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.



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