Q1. Similarities between UnitedHealthcare and Kaiser Permanente
UnitedHealthcare offers both HMO and PPO plans. For all requirements related to healthcare, both of these plans offer a one-stop shopping. Doctor’s visits and hospital care is combined in a single plan. They offer coverage for prescription drugs and even include dental, fitness programs, eye care, hearing care, and other healthcare benefits. Both plans involve a network of doctors and hospitals which provide care to policy holders for less than their usual cost. Policy holders will have to choose their specific doctors and hospitals (UnitedHealthcare).1
Kaiser too offers both HMO and PPO plans, but it is more popular for its HMO plans. It was one of the first HMOs and one of the front runners in the business of managed care. Each member chooses his own PCP. The PCP further arranges the primary, speciality, and hospital care (FAQ about Kaiser Permanente).2
Both UnitedHealthcare and Kaiser Permanente support people with long term conditions. Both the company’s models are associated with improved quality of life to the patient, few hospitalization days and few bed days for the patient(Review of UK and international frameworks).3 AM Best has been rating both the companies as an excellent (A grade) insurance company (Health Quote 360) .4
Q2. Differences between UnitedHealthcare and Kaiser Permanente
UnitedHealthcare’s HMO and PPO plans are available in 38 states and in more than 70 markets. The benefits of both the plans offered by UnitedHealthcare are competitive premiums as compared to commercial plan. Adding to this are more benefits like additional preventive care, customized plans for even greater benefits, Medicare Part D Prescription Drug coverage, anywhere in the US, and full insurance (Medicare Advantage HMO and PPO plans).5 Kaiser Permanente currently serves over 8.7 million members and spread across 9 states. It has been doing business partially as non-profit organisation and partially as for-profit organisation (Review of UK and international frameworks).3
UnitedHealthcare HMO plans focus on targeting those who are at a high risk of getting hospitalised, whereas Kaiser Permanente focuses on assimilating services between primary care and secondary care and removing distinctions between them at all stages. Kaiser Permanente’s approach is based on the Chronic Care Model where high risk patients, 70 -80% of patients with chronic conditions and highly complex patients are being taken care of (Review of UK and international frameworks),3 whereas UnitedHealthcare plans focuses on highly complex patients who are at risk of getting hospitalized (Medicare Advantage HMO and PPO plans).5
Q3. What are the member/patient incentives?
All medical treatment for policy holders enrolled in Kaiser Permanente HMO plan are offered by Kaiser Permanente’s own group of doctors, hospitals, and pharmacies. After participants pay a copayment, the company covers most of the services at 100% (Kaiser Permanente HMO Standard Option Medical Plan).6 In Kaiser Permanente’s PPO plan, preventive benefits are offered at no member cost share. This depends upon the group’s benefit plan. Nearly 60,000 retail pharmacies across the nation participate in the pharmacy network for the policy holder to make use of its service. POS members of Kaiser Permanente can have Permanente Advantage (PA) of Permanente medicine. PA provides better outcomes in terms of patient care coordination, lower medical bills, and reduced number of days in hospital or recovery period. PA is accredited by URAC. UnitedHealthcare offers to its members all other plans as well like eye care, dental care, life insurance, disability, and pharmacy network (Health Quote 360).4
UnitedHealthcare has recently made announcement of its Medicare portfolio which will deliver value to its members by greater cost savings. The company is bringing cost-saving opportunities to its Part –D plan members in the current year by creating a pharmacy network (UnitedHealthcare Announces 2013 Medicare Plans).7
Q4. What are the innovations promoted?
Kaiser Permanente has successfully and influentially adapted a innovative business model that is combining coverage along with health care delivery in one coordinated service (Kaiser Permanente Again Ranks No. 1).8
It displays on its website videos of those who have a Kaiser Permanenete plan and how they are benefited from the plan chosen. The video shows how a busy working mother of three who has opted for a plan for Kaiser Permanente since 2004 and how satisfied she is with what she has chosen for her family. She concludes that Kaiser has given her peace of mind (Kaiser Permanente – A perfect match for busy mom).9
UnitedHealthcare had a special UnitedHealthcareOnline.com webinar exclusively for UnitedHealthcare community health care professionals or various information (various plans, new Health Risk Assessment, and Plans of Care) to get an overview of the features available to use for the community plan patients (UnitedHealthcare Online).10
Q5. What are facilities and patient satisfaction practices?
Patient satisfaction for Kaiser Permanente plans is measured with the help of a standardized survey, which the patient is asked to take upon his discharge. The aim of the survey is to determine the patient’s experience of the healthcare provided. The survey is known as HCAHPS, which is Hospital Consumer Assessment of Healthcare Providers and Systems (Patient satisfaction).11
As with Kaiser Permanente, UnitedHealthcare and few other companies, also measure patient satisfaction with the help of a survey available on http://www.surveymonkey.com/s/P97VLR5 to determine the patient’s experience of the healthcare provided (Patient satisfaction survey).12
Q6. Provider incentives?
As with all insurance companies, UnitedHealthcare and Kaiser Permanente too are funded primarily by enough premiums from the policy holders and then paying them to just a few who actually need. They also make money by earning in investment returns (How the Insurance Business works?).13
Q7. Preferred recommended choice of insurance company?
My preferred choice of insurance company is Kaiser Permanente. It is prepaid, believes in early detection of the disease, provide the best care, and follows up correctly.
References:
- UnitedHealthcare Health Savings Accounts and Health Reimbursement Accounts. Available at: http://www.steveshorr.com/individual_and_family/hsa/hsa.overview.united.healt.care.94.pdf
- Frequently asked questions about Kaiser Permanente. Available at: http://www.bcps.org/offices/benefits/pdf/kaiser-Permanente-faq.pdf
- A review of UK and international frameworks. University of Birmingham. Available at: http://www.improvingchroniccare.org/downloads/review_of_international_frameworks__chris_hamm.pdf
- Top 25 Health Insurance Company Review. Health Quote 360. Available at: http://www.healthquote360.com/Health_Insurance_Companies/Top_25_Health_Insurance_Company_Review.php
- Medicare Advantage HMO and PPO plans. UnitedHealthcare. Available at: http://www.uhc.com/group_retiree_solutions/retiree_health_care_products_services/medicare_advantage_hmo_and_ppo_plans.htm
- Kaiser Permanente HMO Standard Option Medical Plan. Santa Clara University. Available at: http://www.scu.edu/hr/benefits/snapshot_summary/summ_kaiser_standard.cfm
- UnitedHealthcare Announces 2013 Medicare Plans. UnitedHealth Group. Available at: http://www.unitedhealthgroup.com/newsroom/news.aspx?id=26089d03-dade-41ff-bb45-072bfd3ffd5d
- Kaiser Permanente Again Ranks No. 1 in Customer Loyalty in the 2012 Satmetrix Net Promoter® Benchmark Study. Kaiser Permanente News Centre. Available at: http://xnet.kp.org/newscenter/pressreleases/nat/2012/032112netpromoter.html
- Kaiser Permanente – A perfect match for busy mom. Available at: http://www.youtube.com/embed/-yQXZQzIOnw?rel=0&wmode=transparent&autoplay=1
- In the spotlight. UnitedHealthcare Online. Available at: https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Kansas_Community_Plan_UnitedHealthcareOnline%20com_Training_Sessions.pdf
- Patient satisfaction. Northwest Hospitals. Available at: https://northwest-hospitals.kaiserpermanente.org/quality-research/patient-satisfaction
- Patient satisfaction survey. Premier Care Physicians. Available at: http://www.premiercarephysicians.com/patient-info
- How the Insurance Business works? Wikinvest. Available at: http://www.wikinvest.com/concept/How_the_Insurance_Business_Works
