Greetings to all my colleagues in the Permanente Medical
Groups across the United States. I joined Kaiser Permanente in 1969
as an Internist/Gastroenterologist, and I am delighted to see Kaiser
Permanente's spectacular success over the past three decades. There
are a number of reasons for this success. Both Kaiser Foundation Health
Plan and the Permanente Medical Groups - together as Kaiser Permanente
- brought unique ideas of prepayment and group practice as solutions
to the delivery of health care. To succeed now, we must build upon these
initial ideas and find new and unique solutions to the same challenge
that confronted us 50 years ago: delivering quality medical care that
is affordable.
The Permanente Journal aims to do just that - bring our thoughts,
practices, and accomplishments under one roof for everyone's view. As
a result, these new ideas can spread across our Permanente Medical Groups
to bring better health to our members.
Today, it is recognized that "Permanente Practice" can be
a significant marker or brand image for Kaiser Permanente. That is what
makes the Program unique.
Allow me to share a few other observations - some encouraging and some
of concern.
The Permanente Federation is a new legal entity designed to bring the
Permanente Medical Groups together and offer us an opportunity to share
our viewpoints and resources and most importantly to pair with Kaiser
Foundation Health Plan in a national partnership to bring solutions
to American medicine. I am sure your Executive Medical Director is bringing
this development to your attention.
The Federation's business unit, PermCo, was officially formed in February,
1997, and is owned by the Federation and all of us. It provides the
structure to carry out new business practices and, at the same time,
fulfill the business requirements of this national partnership with
Kaiser Foundation Health Plan. This structure allows us to take advantage
of new innovations, new ventures, and individual Medical Group ideas.
It will bring them depth, clarity, financial support, and the human
resources necessary to bring these ideas to fruition. In fact, the Executive
Committee of The Permanente Federation hopes any new ventures directly
benefit both participating Permanente Medical Groups and their individual
physicians.
Our organization is in the process of forging a new national agreement
between Kaiser Foundation Health Plan and The Permanente Federation
that offers an opportunity to create a truly balanced national partnership
between the two entities. As Kaiser Foundation Health Plan consolidates
into a national organization, so, too, must we find ways to respond
and act like one Permanente Medical Group. Why? Because Health Plan/Medical
Group parity is the cornerstone of Kaiser Permanente and has been since
our inception. It allows us to balance the business and insurance interests
of the Health Plan with the medical values and practice of the Permanente
Medical Groups. Any diminution of this relationship weakens Kaiser Permanente
and will lead to our demise. Eugene Trefethen, who died in 1996 and
was the trusted advisor to Henry Kaiser, crafted the Tahoe Accord with
this balance in mind.
The development of a truly national Kaiser Permanente, with a growing
Kaiser Foundation Health Plan and a growing Permanente medical practice
across the United States, can be the most powerful contribution to improving
American health care in our organization's storied history.
We should all be aware of the dangers in front of us - managed care
bashing, distorted physician incentives and profiteering, and medical
practice becoming secondary to economic concerns. We know that these
"malignancies" are antithetical to the very essence of the
self-governed Permanente Medical Groups, which always strive to place
patient interests first, second, and third. We must assure that this
value remains central and prove incorrect the creeping notion that group
practice does not offer an appropriate solution to our nation's health
care problems.
As I stated to physicians in Southern California, the very boundaries
of our industry and in Kaiser Permanente are shifting, not imperceptibly
slowly like changes in the ozone, but daily, and such changes are usually
announced in a major newspaper or press release. We all must learn that
the sun does not, and will not, follow all of us down the street. We
must understand that whatever is meant by the "marketplace"
does not include a special place reserved for the physicians of the
Permanente Medical Groups.
Not withstanding this somber warning, I can assure you on behalf of
the Executive Committee of the Permanente Federation that the Permanente
Medical Groups will stand unwavering in our commitment to excellence
in personal medical care to every patient, and to strengthening all
of the Permanente Medical Groups, which together with Kaiser Foundation
Health Plan comprise the unique Program called Kaiser Permanente.
I welcome the first edition of The Permanente Journal and wish
great success to its Editor, Tom Janisse, MD, and to all those putting
their efforts into this fine endeavor.
