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Comment by actually_a_dog | Hacker News Reader

I have to say that this is exactly why I like having Kaiser as my health insurance. Because Kaiser is also my healthcare provider, if I need to see a specialist, all it takes is a referral from my PCP or any specialist I'm currently seeing, and it's done. And, they practice evidence-based medicine to the extent that's possible, which means that treatment decisions tend to be pretty reasonable. My PCP refers out whenever there's anything outside her expertise.

I know it sounds like a massive conflict of interest to have one's physician working for one's insurance company, but, somehow, it really seems to work and work well, bypassing those failure modes you mentioned entirely. I've gotten in to see specialists within a matter of a couple of weeks whenever I've needed it.

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I wish I had your experience with Kaiser. I've hit that conflict of interest multiple times. Most recently, after going through triage and waiting six weeks for an appointment, and after half way through it with [specialist], I learn that they're actually not the specialist I thought I was getting and just performing triage. This person lacked even basic knowledge on the topic, and none of the classes or groups she can find actually address the issue in question. When our time is almost up she finally decides to lookup a specialist. There's only one available with only one date available in another couple months. But she's only looking in one geographical region because she doesn't have access to data for the other region that can also serve us. If I book this appointment, she informs me I won't be able to find another specialist in the other region because a patient can be assigned to only one specialist. So it seems data actually is integrated across Kaiser's "regions", but only so far as to support their bottom line.

Kaiser doesn't have a "bottom line" to support. North and South Kaiser are two completely different orgs, but they both use the same EHR technology and can move records between them with no real friction.

They may not have a bottom line, but they certainly put up barriers to accessing specialty care that I never experienced when using the Sutter/Blue Shield combo. Also this wasn't a North Kaiser vs South Kaiser thing. More like Solano vs Yolo/Sacramento counties.

Kaiser doesn't excel at specialty care, I will agree with that. There's more friction (and inter-regionally, which is not something I've had to deal with since I'm in the bay area which is the kaiser mothership).

Kaiser exists to maximize healthcare for reasonable costs across a wide range of people, and they do so by keeping general health high, but at the expense of specialty. In a city like SF, that means Kaiser will send you to UCSF for a transplant and pay a significant fraction. In Solano and Yolo/Sacramento there are far fewer specialists and even then I'd expect you to be referred to UCSF (when I worked there, there were constantly people visiting from all over the state for transplants).

Having experienced access to care inside the Kaiser system and outside the Kaiser system I have to say that with the integrated approach that Kaiser has accessing care is easier, getting Kaiser to cover care is easier. Outside of their HMO, with standard PPO care it's a veritable morass of insurance portals, individual doctor portals, no shared medical files so you end up having to request medical records, and send them to each provider individually and for prescriptions... With Kaiser if you need it, you go to the pharmacy at the facility where your doctor is and odds are they'll have it for you. There's no need to "shop around" or wait for a prescription to be transmitted to CVS, Wal-Mart, your local grocery store, etc. It's just there. You have full access to your complete medical record and test results online at any time. My family always received top-notch care and from what I've seen now that I'm on the outside (F's for Cigna), it's just a better way to do medicine.

That said, my experience and my family's is from Kaiser Permanente Southern California (San Diego).

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