Primary Care Redesign

Primary Care Redesign


Rob Ryan, MD

Perm J 2016 Fall;20(4):97-063

For  the  past  several  years,  Kaiser Permanente has been fundamentally redesigning primary care delivery in Georgia. We have built a unique model centered on physician ownership and accountability along with incentives and compensation levels which are tied to performance and member satisfaction. Structured around  small,  semi-autonomous  teams,  this model blends the best of two worlds by leveraging the scale, structure, experience, and reputation of the nation’s largest and most respected health maintenance organization (HMO) to create  and  support  small  teams  of  medical  professionals  who  manage  the  care  of  a  defined panel of patients.


Kaiser Permanente in Atlanta, Georgia (KP-Atlanta) began  operations  in  1985,  and  by  1992  there  were more than 156,000 members enrolled. The plan had accumulated operating debt of approximately $80 million at a time when competition was intensifying. A 1993 study showed that our internal cost for delivering primary care was about 40% higher than in community practice. Our competition was delivering primary care much more efficiently, and our predictions suggested that our price disadvantage would increase.


etoc emailClick here to join the E-TOC list or text TPJ to 22828. You will receive an Email notice with the Table of Contents of each issue.


The Kaiser Permanente National CME Program designates this journal-based CME activity for 4 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


27,000 print readers per quarter, 15,350 eTOC readers, and in 2018, 2 million page views of TPJ articles in PubMed from a broad international readership.

The Permanente Press

The Permanente Press publishes The Permanente Journal and books related to healthcare. For information about subscriptions, missing issues, billing, subscription renewal, and back issues, Email:

ISSN 1552-5775 Copyright © 2019

All Rights Reserved.