Why Kaiser Insurance Members in California Stay on Their Plans

Posted: June 27, 2016

by John Hansen

Kaiser Permanente California Maintains Some of the Highest Retention Rates. Find Out Why.

According to a CA State Exchange representative from Covered California, Kaiser plans have some of the highest retention rates in the state.  When California consumers enroll with Kaiser Permanente California, they tend to stick around. There are three main reasons that those with Kaiser insurance tend to keep their health plans.

1. Kaiser Permanente California’s “Ease of Use”

Kaiser Permanente CA’s integrated system makes access to health care services very simple. Those on Kaiser insurance often can get all their medical needs met under one roof or on one Kaiser campus.

Visit your primary care physician. Walk down the hall to see a specialist. Get your labs and blood tests downstairs, and grab your prescription drugs on the way out the door. And, before you leave, don’t forget to visit grandma in the Kaiser hospital just across the way.

Or, call the Kaiser Permanente California advice nurse hotline and speak to a nurse 24/7. Often, Kaiser insurance patients can avoid going to the doctor by getting support over the phone. Personally, I called the Kaiser Advice nurse when I was sick, and the nurse gave me a prescription right over the phone. That saved me a trip to the doctor.

2. Kaiser Insurance Offers a “High Quality of Care”

Kaiser Permanente CA is the leading HMO in the state and one of the top HMO’s in the world. Through use of advanced technology, like its sophisticated electronic medical records system, Kaiser Permanente insurance has become the leader in California when it comes to treating various medical conditions.

When new medical advancements are made, often those developments take around seven years to become practice in most health care facilities. Kaiser Permanente California, however, is often implementing new advancements in health care in one year.

Kaiser Permanente CA has become the leader when it comes to cancer treatment, cardiac care, and diabetes. Of the California health plans, Kaiser Permanente is ranked #1 for senior care, being the only carrier in the state to receive a four star rating for its Medicare plan by the Office of the Patient Advocate.

3. Kaiser California’s “Affordable Prices”

Kaiser Permanente California has chosen a health care delivery model that incentivizes the health plan to keep its members healthy. In the old fee-for-service model and current PPO models, physicians make more money the more you get sick. However, in the Kaiser insurance system where the hospital, doctors and health plan are all connected, the insurance carrier actually makes more money when you stay well, or as Kaiser loves to say, when you “thrive”.

With this advanced medical delivery system, Kaiser California has been able to gain and maintain a healthier pool of members than most health plans in the state. Healthier members mean lower costs for the health insurance company, which ultimately results in more affordable rates for its members.

The Hard Limiter for Kaiser Permanente CA: Infrastructure

At this point, however, Kaiser Permanente California has a hard limiter, infrastructure. The health plan is limited on how many members it can acquire due to having not enough doctors, hospitals and medical facilities. For health plans like Anthem Blue Cross and Blue Shield of California, they can expand their networks simply by contracting with more physicians.

For Kaiser Permanente, to expand the network means purchasing land or facilities, building, hiring physicians, training staff and much more. Kaiser California has been adding staff and facilities, but it will be some time until it can catch up to the opportunities for gaining members that the health plan has received due to the Affordable Care Act (ACA).

Until infrastructure grows, Kaiser Permanente California will have to be careful how affordable they make their plans. If they price too low, they may end up with more Kaiser insurance enrollment than they could handle, which could decrease quality of care for California’s leading HMO. Other California health plans are threatening double digit rate increases in 2017. Kaiser Permanente CA may need to follow suite simply to keep its membership from becoming too large.