are only lately beginning to address chronic care management.
madbrain
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Re: Kaiser vs Blue Shield

Post by madbrain »

windhog wrote:I find it interesting that none of the Kaiser-favorable responders have reported on long-term disease management problems. If anyone can comment on this experience, I would be delighted to hear of it.
You must have missed my earlier message as I have HIV.
There is a nurse I can call directly in an HIV dept, as opposed to the main Kaiser number, to get an appointment quicker. Of course that nurse doesn't work at all hours, and is off some days, but it's rather useful. I have not called the main Kaiser number in a very long time.
Sometimes I am offered an appointment with my PCP/HIV specialist in the next hour. If he is in the office, I can usually often him the same or next day.
Even when the nurse is not around, the online system is very good and it seems that the online system to book appointments always shows many close appointments the same week.
This didn't use to be the case when I had Kaiser but not HIV 10 years ago. I have probably been "flagged" in the Kaiser system as a priority patient due to HIV.
The electronic records have really improved a lot over time. Emails to my doc are very conveniently and quickly answered, usually within a day.
When I go to the lab, I sometimes get results for certain tests on my smartphone within only 20 minutes !
My 8 maintenance prescriptions are sent by mail, in 90 or 100 day supply at a time (90 for some brand name boxes which can't be broken down, 100 for generics) which is very convenient. I checked the other insurance plans offered by my employer and none offer more than 30 days at a time. When you have HIV you really can't miss your pills, or you can become resistant to the drugs, so it's very important to me to always have ample supply of meds before running out.
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Tortoise
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Re: Kaiser vs Blue Shield

Post by Tortoise »

windhog wrote:I find it interesting that none of the Kaiser-favorable responders have reported on long-term disease management problems.
I have Multiple Myeloma, which is a cancer of the blood plasma. I have lived with it for 5 years. There is no cure, and I will likely die from complications due to the cancer. But I have not had any long-term disease management problems with Kaiser.

I have been with Kaiser since well before I had Multiple Myeloma. After I was diagnosed, I chose my Kaiser oncologist based on the fact that her specialty was hematological cancers and that she was very familiar with ongoing Multiple Myeloma trials and treatments around the world. I have her direct phone number, as well as the phone number of the infusion center. She also almost always answers my emails the same day that I write them.
"Always do right. This will gratify some people, and astonish the rest." --Mark Twain
anncatchingup
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Re: Kaiser vs Blue Shield

Post by anncatchingup »

Tortoise wrote:
windhog wrote:I find it interesting that none of the Kaiser-favorable responders have reported on long-term disease management problems.
I have Multiple Myeloma, which is a cancer of the blood plasma. I have lived with it for 5 years. There is no cure, and I will likely die from complications due to the cancer. But I have not had any long-term disease management problems with Kaiser.

I have been with Kaiser since well before I had Multiple Myeloma. After I was diagnosed, I chose my Kaiser oncologist based on the fact that her specialty was hematological cancers and that she was very familiar with ongoing Multiple Myeloma trials and treatments around the world. I have her direct phone number, as well as the phone number of the infusion center. She also almost always answers my emails the same day that I write them.
I have a relative with Multiple Sclerosis and another with liver failure due to a congenital disease. Both on Kaiser and getting excellent care.
chuppi wrote:
oxothuk wrote:
Scal wrote:My only major issue with Kaiser? Get used to hearing the phrase "higher than expected call volume", because you will hear that every time you call.
That may be a regional issue. I've never had to wait on hold for more than 5 minutes (in Colorado).
Agree. Have made dozens of phone calls in the last 2 years and the wait is no more than 5minutes.
I've never been on the phone more than 5 minutes either. In fact, I love their phone and email services! I love being able to email my doctor or other healthcare team members (like physical therapy) about any problem, new or old. I love being able to talk with an advice nurse, and if needed, a specialist on-call, to get immediate advice. I've even taken advantage of phone appointments with my primary care doctor for minor issues. There's no charge for phone appointments and he's responded even on weekends. Also, I have never felt rushed during appointments, ever. My primary care doctor takes the time to answer all my questions. I had the same orthopedist when I broke my wrist and when I needed knee surgery. He took his time with me. My husband recently had a total hip replacement with the top joint replacement doc (who was highly recommended by a co-worker who had the same surgery done) and he was very patient with all of our questions at each pre-op and post-op appointment. Awesome!

I have no vested interest in Kaiser. I'm just a very happy patient. :happy

Ann

Ann
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Jazztonight
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Re: Kaiser vs Blue Shield

Post by Jazztonight »

Kaiser all the way (N. calif.).

Many doctors who were in other modes of practice are now at Kaiser. My urologist , who was chief of urology/oncology at Stanford before he moved to Kaiser, responds quickly to emails and is very personable. Same with my primary care MD.

DW and I have been at Kaiser Oakland for many years, and it just gets better and more efficient. She's had back surgery, and was very pleased with the results and follow up care. She loves her doctors.

On a side note, I've been part of Volunteer Services for almost 10 years, and even they are well-organized.

Day or night, you can always be seen. All your records are centralized and computerized. Labs and pharmacies are efficient.

I am now on Medicare, and happy to stay at Kaiser.
"What does not destroy me, makes me stronger." Nietzsche
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vv19
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Re: Kaiser vs Blue Shield

Post by vv19 »

Thanks so much for all the insightful replies, folks! I can always trust this forum to get answers to whatever mundane questions I might have. :happy
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windhog
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Re: Kaiser vs Blue Shield

Post by windhog »

I appreciate the responses of Kaiser-supportive folks with chronic disease problems, and glad to hear that they are happy with their care. As for the article on Kaiser’s focus on chronic disease management, it makes sense to me that a true HMO would see the logic of this approach and actively explore ways to save money: kudos for that. The reason this approach is working at Kaiser and rare in the rest of the industry is that most indemnity companies expect rapid turn-over of patient coverage and discount the investment in disease management that will only help some subsequent insurer’s bottom line.

The chronic disease problems targeted by Kaiser are so prevalent in our population that they are (or should be) recognized as primary care disorders and managed by first-line providers. To clarify this point, the article linked by Minot listed the following chronic disease problems: diabetes, coronary disease, hyperlipidemia, congestive heart failure, asthma and depression. I think this data confirms my view that Kaiser does do primary care well.

Oncologic care and HIV treatment both benefit from the availability of cutting-edge data-driven treatment protocols, and one would expect few differences between the community practice and the tertiary medical center. There should be no expectation that Kaiser would be inferior to other care for these problems.

I will reiterate my concerns about Kaiser. I worry about the problem of recognition of uncommon diseases by primary care providers. (When there is a hammer in your hand, everything looks like a nail.) I worry about the moral hazard of being both an insurance provider and the provider of medical services. The insurance side is all about cost-effective care for the group and being user-friendly. The medical side is one doctor making the best decision for the patient sitting on the exam table, regardless of the cost. I am afraid the Kaiser model works by forcing this dilemma onto the provider by limiting coverage outside of their panel.

Just my 2 cents.

Paul
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dm200
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Re: Kaiser vs Blue Shield

Post by dm200 »

windhog wrote:I appreciate the responses of Kaiser-supportive folks with chronic disease problems, and glad to hear that they are happy with their care. As for the article on Kaiser’s focus on chronic disease management, it makes sense to me that a true HMO would see the logic of this approach and actively explore ways to save money: kudos for that. The reason this approach is working at Kaiser and rare in the rest of the industry is that most indemnity companies expect rapid turn-over of patient coverage and discount the investment in disease management that will only help some subsequent insurer’s bottom line.

The chronic disease problems targeted by Kaiser are so prevalent in our population that they are (or should be) recognized as primary care disorders and managed by first-line providers. To clarify this point, the article linked by Minot listed the following chronic disease problems: diabetes, coronary disease, hyperlipidemia, congestive heart failure, asthma and depression. I think this data confirms my view that Kaiser does do primary care well.

Oncologic care and HIV treatment both benefit from the availability of cutting-edge data-driven treatment protocols, and one would expect few differences between the community practice and the tertiary medical center. There should be no expectation that Kaiser would be inferior to other care for these problems.

I will reiterate my concerns about Kaiser. I worry about the problem of recognition of uncommon diseases by primary care providers. (When there is a hammer in your hand, everything looks like a nail.) I worry about the moral hazard of being both an insurance provider and the provider of medical services. The insurance side is all about cost-effective care for the group and being user-friendly. The medical side is one doctor making the best decision for the patient sitting on the exam table, regardless of the cost. I am afraid the Kaiser model works by forcing this dilemma onto the provider by limiting coverage outside of their panel.
Just my 2 cents.

Paul
I can only express an opinion about this as a (I believe) informed layperson (no medical training) and Kaiser patient (on and off) for about half of the last 40 years. Based on what I have seen, experienced, heard and read about Kaiser - it is my belief that I am at no greater risk or disadvantage from the risks of having an "uncommon disease" at Kaiser than other kinds of insurance and/or medical providers normally available to me. I would be interested, perhaps, in some examples of how some "uncommon diseases" are best recognized. Kaiser primary care Physicians are Internal medicine or Family practice (for adults). if you have a preference for one designation - you pick a Physician with that designation. I picked an Internal Medicine Physician and my wife picked a family Practice Physician. Women can also directly see an OB/Gyn. Children have a Pediatrician (or perhaps they can see Family Practice Physician). If you have symptoms from an "uncommon disease", I think you would usually consult the same kind of Primary care Physician whether you have Kaiser or other coverage. I see no reason why a Kaiser primary care Physician would be any less capable of recognizing or referring a patient to diagnose an "uncommon disease". If the issue/question is whether Kaiser Primary care Physicians are less likely or less able to refer you to an appropriate specialist (onside or outside Kaiser) - because that would (or might) cost more - my experience (for multiple situations) has been that I have never detected or sensed any such reluctance. Occasionally - there may be a very slight delay (maybe a day) in getting some test or referral approved. In my cases, these were always approved quickly. Sometimes (depending on both the nature of the tests/conditions as well as the knowledge/experience of the Primary care Physician) - a Specialist (such as a cardiologist) may review the tests and the report/results go back to/through the Primary Care Physician to you. Sometimes (probably more often) - you would be referred to see the specialist.

If you are already seeing a Kaiser specialist for some ongoing situation and something related comes up - you can usually contact that specialist directly (without the need to go through the Primary care Physician). This might be how an "uncommon disease" could be detected/diagnosed/treated.

In my case, there have been a few situations where Kaiser was willing to do a referral and/or testing where I declined because it was my strong opinion that such referral/testing was completely unnecessary. Although not "uncommon" conditions, I have several things over the years where I can compare the kinds of things Kaiser has done/tested/etc. vs. other insurance/physicians - and as often as not, Kaiser did more than was done outside Kaiser.
123
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Re: Kaiser vs Blue Shield

Post by 123 »

Just a short comment. There are lots of anecdotal stories about service problems and bad/delayed diagnoses at Kaiser that have been passed around for years. I have no doubt that they are for the most part true and not exaggerated. Those incidents have to be weighted again a medical care history that has extended over 50 years and covers probably close to 50% of the population in many of the areas in which it operates (like Southern California). Yes, it's possible that something could go wrong if Kaiser takes care of you but the chances of that seem small when you appreciate the thoroughness and diligence of the healthcare team structure that Kaiser has in place.
The closest helping hand is at the end of your own arm.
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dm200
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Re: Kaiser vs Blue Shield

Post by dm200 »

123 wrote:Just a short comment. There are lots of anecdotal stories about service problems and bad/delayed diagnoses at Kaiser that have been passed around for years. I have no doubt that they are for the most part true and not exaggerated. Those incidents have to be weighted again a medical care history that has extended over 50 years and covers probably close to 50% of the population in many of the areas in which it operates (like Southern California). Yes, it's possible that something could go wrong if Kaiser takes care of you but the chances of that seem small when you appreciate the thoroughness and diligence of the healthcare team structure that Kaiser has in place.
Well said, indeed.

It is my opinion that a great many people highly rate Physicians who tell them what they want to hear (even if it is not medically sound). "Just keep giving me those blood pressure pills that I have been taking for the last 30 years", or "I just love Dr. Schwartz. He tells me that I can eat and drink whatever I want, and all I need to do about the Diabetes is take these pills before each meal."
travellight
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Re: Kaiser vs Blue Shield

Post by travellight »

I have had excellent care at Kaiser.
364
bowtie
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Re: Kaiser vs Blue Shield

Post by bowtie »

I know people who've been happy with their care with Kaiser.
I've never used it, but now have a choice between Blue Shield and Kaiser too.

I have had excellent experiences at Blue Shield .... really good specialists and primary care. Since both premiums are the same price for me.... I don't know if I would switch but I appreciate reading all the positives. I actually don't know anyone who doesn't like Kaiser who has it..... I just never felt interested enough in it.
teacher
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Re: Kaiser vs Blue Shield

Post by teacher »

Paul wrote:
I worry about the moral hazard of being both an insurance provider and the provider of medical services. The insurance side is all about cost-effective care for the group and being user-friendly. The medical side is one doctor making the best decision for the patient sitting on the exam table, regardless of the cost. I am afraid the Kaiser model works by forcing this dilemma onto the provider by limiting coverage outside of their panel.
There is no conflict of interest. Here's why:
"Kaiser Permanente is made up of three distinct groups of entities: the Kaiser Foundation Health Plan and its regional operating subsidiaries; Kaiser Foundation Hospitals; and the autonomous regional Permanente Medical Groups.

• Kaiser Foundation Health Plans (KFHP) work with employers, employees, and individual members to offer prepaid health plans and insurance. The health plans are not-for-profit and provide infrastructure for and invest in Kaiser Foundation Hospitals and provide a tax-exempt shelter for the for-profit medical groups.
• Permanente Medical Groups are physician-owned organizations, which provide and arrange for medical care for Kaiser Foundation Health Plan members in each respective region. The medical groups are for-profit partnerships or professional corporations and receive nearly all of their funding from Kaiser Foundation Health Plans. The first medical group, The Permanente Medical Group, formed in 1948 in Northern California.
• Kaiser Foundation Hospitals operates medical centers in California, Oregon and Hawaii, and outpatient facilities in the remaining Kaiser Permanente regions. The hospital foundations are not-for-profit and rely on the Kaiser Foundation Health Plans for funding. They also provide infrastructure and facilities that benefit the for-profit medical groups."
http://en.wikipedia.org/wiki/Kaiser_Permanente
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