By Ginny McPartland
The year 1962 is as good a time as any to begin a year-end reflection on Kaiser Permanente’s past. The 1950s and early 1960s were the days when the Health Plan was still getting established, and its pioneers were counting the blessings that kept their enterprise going.
KP Heritage Resources’ expansive archive of newsletters and magazines from previous decades provide the fodder for a historical review. We can trace the concerns and triumphs of each era from the words and pictures that appear on the pages of the December editions. Some issues are remarkably like the ones we face today; others are no longer worries.
In the December 1962 issue of the KP Reporter, you can find a photo of the white-uniformed and cap-clad student nurses’ choir that strolled through the corridors of the Oakland Kaiser Foundation Hospital singing carols during the holiday season. The Kaiser Foundation School of Nursing choir also entertained at San Francisco and Vallejo hospitals, area nursing homes and the Business and Professional Women’s Club holiday party.
In the same issue, a visiting lecturer talked about the dangers of radiation exposure: “There is evidence that radiation causes something akin to aging, a shortening of the life span due to the loss of hereditary material, and damage to chromosome and malfunctioning of cells. This brings on death,” said Irwin Oster, PhD, of the Institute of Cancer Research in Philadelphia.
Medicare emerges onto the scene
Skip ahead to 1965 and you can read about the new program called “Medicare” just enacted by the federal government. Planning for Health, the member newsletter, carried an article introducing members to Medicare: “If you are 65 or over on July 1, 1966, your Health Plan coverage will be changed . . . Medicare covers a broad range of benefits.” Members were urged to tell their friends about the new coverage.
In the winter of 1968, Planning for Health had articles about KP’s $80 million, four-year plan to build new facilities and to update others. This program called for a new medical center in South San Francisco, and additions to those in Oakland, Hayward, Vallejo, San Rafael, Walnut Creek and Sacramento. New medical centers were planned for West Los Angeles and San Diego, and additions were planned for four Southern California medical centers and for one in Portland, Ore
Planning for Health editors ran a cover story in the winter of 1969 edition about the 1960s as the “Decade of Change for Medicine.” The article’s author wrote: “Experimental organ transplants, Medicare and The Pill collected headlines during the past decade, but medicine made gigantic strides forward in less glamorous areas as well. . . examples are the almost complete eradication of polio through universal immunization (and) the development of vaccines for mumps, measles, and Rubella (German measles) . . . ”
Membership in the Northern California Region alone increased from 375,000 in 1960 to over 920,000 by the end of the 1960s. In all other regions, membership increased from 807,000 to nearly 2 million.
The winter 1975 issue of Planning for Health carried a story about research involving 11,000 sets of twins. “(Twins) offer the unique opportunity to examine how heredity and environment interact to affect the total health picture,” the article reported.
Are you having fun jogging?
Stuart Frank, MD, wrote an article for the winter 1977 issue of Planning for Health about the pros and cons of jogging. Praising the activity for its many benefits, Frank admits: “I stopped jogging when it . . . was no longer fun.” Enjoying yourself is the only good reason for jogging, he said. “Life is too short to inflict this regular punishment on your feet and psyche if you don’t enjoy it.”
In the 1980s, the new Reporter (for employees) emerged with magazine-style articles that reflected the changing role of women and other social issues of the time. In December 1984, Molly Prescott interviewed three pregnant KP managers about how they coped with work and family life. “I told my boss not to treat me any differently just because I was pregnant,” Cora Tellez, an accounting manager, told Prescott. “He took me at my word, and didn’t cut down on his demands or expectations of me.”
The same issue carried a story by Kaaren Poole, who interviewed KP employees about using personal computers for the first time. There was also a first person story by staffer JoAnn Lieberman, “On being Jewish at Christmas.”
Remembering year’s sad eventsThe December 1987 edition highlighted KP’s part in the “Names Project,” the creating of a quilt whose pieces commemorated individuals who had died from AIDS. KP South San Francisco employee JoAnne Melody said: “The quilt project gives us all a chance to look at this disease with a little more heart, to see the (patients) as people, not just statistics.”
The Loma Prieta Earthquake in October 1989 prompted an article on disaster preparedness in the winter 1989-90 issue of Planning for Health; the winter 1990 issue of Spectrum (for employees) carried a story about the 50 KP employees who suffered significant financial losses in the quake. Funds were created to help employees, including 27 whose homes were severely damaged.
The 1991 year-end issue of the employee newsletter Contact reported that relief funds were set up for the victims of the Oakland/Berkeley Hills fire. Homes belonging to 80 KP physicians and employees were among the 3,800 dwellings destroyed by the firestorm. “Our thoughts and best holiday wishes are with all the people of Kaiser Permanente, especially those affected by the fire,” the Contact editor wrote.
By Ginny McPartland, Heritage writer
Kaiser Permanente founding physician Sidney Garfield had good advice for his Northern California colleagues in 1974. He basically told them to stick together. “Keep your arms on each other’s shoulders and keep your eyes on the stars for innovation and change for the future.”
The executive medical directors took that sage advice in 1997 and created The Permanente Federation (the Federation) to serve the collective interests of the physicians to deliver the highest quality medical care through partnership with Kaiser Foundation Health Plan.
This year, the Federation marks the 15-year anniversary of this collaboration, which has contributed to Kaiser Permanente’s high-performing integrated care delivery system, the creation of a cutting-edge national electronic health records system, a formal sharing of best medical practices, and a shared vision for the future of health care.
In his talk to KP physician leaders 38 years ago, Garfield was speaking from the perspective of someone who had locked horns with traditional fee-for-service medicine over prepaid group practice. He understood that in order for physicians to be able to deliver the highest quality care, they need to be well-positioned to advocate for their patients.
Creating a balance
Permanente physicians have rubbed elbows with Washington movers and shakers over the years. Here, Sidney GarfieldThe alignment of KP’s medical groups created an effective model for collaboration with the eight Kaiser Permanente regional Health Plans and Hospitals. Today, this collaboration continues to drive ongoing dialog through the Kaiser Permanente Program Group, the joint strategic leadership body, and is recognized for its balanced leadership and shared commitment to patient-centered care.
In the inaugural issue (summer 1997) of The Permanente Journal, KP’s peer-reviewed medical journal, Oliver Goldsmith, MD, first chairman of the Federation’s Executive Committee, described the need for physician alignment: “We must assure the value (of putting patient interests first) remains central and (we must) prove incorrect the creeping notion that group practice does not offer an appropriate solution to our nation’s health care problems.”
In the June 2002 issue of Managed Care magazine, former KP CEO and President David Lawrence, MD, noted that new opportunities for collaboration through the Federation represented a change necessary to KP’s continued success. “. . . We now can start to take advantage of our intellectual scale, this incredible experience that occurs across all the geographic areas with all the clinicians and all the Health Plan executives,” Lawrence told the magazine.
Federation progresses toward its goals
On the Federation’s 10th anniversary in 2007, Jay Crosson, MD, the first Federation executive director, gave his evaluation of its success: “In the areas of quality and service improvement, IT development, external relations, and other endeavors, the renewed partnership among the Federation, Health Plans, and organized labor (through the Labor Management Partnership) has been a historic contribution to maintaining KP’s reputation for excellence and superior value.”
Today, the Federation represents approximately 17,000 physicians in eight Permanente Medical Groups nationwide, caring for more than 9 million Kaiser Permanente members. Jack Cochran, MD, the current executive director, offers his perspective on the Federation’s first 15 years:
“Over the years, the partnership between the PMGs and the Federation to leverage advanced technology, create innovative ideas, and share best practices has advanced our clinical quality. Ingrained in KP’s physician culture and rooted in Sidney Garfield’s leadership and vision, is our commitment to provide excellent care through evidence-based medicine that puts the patient first, always.”
CMI helps transform care delivery
The Care Management Institute, also established in 1997, partners with the PMGs and the Kaiser Foundation Health Plan to realize Kaiser Permanente’s vision of consistent, high-quality care.
CMI works with physicians and researchers in all eight Kaiser Permanente regions to gather new epidemiological research and outcomes information and to develop evidence-based best practices to share with all KP physicians and other health care professionals.
“CMI was established to optimize care quality, to further KP’s mission in improving the health of its members, and to transform its health care culture,” said CMI’s Executive Director Scott Young, MD. “We spread clinical best practices, develop integrated care delivery models with regional partners, and support the national program by working with physicians, clinical experts and leaders throughout KP.”
In his 1997 Journal article, Dr. Goldsmith summed up the potential of KP’s partnerships: “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.”