Our model

Integrated care and coverage enable high-quality, connected, expert care.

Our model

Integrated care and coverage enable high-quality, connected, expert care.

Kaiser Permanente is one of America’s leading health care providers and nonprofit health plans. Our health plan finances the care delivered by the more than physicians of the Permanente Medical Groups, nurses, and 75,000 allied health professionals in our hospitals and medical facilities. We serve 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.

 


Kaiser Permanente’s integrated care model is different from how health care often works in America. This brief video provides the basics.
 


The Kaiser Permanente health care delivery system is accountable both to provide the most appropriate and necessary care to each individual, and to serve as a steward of resources on behalf of our entire membership. This accountability aligns incentives to keep people healthy, rather than seeking to generate revenues when they are sick. 

Our approach enables our multispecialty medical groups to practice person-centered, high-quality care that embraces the latest innovations in medicine. Our self-governed medical groups hire and retain highly sought-after physicians and other medical personnel with a payment model that enables them to make decisions with the best interest of the patient in mind. This approach eliminates the pressures that can come from physicians having to manage a business based on the volume of services provided. Instead, Kaiser Permanente physicians are salaried and utilize an evidence-based approach to the practice of medicine, which leads to more effective and efficient care for our patients and members, and better health outcomes.

Integrating evidence-based health care and prepaid financing of coverage the way we do drives coordination of care across all settings and care teams. It enables quality outcomes by ensuring that our members receive the right care, at the right time, in the right setting. We avoid unnecessary costs by eliminating unneeded or duplicate tests or procedures that occur when care is not coordinated. This is a significant factor in keeping our operating costs reasonable.


Why Kaiser Permanente’s care and coverage model works

  • Focuses on quality of care, not volume of services provided
  • Aligns incentives across all parts of our system, with patients at the center, delivering high-value care and keeping costs reasonable
  • Invests in new technologies and innovations to advance quality of care
  • Addresses social, environmental, and economic drivers of health in the communities we serve
  •  Finances care for our entire member population through our nonprofit health plan 


We’re able to reinvest a significant amount of our operating revenue to continually advance the quality of care we provide. For example, Kaiser Permanente pioneered electronic health records in the 1960s — a cutting-edge, technological undertaking for the organization. We are using the power of that technology today to enable our care teams to provide coordinated, high-quality care for our patients that is seamless across various care settings. We are also able to aggregate anonymized data to understand clinical best practice to innovate care through population health studies. Kaiser Permanente is also at the forefront in the use of telehealth to provide care to our members. We provide convenient care options including email, video, and phone consultations to give our members flexibility in accessing our providers.  

Central to Kaiser Permanente’s business model is a focus that extends beyond our members into the communities where they live, work, and play. We are a leader in recognizing that healthy individuals need healthy communities, and healthy communities need healthy people to thrive. That is why we are working to improve the conditions for health and equity in our communities by addressing the root causes of many chronic health issues, such as economic opportunity, access to quality and nutritious food, affordable housing, safe and supportive schools, and a healthy environment, among the numerous social determinants of health. We invest significantly in the geographies where we operate by supporting community organizations and providing social health resources. Through these efforts we are working to create communities that are among the healthiest in the nation.

Kaiser Permanente, and our model of a nonprofit health plan and hospital system integrated with prepaid multispecialty medical groups, is recognized for the outcomes we achieve in pursuit of our mission: to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve.