As debates over healthcare reform become more heated in Congress, it is important to remember that there are many successful models of healthcare delivery right here in the US. One of these is the case of Kaiser Permanente in California and its implementation of disease management.

Kaiser Permanente is the largest not-for-profit healthcare organization in the country, consisting of a health plan, 30 hospitals, and hundreds of doctor clinics operating in ten different states. It is considered an integrated healthcare system because it pays for healthcare (through its health plan) and delivers it to patients through its hospitals and physicians) all under the same Kaiser umbrella.

It is well known in healthcare that 80% of the costs are incurred by 20% of the population. These 20% are those patients with chronic diseases such as diabetes, heart disease and asthma. Therefore, Kaiser has implemented aggressive disease management programs for this portion of the population.

Disease management “is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant.” It focuses on preventing complications by using evidence-based practice guidelines and patient empowerment strategies.

For example, among its 3 million members in Northern California, Kaiser monitors and controls their blood pressures and cholesterol by promoting the use of Aspirin and beta-blockers (to reduce risk of heart attack) and statins (to lower cholesterol), in addition to aggressive education on diet, exercise and smoking cessation.

Studies show that the death rate from heart disease among this population is 30% lower than the general population (of the same age). One 2002 study actually showed that after adjusting for age and socio-economic differences, health care costs per capita in Kaiser and the National Health System in Britain were similar (within 10%) but that Kaiser had significantly better health outcomes (this study was later challenged by other studies).

But how can Kaiser do this? And why aren’t other systems doing the same? The reality is that Kaiser can afford to spend $55 million annually on disease management because these investments remain within its system in terms of lower patient costs, since Kaiser is both a payer and a provider. Any healthcare system that is only a provider cannot afford to spend so much on prevention and education — otherwise it would drive itself out of business as patient become healthier and need less costly hospital care and complicated surgeries.

Healthcare providers within the Kaiser organization take patient education and preventative services very seriously becuase they have an incentive to do so. As long as the rest of the healthcare system only gets paid when patients get sick, our costs will continue to grow with no visible improvements in quality.