All About Kaiser Permanente
Kaiser Permanente is an integrated managed care consortium based in Oakland, California. It encompasses the Permanente Medical Groups, self-acclaimed experts in preventive medicine, along with the Kaiser Foundation Health Plan, the Kaiser Foundation Hospital system, and The Permanente Foundation. Kaiser Permanente serves over 12.6 million members in eight states and the District of Columbia, making it one of the largest not-for-profit health plans in the United States. It reportedly has 23,515 physicians along with 64,691 nurses and trained medical professionals. The organization offers care 24 hours a day, seven days a week. Kaiser Permanente’s mission is "to provide high-quality and affordable health care services to improve the health of our members and the communities we serve." Throughout its history, the health plan has maintained its commitment to this mission.
Kaiser Permanente was founded in 1945 by Dr. Sidney Garfield and industrialist Henry J. Kaiser. Originally intended to serve the employees of Kaiser Steel, Garfield offered the new health plan to the general population as World War II ended. Garfield and the Kaiser Permanente’s mission were crucial in making quality health care available to economically disadvantaged and disabled people.
In the 1960s, Harry and Jeanette Weinberg joined the mission of the KPMH . Their donation of 156,000 HMO policies for the poor and aged led Douglas Hospital, the precursor to Loma Linda University Medical Center and Medical Center of Southern California, becoming a major tertiary center. Under the plan, enrollees could access a network of Kaiser Permanente providers across 8 states. Kaiser Permanente Health Plan became the pioneer of the "medical home" concept, which is still relevant today. In 1985, the organization was selectively accredited and joined the NCQA voluntary accreditation program.
Many innovative programs, such as those that promote wellness, offer 24/7 convenience and provide online communication between patients and providers, have been pioneered by Kaiser Permanente. The organization has also established a national reputation for the quality of its diabetes care and treatment, cardiac care, and mental health services. In 2011, the rating organization NCQA rated Kaiser Permanente second in the nation in terms of quality of care for people with diabetes.
The Kaiser Permanente Law Department acts in compliance with Kaiser Permanente’s mission "to provide high-quality health care services designed to improve the health of our members and the communities we serve." With that mission in mind, the legal department’s function is to advise on, review, and represent Kaiser Permanente regarding all matters that may affect the health plan or impair its ability to provide quality and affordable health care.
Functions of the Legal Department
The legal department at Kaiser Permanente plays a critical role in ensuring the organization’s compliance with federal, state, and local laws and regulations. With a strong focus on preventative measures, the team works to identify potential legal risks and develop strategies to mitigate them. This proactive approach helps protect Kaiser Permanente from potential lawsuits and other legal issues that could have a negative impact on the organization and its members.
Kaiser Permanente’s legal department is also responsible for reviewing and drafting contracts and agreements. This includes contracts related to healthcare services, employment, and vendor relationships. The team ensures that these agreements comply with all relevant laws and regulations, while also protecting Kaiser Permanente’s interests. They work closely with other departments, such as human resources and finance, to ensure that the organization’s contracts are in good legal standing at all times.
In addition to these core functions, Kaiser Permanente’s legal department provides training and support to other departments within the organization. This includes training on topics such as contracts administration and regulatory compliance. By providing this support, the legal department helps to ensure that all Kaiser Permanente staff understand their legal obligations and can carry out their roles in a way that protects the organization’s interests.
Overall, the legal department at Kaiser Permanente is essential to the organization’s operations. From ensuring compliance with laws and regulations to protecting the organization’s interests in contracts and other legal matters, the legal team plays a vital role in helping Kaiser Permanente deliver quality healthcare to its members.
Legal Issues Facing Health Care
The healthcare industry is rife with complex legal concerns that Kaiser Permanente’s legal department must effectively handle. Of these issues, healthcare regulation is perhaps the most significant. Healthcare regulation has such a profound effect on Kaiser Permanente that the "providers" have to incorporate these rules and regulations into their internal policies and procedures. This not only keeps them compliant but also means that they can continue providing essential services to their members. Legal issues are also an ever-present concern. These problems can range from tackling new laws to responding to patient-related lawsuits and other more unique situations. For the most part, however, legal issues are handled as part of the normal course of doing business. As a privately held nonprofit company, KP has a remarkable degree of freedom over the specifics of their internal legal and business policies and procedures. Indeed, this organization is so compelling that it continues to draw interest among students, healthcare analysts and just about anyone else that is intrigued by the management of an organization that is both so massive and so specific in its mission.
Structure of Legal Department
Kaiser Permanente’s legal department is a large and complex function within the organization and maintains a broad and deep bench. The cohesive team works together to contribute to Kaiser Permanente’s success and manage risks. The legal department constantly reviews KP business practices to evaluate legal risk, and this requires a highly organized and structured function.
At the head of the legal department is the Senior Vice President and General Counsel, Joseph Selna. Reporting to him are two Deputy General Counsels, Jennifer DePalma and John Shirey. Jennifer DePalma oversees the transactional side of the legal department, and John Shirey manages litigation, government relations, regulatory and environmental law. Reporting to Jen DePalma are five practice groups specializing in different areas of Kaiser Permanente’s business. They are Commercial and Financial transactions, Business Practices, Labor & Employment, Intellectual Property , and Facility Development and Management.
Each practice group is managed by an Associate General Counsel. The Commercial and Financial transactions group is managed by John Geertsen. The Business Practices group is managed by Rebecca McCoy. The Labor & Employment group is managed by Joyce Reynolds. The Intellectual Property group is managed by Monique Levy. The Facilities Development and Management group is managed by Chris Walker.
Debra O’Connor manages KP’s taxation practice. Charles Wilson manages the regulatory and government relations group. Chuck Wilson is also responsible for reporting and corporate governance and is also responsible for the litigation team. The litigation team is comprised of strategic advisors and well-respected litigators that handle all areas of litigation within the department.
There are teams of law clerks and interns that work on various projects, support the group and litigation teams, and assist in filing and research. The groups correspond with and consult unionized employees, corporate headquarters staff, contract managers, real estate administrators and policies staff.
How to Prepare for Legal Action
Anticipating future legal challenges requires a proactive approach that is often focused on compliance. We are immediately notified when an issue requiring legal expertise arises within Kaiser Permanente and therefore we have the opportunity to counsel the program or department on potential risks and even assist in creating solutions to avoid problems before they materialize. For example, our Litigation team not only litigates cases but also puts in place processes so we can avoid potential pitfalls in the future. Similarly, our Labor and Employee Relations team does not wait to be called in to help on a grievance an employee files. The LEAD team is part of weekly meetings with front line supervisors so that any potential employee problems can be addressed. WE need to know about issues as soon as possible and that can be accomplished by being a true partner with the business. Proactive compliance training for our clients not only allows them to understand what’s expected or required, but also gives them the opportunity to ask questions about the law, which is essential in minimizing risk and avoiding litigation. A major component of our LEAD training is concerned with preemptively identifying risk before it manifests in the form of a potential claim or lawsuit. Depending on the type of issue, staff members can receive in-person or online training on how to comply with various laws and regulations that govern Kaiser Permanente as an employer.
Influence of the Legal Department on Patient Care
The work of Kaiser Permanente’s legal department has a significant impact on patient care. For example, in the last two years alone, in-house counsel drafted and negotiated over 1,190 new physician agreements that improved patient access to healthcare providers, or replaced expired or unnecessary documents. In addition, they developed, revised, approved, and/ or negotiated over 80 policies or documents focused on creating consistent application of best practices, privacy, safety, and compliance with applicable laws .
The legal department also provides accountability and tracking, compared with external law firms. When when a law firm is retained for an issue, in-house counsel drives and manages those issues. In-house counsel keeps track of issues and follow through. An additional benefit of tracking, is that Kaiser Permanente can recover costs.
In-house counsel are also involved in Kaiser Permanente’s staff education initiatives, allowing them to directly touch and contribute to meeting patient’s health care needs by, for example, training the physicians on new medical board rules or fine institutions.