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 Ginny McPartland
When we talk about quality of care today, the name “Jim Vohs” inevitably comes up. That’s because many Kaiser Permanente (KP) people have heard of the annual James A.Vohs Award for Quality. It’s a great honor to receive the Vohs award, and every year since 1997 people across the program have pulled out all stops to garner the coveted distinction for quality improvement projects. But fewer people know the story of James A. Vohs, the man behind the name, and why he is associated with quality assurance.
Jim Vohs was an early health plan leader, a champion of prepaid, group medical practice, a believer in strong partnerships between health plans and the medical groups, and an adamant advocate for Kaiser Foundation Health Plan and Hospitals as nonprofit institutions that provide quality, affordable health care.
Right out of Berkeley High School in 1946, Vohs first worked as a “mail boy” for a Kaiser Industries unit called Kaiser Services, where his mother worked as a bookkeeper. After his graduation from UC Berkeley in 1952, he rejoined Kaiser Services, which provided administrative support for the various Kaiser industrial companies, like Kaiser Steel, Kaiser Aluminum and Kaiser Engineers.
With his career blossoming, he shocked his Kaiser Services colleagues by choosing to switch to the nonprofit Kaiser Foundation Health Plan and Hospitals in 1957 because he believed in its principles. It was a good choice. During a 50-plus year career, he rose to become President and CEO as well as the first chairman of Foundation Health Plans and Hospitals boards of directors who was not a Kaiser family member, succeeding Edgar F. Kaiser, Henry J. Kaiser’s son.
Quality a big priority
Quality of care was an issue early on in the life of the Kaiser Permanente Medical Care Program. Detractors of prepaid, group practice were quite happy to spread rumors about how Kaiser Permanente doctors were not qualified or competent and that their patients were “captives” of no choice.
Vohs was very much aware that these attacks contributed to a “poor reputation,” however wrong, in KP’s early days. Even the prevailing attitude at Kaiser Services was that the medical care program was an “embarrassment.”
Meanwhile, Kaiser Permanente was early and quick in its efforts to show the skeptical world evidence of its excellent care. Early physicians published research that showcased their innovative treatment, sponsored medical symposiums, aligned themselves with academic medicine, and kept their heads down when the insults were hurled.
Reputation aside, Jim Vohs had faith in the high caliber of Permanente physicians, and he bravely faced critics who implied Permanente cut corners in medical treatment. “It is quite clear to me that the economic incentive . . . for the program and the participating physicians —who by and large spend their careers (with Permanente) — is to resolve medical problems as promptly and completely as possible,” Vohs told an interviewer in 1983.
Documenting quality of care
Today’s medical quality movement got its start with the creation of the Joint Commission on the Accreditation of Hospitals in 1952. The federal government started requiring quality data following the adoption of Medicare for the retired and Medicaid for the poor in 1965. The American Hospital Association published its Quality Assurance for Medical Care in the Hospital in 1972. The HMO (Health Maintenance Organization) act of 1973 required each federally qualified HMO to have an internal quality assurance program.
In 1974, Kaiser Permanente physicians from all regions started meeting regularly to discuss quality related issues, and Vohs established a department of quality and a board of directors committee on quality assurance. The committee, including Vohs, made site visits to each of the regions several times a year.
In 1979, Drs. Leonard Rubin and Sam Sapin served on an advisory committee that set up the National Committee for Quality Assurance (NCQA), which sets standards for HMOs. The Permanente physicians were successful in getting the committee to adopt a problem-focused approach to quality assessment, which Rubin had developed and tested starting in 1967.
By 1983, Kaiser Permanente was getting good reviews. Dr. Sapin reports: “Almost without exception, published reports comparing health care delivery by Kaiser Permanente physicians to others have shown us to be better than or at least equal to others.”
Vohs is proud of having the quality award as part of his legacy: “It’s so important for Kaiser Permanente. The regions are competing for the award; they are supporting programs in quality because they want to win that award.”
Vohs a key player in KP milestones
Throughout the years, Vohs played a key role in many of the milestones of Kaiser Permanente’s history. Each chapter helped to make Kaiser Permanente stronger and more capable of providing high quality care.
• Passing of the Federal Employees Benefits Act in 1959. This legislation was heavily influenced by Kaiser Permanente leaders who urged Congress to include a choice of fee-for-service and prepaid medical plans. Kaiser Permanente gained many members as a result.
• Passing of the HMO Act of 1973. Kaiser Permanente leaders also heavily influenced this legislation. They worked with Health, Education and Welfare Agency officials to develop a proposal for a per-person or capitation method of Medicare reimbursement for health maintenance organizations (HMOs), which became part of the act.
• Formalizing Equal Employment Opportunities (EEO) and Affirmative Action practices in the 1960s and 1970s. Opening a Kaiser Permanente EEO conference in 1976, Vohs reaffirmed Kaiser Permanente’s commitment to the employment of minorities and women. He reported an increase of minority and women employees from 4,600 in March 1974 to 5,084 a year later, almost one third of the total work force at the time. Women held 56 percent of the management or supervisory positions in 1975, up 2 percent from 1975; minorities held 14 percent of the top jobs in 1975, compared to 13 percent a year earlier.
Vohs affirmed KP’s historical “one-door, one-class” system of health care dating back to 1945. “Each member is entitled to necessary medical care of the same quality, in the same place, irrespective of income, race, religion or age. Given this policy, it would make little sense if we were to discriminate in our employment practices.”
• Partnership and eventual takeover of the Georgetown Health Plan strategically located in Washington, D.C. This medical care program provided the springboard for the creation of our Mid-Atlantic States region.
• Convening a meeting among health plan and medical group leaders in 1996 to re-confirm the principles of the historic 1955 Tahoe Agreement. The earlier agreement set up the business relationship and clear authorities for the Kaiser Permanente Health Plan and Hospitals leadership and the Southern and Northern California medical groups. Forty years later, the outcomes of “Tahoe II” were the National Partnership Agreement and the creation of the physicians’ Permanente Federation, which represents all regional medical groups in dealings with the health plan leadership.
Kaiser Permanente on a mission
An able administrator, Vohs believed in the health plan: “There was a sense of commitment to a program that was performing social good and demonstrating a way of providing care and financing that was important to the country.”
Vohs firmly dispatched any insinuation that Kaiser Permanente was like for-profit health plans: “Over the years, Kaiser Permanente has been driven by particular values that essentially relate to providing quality medical care to enrolled members for a fixed monthly premium. We don’t conceive of ourselves as a commercial enterprise,” Vohs told John K. Iglehart of Health Affairs in 1983. Quoted in a New York Times article “King of the HMO Mountain” the same year, Vohs added: “There’s a certain missionary zeal in what we’re doing. We think this is a good model for the way in which medical care ought to be organized – so we want to see it spread.”
The Southern California Region’s Proactive Office Encounter (POE), which promotes preventive care, and the California regions’ programs to prevent heart attacks and strokes, were awarded the 2009 Vohs Awards earlier this year. The Fall 2010 issue of the Permanente Journal carries an article about the POE.