Kaiser Permanente: integrating around a care delivery model

Area of Science:

• Health Services Research
• Health Economics
• Healthcare Management

Background:

• The Balanced Budget Act of 1997 introduced a risk-adjusted payment model for Medicare + Choice organizations.
• This model necessitates a shift in focus towards capturing data on chronic medical conditions within the ambulatory care setting.

Purpose of the Study:

• To analyze the implications of the Medicare + Choice risk-adjusted payment model on healthcare organizations.
• To identify challenges in data capture and operational adjustments required for compliance.

Main Methods:

• Analysis of the regulatory requirements of the risk-adjusted payment model.
• Assessment of the current technological and financial capabilities of healthcare organizations in California.
• Evaluation of the impact on private practitioners' data management.

Main Results:

• Healthcare organizations require substantial retooling of ambulatory care operations for data capture.
• California healthcare organizations face capital limitations for necessary information management tools.
• Private practitioners lack the requisite technology and expertise for the model's data demands.

Conclusions:

• The risk-adjusted payment model presents significant operational and financial challenges for healthcare providers.
• Successful implementation requires investment in information management and technology.
• The model offers potential for improved integrated care delivery based on population health needs.