Permanente Medicine:
The Principles of Permanente Medicine

The ongoing effort to articulate the basic principles and dimensions of the professional identity and practice style known as Permanente Medicine has resulted, to date, in the following definitions:

Group Responsibility:
Physicians sharing a group ethic that promotes shared responsibility and accountability for the care of individual patients and an entire member population in a capitated environment

• Group Capitation--Prepayment for healthcare services allows physicians to be prudent stewards of healthcare resources
• Dual Responsibility--Physicians are responsible to the individual patient and to the membership for providing quality care and service that is affordable
• Multi-specialty Collaboration--Physicians work together to ensure the total health of our members using a shared medical record
• Professional Development--Culture that is dedicated to life-long learning in the art and science of medicine, and in the management of a high quality care delivery system

Self-Governance:
Physicians determine Medical Group policy through elected, representative physician leadership

• Partnership--Physician peer relationship that encourages participation in Medical Group affairs, builds greater commitment to quality and supports a long-term perspective
• Representative Decision Making/Due Process--Physicians have a right and a responsibility to contribute to group decisions
• Physician Leadership Development--Physician leaders and future physician leaders develop the necessary skills to provide the best leadership to the Medical Group at every level of management
• Ethical Compensation--Salaried physicians and other compensation practices that support physicians in making the best clinical decisions for patients
• Access to Capital--Capital is required for investment in new technologies, facilities and improving the delivery system to continue to meet the needs of our membership

Self-Management:
Physicians direct all clinical decisions and the design and operations of the care delivery system

• Care Teams--Physician-led, multidisciplinary care teams bring together expertise to meet the diverse needs of our members
• Management of Medicine/Operations--Physicians formulate all clinical policy and actively participate in the design of every level of our care delivery system
• Co-Management of Business--Physician leaders partner with health plan executives in making critical operational and business decisions
• Performance Improvement--Physicians directly oversee and measure key aspects of the care delivery system and analyze variation, which fosters innovation and improvement
• Peer Review--Physicians/Staff receive feedback and training on clinical and service performance based on continuous peer review and member feedback

Quality Medicine:
Health care experiences and outcomes that set the quality standards for American medicine

• Evidence-Based Medicine--Disseminate and implement Program-wide clinical guidelines by sharing best practices and the collective clinical experience of 10,000 physicians
• Integrated Member Care/Service--Integrate care across multiple care settings, populations, life stages, specialties and care teams, using ubiquitous access to clinical information
• State-of-the-Art Clinical Decision Making--Developing a national clinical information system to integrate information at the point of care--facilitating the rapid flow of clinical knowledge using common data elements and terminology
• Preventive Care/Community Health--Promote healthy lifestyles, disease prevention, health risk assessment, education, and communication
• Advancing Medical Knowledge--Fund and perform research, contributing to the continuous improvement of our system of care and medical knowledge

Permanente-Patient Relationship:
Patients, physicians, health care practitioners, and staff work as a team to make care decisions and meet the patients' needs

• Partnering In Care--Patients are given the educational tools and empowered to participate as partners in decision-making and to share responsibility for their care
• Continuity of Care--Stable physicians and entire care teams continue in their practice with little turnover
• Care Based on Trust--Patients are assured confidentiality and our best professional judgment by a structure that gives physicians and patients sole responsibility for care decisions
• Culturally Competent Care--Members' cultural diversity and health care preferences are respected and accommodated
• Support Systems--Operational systems/procedures (patient registration, appointment scheduling technology, Call Centers) provide the environment necessary to foster the Permanente-Patient Relationship

Resource Management
Physicians determine appropriate use of members' resources across multiple care settings to improve the health outcomes of our membership and ensure affordable health care

• Utilization--Physicians and members together control the entire episode of care, which enables us to determine the appropriate care in the appropriate setting at the appropriate time
• Staffing--Use physician-led care teams to leverage the skills of physicians and other health care practitioners to effectively meet needs of member
• Cost of Care--Provide effective and efficient diagnosis and treatment by reviewing patterns of care with the aim of improving quality and eliminating waste

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