By Ginny McPartland
For Harper Gaston, MD, going to Atlanta 25 years ago to start Kaiser Permanente in Georgia was much like going home. A Georgia native and alumnus of Emory University, Gaston was at first reluctant. He had been practicing internal medicine and cardiology at the Hayward Kaiser Permanente Medical Center in Northern California for 23 years and had just been elected physician-in-chief.
“I told them: I am planning on retiring to Georgia, but my intent is to serve out my term, about four more years in California,” Gaston said in an interview with Historian Steve Gilford after his retirement in 1993.
However, the pressure to help establish a Georgia Region for Kaiser Permanente was intense. In 1985, Atlanta was the fastest growing city in the U.S. and was rated as the best place to do business in a survey of 400 CEOs. Atlanta was second only to Los Angeles in employer growth. Kaiser Permanente, with a presence in California, Oregon, Hawaii and the Midwest, was anxious to bring its brand of community-based prepaid health care to Atlanta, the hub of the Southeast.
Eventually convinced Atlanta was a good move, Gaston packed up with his wife, Anne Gaston, a Hayward KP pediatrician, and went to Georgia in the summer of 1985. Anne Gaston was also going home; she had come to Northern California from Georgia with her husband to join KP in 1961.
Gaston also took along two key people to start the health care program: Edgar T. Carlson of the Ohio Permanente Region who became Georgia regional manager; and Margaret Jordan, RN, a quality leader in Oakland, as Georgia health plan manager. Ron Hostettler, also from Ohio, came as assistant health plan manager and marketing director; John Blankenship came from Southern California Region as chief financial officer.
When Gaston hit the ground in Atlanta, he knew just what to do. He renewed his community contacts and got involved with Emory University, the Medical Association of Georgia, and other local physician organizations. “Knowing the leadership of these places and refurbishing old contacts was a great help. I think you can go home again.”
Gaston also picked several prominent members of the Atlanta community – banker John W. McIntyre; physician Louis Wade Sullivan, dean and director of the Morehouse College of Medicine (later to be appointed secretary of the U.S. Department of Health and Human Services); and community leader Laura Jones Hardman – to sit on the KP Georgia board of directors. Bruce Sams, MD, a native Georgian and executive director of the Northern California Permanente Medical Group, was also a key figure on the Georgia board.
As founding medical director, Gaston personally called on many of Atlanta’s physicians in their offices during 1985, the start-up year. He selected the best doctors in all parts of the metro Atlanta, including the black community, and invited them to join the Southeast Permanente Medical Group (TSPMG) to care for KP members. He negotiated contracts with three Atlanta area hospitals for KP inpatient care. “They were exactly the best hospitals in Atlanta, no question about it,” he said.
Early acceptance and rapid growth
KP Georgia’s earliest members were seen starting in October of 1985 at Northlake Medical Office in DeKalb County. Three months later, the Cumberland office was opened and then, another facility was opened near Southwest Community Hospital in the black community. The new region ended the year with 265 members, 25 health plan employees and seven TSPMG employees. Acquiring financially ailing Maxicare and securing the state of Georgia employee account in 1988, the region grew to 100,000 members by 1989.
Georgia KP had set up 10 medical facilities by the end of the 1990s and added another seven in the 2000s. This year, development has accelerated with four new buildings already launched and three more planned. Today, 280 Georgia region physicians and 2,200 staff members care for about a quarter of a million members in 20-plus facilities throughout the 28-county Atlanta metro area.
Emphasis on quality care
From the beginning, Gaston was intent on high quality for Georgia KP members. His efforts paid off. In 1995, Georgia Kaiser Permanente was one of two health plans in Atlanta to earn the National Committee on Quality Assurance (NCQA) three-year accreditation. In 1998, Newsweek and US News and World Report rated Kaiser Permanente the No. 1 health plan in Georgia. The American Medical Group Association gave the Southeast Permanente Medical Group (TSPMG) its Preeminence Award in 2002.
More accolades were to follow:
- Special NCQA recognition in 2006 for putting into place programs to solve health disparities for African Americans, Latinos and Asians
- Atlanta Magazine’s 2008 award to KP as a “Best Place to Work”
- J.D. Power’s ranking of Georgia KP as highest in customer satisfaction among health plans in the South Atlantic region, 2008
- US News and World Report top-rated health plan in Georgia, 2008
- 2010: the NCQA announced in October that KP Georgia has the highest breast cancer screening rate in the country, 91 percent, compared to a 71 percent national average.
Community service a given for KP
Shortly after opening in Georgia, Kaiser Permanente looked for opportunities to offer help to the community. In 1986, Permanente physicians agreed to reinstate recently discontinued hearing and vision screening for financially strapped area schools. Physicians screened 3,600 children in 17 DeKalb County elementary schools and two City of Decatur schools.
Over the years, the scale has only gotten bigger. Georgia region has sponsored the huge, area-wide Kaiser Permanente Corporate Run/Walk and Fitness Program since 2004. In 2005, the Atlanta American Red Cross named KP Georgia the Philanthropist of the Year for its sponsorship of the annual CPR Saturday program. For its 20th anniversary in 2005, KP Georgia gave $1 million to the Community Foundation for Greater Atlanta.
To wrap up its quarter of a century, Georgia KP topped itself with a $2.5 million donation for the development of the Eastside section of the Atlanta Beltline trail. The corridor of parks, trails and passenger rail service takes advantage of an old 22-mile railroad right-of-way that loops around the city. KP Georgia has also committed to a $5 million donation to Children’s Healthcare of Atlanta for a new hospital.
By Jacqueline F. Brown
Kaiser Permanente’s interest in energy conservation and sustainability can be traced back to a time when many considered a concern for the environment to be irrational. However, rather than shy away from this controversy, Clifford Keene, vice president and general manager of Kaiser Foundation Health Plan and Hospitals, placed Kaiser Permanente in the center of it.
Keene invited naturalist, Rachel Carson, to deliver a public lecture at a celebrated forum after the publication of her widely debated book “Silent Spring”. Carson delivered the keynote address to a large audience in October 1963 at the Seventh Annual Kaiser Foundation Hospitals and Permanente Medical Group symposium, “Man Against Himself,” held at the Fairmont Hotel in San Francisco. Keene stated that the purpose of the symposium was “to examine the propensity and the ability of man to harm man on a grand scale.”
In her groundbreaking book, Carson warned of an environmental and health apocalypse from the overuse of pesticides and chemical pollutants. Though Carson’s book had been roundly criticized in the national press, Kaiser Permanente leadership demonstrated its willingness to engage her and the concerned public.
In the early 1970s, employees at the KP Santa Clara Medical Center in Santa Clara, Calif., formed an Ecology Committee with an objective of teaching employees “ecological common sense.” Santa Clara employees launched an initiative in paper recycling, pushed for carpooling and bike riding, and lobbied county officials for better public transportation.
Santa Clara was not the only Kaiser Foundation medical center to initiate environmentally friendly practices. In 1981, employees at the Kaiser Permanente Vallejo Medical Center in Vallejo, Calif., earned an award for energy-saving efforts. In just five years, the staff at Vallejo reduced energy consumption by 50 percent, even with the addition of a new floor at the facility.
Kaiser Permanente is adding solar panels to 11 facilities in California by the summer of 2011, furthering a solar initiative begun in 2008 when KP opened one of the “greenest” hospitals in the country in Modesto, Calif.
The addition of solar panels to these facilities will eliminate the purchase and disposal of 40 tons of harmful chemicals and drastically reduce Kaiser Permanente’s use of fossil fuels.
Kaiser Permanente also recently announced that it will require its suppliers to provide environmental data for medical equipment and products used in hospitals, medical offices and other facilities.
Each supplier is required to use Kaiser Permanente’s Sustainability Scorecard, which asks the supplier to provide information on their company’s environmental commitment, use of potentially harmful chemicals in the products, and information about product and packaging recycling.
The Sustainability Scorecards not only ensure that Kaiser Permanente is using green products, but it encourages suppliers to create products that are safe for the environment.
In May, many of Kaiser Permanente’s efforts towards creating a healthy environment were honored as 18 Kaiser facilities across the nation were recognized for their efforts in waste reduction and pollution prevention. The awards were given at CleanMed 2010, a global conference for environmental leaders in health care.
Kaiser Permanente’s recent success in reducing waste and conserving energy can be easily explained through its history. While Carson is now considered a leader of the early environmental movement, Kaiser Permanente’s forward-thinking leaders recognized the need to hear her voice when many others would not.
By Ginny McPartland
To most outsiders, Hawaii is that far-off paradise where people go for that well-deserved rest and recreation. They come back tan and relaxed, and everyone is green with envy. To be sure, the Hawaiian Islands offer plenty for the casual visitor. But to the residents, it isn’t just about gargantuan waves and potent Mai Tai’s.
Hawaiians have to worry about the same things mainlanders worry about: a livelihood, a good future for their children, and quality health care. Lucky for them, taking good care of patients is top of mind for physicians in the Hawaii Permanente Medical Group. On a recent trip to Honolulu, I witnessed their determination first hand.
Although in a partying mood (they’re celebrating 50 years as a medical group in Hawaii), Permanente doctors focused on issues during a party/seminar in Honolulu. What have they done right in the past five decades? And what do they need to do differently – better – in the future?
Overcoming a tough situation
The Hawaii Permanente Medical Group staffed the second launching of Kaiser Permanente in Hawaii. In 1958, Henry J. Kaiser had built a 143-bed hospital in Waikiki and had hired a group of doctors who had other interests as well. In 1960, Kaiser realized that the doctors needed to serve the KP membership exclusively for the partnership to work. He then asked The Permanente Medical Group in California to help set up a new group. Headed by Phillip Chu, MD, the reconfigured medical group began providing for Hawaii members in August of 1960.
The 1960s was a difficult time for Permanente physicians, indeed for all group practice doctors. Across the country, traditional medical societies resisted prepaid group practice claiming it was “unethical” and denied patients choice of physicians. The hostile physicians denied hospital privileges and medical society membership to group practice physicians, and at times labeled the new care delivery method as “socialist” and its product “inferior.”
Undaunted, the Hawaii Permanente physicians persevered. They set out to prove their detractors wrong. In 1969, the Hawaii region participated in a study conducted by the Hawaii Medical Association and the University of Michigan that showed KP hospital care to be above average in the state. Later, in 1977, the results of a University of Michigan quality of care study showed Hawaii Permanente Medical Group doctors to be well above the average among Hawaiian physicians. A total of 454 Oahu physicians in 18 specialties, including 42 Permanente physicians, participated in the study.
Quality a major focus
As early as 1969, the Hawaii region had established its own ongoing medical audit system. In 1971, the region received a federal grant to set up an experimental four-year program to monitor inpatient care. Later, Hawaii medical staff developed methods for monitoring outpatient care for all the Kaiser Permanente regions.
Not only was the Hawaii staff distinguishing itself in quality of care, but they were also participating in government programs to reach out and help the poor of its communities. The group participated in a federal Medicaid program in 1971 to care for 500 indigent families on Oahu and later expanded the program to Maui. Other community outreach programs followed.
Perhaps the ultimate community outreach program was launched in Hawaii last year when Kaiser Permanente started a high-tech mobile service on the Big Island. The 500-square-foot exam unit on wheels brings care and preventive screenings to thousands of KP members and to the uninsured in the community. The van is equipped with digital mammography equipment and is connected to Kaiser Permanente’s comprehensive electronic health record system.
Doing fine now, thank you very much
Fifty years after its founding, Kaiser Permanente Hawaii is thriving. With 430 physicians, 4,400 employees, almost 224,000 members, 278 critical care hospital beds, and 17 outpatient clinics on three islands, the region has established itself as an organization bent on excellence and community service. In the past year, Kaiser Permanente Hawaii has received these designations:
— Highest-rated private health insurance plan in Hawaii (National Committee on Quality Assurance, NCQA, 2009)
–Number 1 Medicaid plan in the nation (US. News & World Report, 2010)
–Highest-rated health plan in the U.S. for breast cancer screening (NCQA, 2009)
–Highest accreditation rating of “excellence of quality and service (NCQA, 2009). Hawaii has earned this rating every year since the NCQA began rating health plans in 1999.
Henry J. Kaiser’s big Hawaii plans honored
In 1986, the old hospital was blown up in a public spectacle that became part of an episode of the celebrated television series of the time, “Magnum, P. I.” starring Tom Selleck. The implosion made way for the new hotel, and Kaiser Permanente built a new, modern hospital on Moanalua Road north of Honolulu. This is the site of the Hawaii region Moanalua Medical Center and Clinic where construction is under way to expand and improve services.
Meanwhile, just around the corner in Waikiki, Henry J. Kaiser had built his Kaiser Hawaiian Village, a uniquely designed resort that is now the Hilton Hawaiian Village. Kaiser showed his respect for the indigenous population by designing the villages to represent the culture of the hotel’s surroundings. He employed Hawaiian Samoans to come to the resort site and hand-build the guest cottages. These craftsmen actually wove coconut fronds into thatching. To honor Henry Kaiser, the resort has created museum-like public displays telling the story of his Hawaiian feats.
Today, the Hilton resort also hosts the Bishop Museum Collection, a satellite museum that gives visitors a taste of the original Hawaii. The main Bishop Museum, recently restored and with a new science building, is the largest museum in the state and the premier natural and cultural history institution in the Pacific. The museum is located in Honolulu off the beaten tourist path.