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New York  -
Massachusetts -  Connecticut -  Vermont (8)

North Carolina

News Stories About Kaiser Permanente From Areas that Kaiser was kicked out of!

Did you know that Kaiser had a total of 124,000 enrollees, 

Kaiser Texas
"We basically said to the doctors, `If you value your job, you won't say anything about hospitalization.' All you'll say is, `I think you need further evaluation..."The first thing that ever comes out of a Kaiser CEO now is what's the bottom line," Vogt said on a videotape of his speech. "Anytime you have to balance the budget, how do you do it? You cut utilization, drop referral rates, and drop your hospitalization."

"The reason we're revising that protocol now is because our utilization exploded" Vogt said. "The cost of dropping it to only one missed heart attack was tripling our hospital days."

Fort Worth Star-Telegram - Thursday, March 27, 1997

AUSTIN - Attorney General Dan Morales has chided the Kaiser Permanente health maintenance organization for trying to "harass and intimidate state officials and public employees" in its battle with insurance regulators. 

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1997 - DALLAS -- An HMO has agreed to pay $5.35 million to a family who claimed that medical cost-cutting led to a man's death from untreated heart disease. 

   Lawyers for the family of Ronald Henderson alleged that a plan by Kaiser Permanente's North Texas HMO to cut hospital expenses by 45 percent, plus an HMO official's speech that stressed putting ``the bottom line'' first, led to the 56-year-old man's death.

Fines and related articles
DALLAS -- Kaiser Permanente - An HMO has agreed to pay $5.35 million to a family who claimed that medical cost-cutting led to a man's death from untreated heart disease.

   Lawyers for the family of Ronald Henderson alleged that a plan by Kaiser Permanente's North Texas HMO to cut hospital expenses by 45 percent, plus an HMO official's speech that stressed putting ``the bottom line'' first, led to the 56-year-old man's death.
The HMO agreed to the settlement Tuesday after a test jury in a novel nonbinding minitrial said it would have awarded the family more than 10 times that amount if the case had gone to an actual trial.

Managed Care Insurer Liability : The Texas Law
Explanations on how the state of Texas has handled HMO issues more productively, more fairly, for proactively for the patient than other areas.

Care Versus Cost
Nation’s Wealthiest HMO Leaves Jury Outraged
Feb. 13, 1998

              FORREST SAWYER

It begins with a malpractice lawsuit in Texas, a family claiming the negligence of the country’s largest HMO, Kaiser Permanente, left their loved one dead. During the trial, startling evidence emerged, an internal speech by a Kaiser
administrator. The administrator painted a picture of a company that appeared willing to risk placing profit above patient welfare. Together with the rest of the evidence, the speech stunned jurors and helped drive Kaiser to settle the
lawsuit for millions.

SHUTTERED HOSPITALS. Meanwhile, Texas State Attorney General Dan Morales says there are 
''sufficient grounds and justification'' for the state to yank Kaiser's HMO license.  

October 31, 1998  Sierra Health Subsidiary Completes Purchase of Kaiser Southwest; Texas Health Choice Will Be New Name

Kaiser Permanente and TDI Settle Dispute
April 18, 1997
Return to Index
Kaiser Foundation Health Plan of Texas agreed today to drop its lawsuit against the Texas Department of Insurance, pay a $1 million fine and take specific steps to assure high-quality patient care for its 124,000 enrollees.

Kaiser New York  - Kaiser Massachusetts - Kaiser Connecticut - Kaiser Vermont

[Kaiser Permanente/Community Health Plan of New York (enrollment codes PW and QB) will be
acquired and administered by Capital District Physicians Health Plan (CDPHP), enrollment code
SG. CDPHP applied for and received approval for all counties within Kaiser Permanente/Community Health Plan’s service area. The state of New York approved all of those counties except Clinton and Sullivan (PW) Counties, and Putnam (QB) County. CDPHP is therefore not authorized to operate a health plan in those counties.]

Spring, 1999

In a recent court decision in New York, Kaiser Permanente/Community Health Plan was found not responsible for violation of a patient’s confidential information by one of its file clerks (Melissa Grace, “State judge rejects claim against CHP,” Albany Times Union, April 14, 1999). The clerk had told people at a party that the patient was a lesbian, which she had learned from the records of a Kaiser social worker who was counseling the patient. Kaiser was off the hook legally because Kaiser had provided training to its employees about the need to protect patient information in confidential files at the HMO. Further, according to New York law employers are not liable for their employees’ conduct unless the conduct was in furtherance of the employers’ interests , and the clerk was not acting within the scope of her duties. The decision is being appealed.

CCEMHC takes the position that such information, obtained in the process of mental health care, should not be in patient-identifiable records at HMOs in the first place. Nor should clerks have access to the information.

May 13, 1999 - The New York state attorney general's office is investigating some managed-care plans for possibly violating a state law by telling patients and doctors that patients must first get approval from their primarycare doctor to be covered for an emergency-room visit.

The HMOs, which include Oxford Health Plans Inc., Cigna Corp.'s Cigna HealthCare unit and Kaiser Permanente's Northeast health plan, have received subpoenas, the attorney general's office said. The office is seeking materials that it believes would show violations of the socalled "prudent layperson" standard of a 1996 state patient's rights law.

Statement on Decision of Kaiser Permanente to Leave New York and Its Northeast Market

Albany, June 18 – The New York State Department of Health has been notified by Kaiser Permanente, a managed care organization licensed under Article 43 of New York State Insurance Law and Article 44 of New York State Public Health Law, that it intends to cease operation in New York and three neighboring states by December 31, 1999.

The Department was notified yesterday by the company of its decision.

The State Health Department will work with Kaiser Permanente to effect a smooth transition for the plan's 285,000 enrollees in New York State, and to ensure that they continue to have access to care. Ideally, Kaiser's provider network will continue to be available to Kaiser members after the transition period, through provider contracts with other insurers or acquisition of the company's provider network by another health plan.

Kaiser Pemanente has been a quality provider of managed care in New York State, and we expect that the company's commitment to its members will continue through the transition period. Currently, Kaiser is working with the providers who staff its health clinics to form independent provider groups which will be able to contract with other health plans.

The State Health Department, along with the State Insurance Department, must approve any proposed transaction for transfer of Kaiser Permanente's New York assets to another managed care organization. Among the factors the Department will review before approving a sale is whether there would continue to be sufficient provider network capacity for current Kaiser enrollees under the new health plan.

6/18/99-63 OPA

is leaving not just Vermont, but all of New England 100,000 customers here are a small piece of the puzzle. That said, Kaiser lost millions of dollars in Vermont and was gaining a reputation for less-than-perfect customer service. In a competitive world, those are the companies that do not and should not survive.

Rude Awakening When Kaiser Retreats
By the end of 1999, Kaiser Permanente is leaving western Massachusetts, two regions in New York, parts of Connecticut and all of Vermont. .....The era of having group practices exclusive to one insurer has probably passed.

Kaiser Permanente Pulls out of Kansas City several fines and sanctions on this web page.

Kaiser  vs Director of Revenue State of Missouri - Kaiser advised that they do have to pay sales tax and cannot get a refund.


North Carolina

There is lots of good information on the entire Kaiser system, and why they failed in so many areas in this following document from the university of North Carolina.
The Rise and Fall of a Kaiser Permanente Expansion Region

From The Insider - The North Carolina State Government News Service
V. 4, No. 93  Monday, May 13, 1996 18 pages
  HMO LAWSUITS RAISE ISSUES: Kaiser Foundation Health Plan of North Carolina, the first large, out-of-state HMO to tap the N.C. market in 1985, has grappled with a spate of patient lawsuits in recent years.

RALEIGH, N.C.--(BW HealthWire)--Aug. 17, 1999--

The Carolina Permanente Medical Group Also Signs Agreement

With PARTNERS Enabling Members to Continue Receiving Care

From Their Permanente Physicians After the Sale

PARTNERS National Health Plans of North Carolina Inc. has signed a definitive sale agreement with Kaiser Foundation Health Plan to transfer Kaiser's employer-sponsored and Medicare membership in the Raleigh-Durham-Chapel Hill area to PARTNERS.

PARTNERS, a subsidiary of Novant Health Inc., is based in Winston-Salem, N.C. The sale is expected to close on or before December 31, contingent upon regulatory and other customary approvals. Financial terms were not disclosed.

The Rise and Fall of a Kaiser Permanente Expansion Region
The Milbank Quarterly

..........we examine the rise and fall of the Kaiser Permanente (KP) expansion effort in North Carolina in order to gain insight into making prepaid group practice work. We trace and analyze the key events in the North Carolina KP's entry and start-up, its performance and growth over time, and its exit. We use interview data collected from former and current KP national, regional, and local managers; North Carolina public officials; state and national health care experts; and supplemental analyses of enrollment, financial, and other secondary data. We conclude that KP's failed North Carolina expansion resulted not from an inherent flaw in the PGP model but from a complex interaction of political, economic, and organizational factors. Finally, we offer some policy recommendations for PGPs’ role in future reform efforts. We believe that PGPs should still remain of special interest to those reformers who see the health system changing through marketplace competition.

The Origins of Kaiser Permanente's Expansion into North Carolina

Kaiser Permanente (KP) began on the West Coast as a company-funded and company-managed means of providing medical care services to workers in Henry J. Kaiser's industrial enterprises. Its corporate headquarters began and remain in Oakland, California. By 1955, KP had a major presence in three regions (Northern California, Southern California, and Oregon), with a growing network of hospitals and clinics and a combined membership of 500,000. KP expanded to Hawaii in 1958 and a decade later established regions in Colorado (1969) and Ohio (1969). After the passage of the Health Maintenance Organization Act in 1973, the KP plans in all six regions became federally qualified HMOs. By the early 1980s, KP had additional regions in Texas (1979), the greater Washington, D.C., metropolitan area (1980), and greater Hartford, Connecticut (1982). The plan in Texas began as a 50–50 joint venture of KP and Prudential, and in 1983 KP took over Prudential's interest. KP tried (and failed) to acquire a plan in Chicago but eventually bought an existing plan in Kansas City.

Whereas our interview participants described KP's earlier expansions as “opportunistic,” KP's expansion into the Southeast appeared to be more purposeful. KP wanted a national presence in order to compete more effectively for national corporate accounts and to position itself more favorably in the event of national health care reform. Accordingly, it chose to expand in regions where it did not have a presence, namely, the South. KP conducted comprehensive analyses of several markets in the South and Midwest and narrowed its final expansion choices to Raleigh-Durham, North Carolina, and Atlanta, Georgia. Because half the organization's joint national health plan/physician leadership committee preferred one market, and the other half preferred the other market, KP decided to enter both markets ().

At the same time that KP was trying to expand regionally, elected officials and policy reformers in North Carolina were trying to make the state an attractive operating environment for health care delivery systems that were not fee-for-service plans. Impressed by the cost-containment achievements of PGPs such as Kaiser Permanente, the Group Health Cooperative of Puget Sound, and the Health Insurance Plan of New York, Congress had already passed the Health Maintenance Organization Act in 1973. The act defined HMOs, provided grants and loans for the start-ups of nonprofit HMOs, and required all employers of 25 or more employees to offer at least one PGP and one Independent Practice Association–based HMO as health insurance options wherever they were available and desired. This requirement was a big boost to the development of HMOs, including PGPs, and a spark for state-level reforms in the late 1970s and early 1980s.

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