For the last several weeks Kaiser Permanente has been running a series of TV and print commercials called “Thrive“. They ads contain a bunch of pap series of suggestions about living a healthier lifestyle and how Kaiser Permanente wants its members to “thrive”. This is apparently a $40m campaign, but given that Kaiser has been losing some market share and has been having trouble combating the high-deductible health plans on offer from its rivals like Wellpoint, Blue Shield, Healthnet et al, it doesn’t sound like an outrageous amount to spend. Of course, like every other health plan Kaiser is trying to get younger, healthier people to sign up as members. And while the commercials may not make much sense (be honest, which ones on TV do?), they are at least related to healthcare in some way, unlike an early 1990s campaign in which Roger Greaves, then Healthnet’s CEO, was shown kayaking next to a pod of killer whales.

Up to now I’ve ignored this as I think these type of ads are mostly irrelevant to the real health care market. But as with any big organization, Kaiser has its detractors, and there’s been some fuss about the campaign in the Oakland Tribune. One Kasier detractor has written to several health care bloggers suggesting that we cover it. Well, after confirming that my correspondent really is an ex-Kaiser employee, I’ve taken the bait, although I’m not sure my correspondent will be too happy with my conclusions. (Full disclosure–Kaiser was a client of organizations that I worked for back before 1999. I never worked for them on a dedicated project and have had no financial connection with them since).

Kaiser has made some basic if not serious missteps, and in the “Thrive” campaign it has left its detractors a few open goals. For a start, despite the name of the campaign, the URL KaiserThrive was not reserved and unfortunately for Kaiser was taken by a very upset Kaiser patient/member. And it gets a little worse, particularly as several of the internal powerpoints describing Kaiser’s communications issues were left openly available on the Internet. Now, having looked at what’s in one document I can’t find anything that reflects too badly on Kaiser. It’s mostly a series of suggestions as to how to position the corporate message and relate to members better. And those problems are basically the same ones Kaiser’s always had.

For as long as I can remember Kaiser has had a good reputation with a high percentage of its members, and a reputation amongst better-off socio-economic groups as a plan OK for working-class people but not for people like “you and me”. While the some of this attitude is down to class snobbery, part of it is due to the inherent structure of the Kaiser system which restricts its members to Permanente doctors and Kaiser facilities.

There are some genuine criticisms of the way Kaiser does business. Wellpoint’s Len Schaeffer has long criticized Kaiser’s commitment to charity care and providing care for Medicaid patients. This quote is from a 1995 interview:

Q: How does Kaiser Permanente fit into the changing market picture in California?
A: Kaiser Permanente has done a marvelous job for its membership, the bulk of which resides in California. But, as a nonprofit HMO, I don’t think it has done much for other Californians. Kaiser does not enroll those who cannot pay its premiums. In fact, I argue that Kaiser has taken all of the medical revenues of its California membership-almost, five million people-out of the state’s pool of available health care monies, put it in its own private health insurance system, and therefore made the rest of the system bear the burden of caring for all of the people who are uninsured.

However, despite criticism that it doesn’t do enough for non-members, Kaiser has been at the forefront of some genuinely innovative medical programs for those who are its members, even if it might be financially better off without them. It was one for the first to introduce a comprehensive HIV care program and introduced comprehensive disease management programs back in the 1990s, some way ahead of most of its competitors. That of course means that Kaiser’s sicker members tend to stay with it, which really is the opposite of what a health plan’s CFO might want, and what some of its more financially successful rivals have actually done.

And despite some criticism of the technology behind its HealthConnect program (for one dissenting view see here) and its tendency to inadvertently kill off smaller software vendors by bureaucratic mind-shifts, Kaiser is the private organization in America with the biggest initiative in health IT. The commitment to improving care by implementing electronic health records is genuine and huge, and at least by its own account (as reported in Health-IT World) is going quite well.

So overall I still believe that Kaiser is on the side of the Angels. There are though several issues that need to be cleaned up. One is the slightly obvious one of taking care that internal documents stay internal. While I haven’t read anything that showed malfeasance or bad intent in those documents that were left unprotected, that level of attention to detail doesn’t demonstrate too much security competence. As Kaiser is going to be creating probably the largest interconnected medical database in the private sector, they are going to have to make sure that that data is secure, and understood to be secure. Already some commentators are suggesting that outsourcing some of the technology to India will compromise data privacy. My correspondent has a weblog devoted to these and other issues. A quick perusal of that weblog shows an unhappy ex-employee, who is mostly upset at the internal office politics s/he experienced at Kaiser. But that doesn’t mean that all the comments can be dismissed out of hand, especially as some documents linked to on the web are clearly not meant for public viewing. Scratch this type of thing and it gets even weirder. There is one baffling web site which suggests that there’s a pattern of criminal and violent behavior apparently attributal to rogue employees within Kaiser, but I think this seems to be descending into conspiracy theory.

I suspect the truth is all much more mundane. Kaiser is a big bureacractic organization with all the turf battles and complications that you’d expect. Add to the mix the fact that Kaiser, for all the efforts of the corporate office, is still a collection of regional insurers and of regional medical groups that all have their own politics and agendas. Nonetheless, it has consistently scored well on NCQA and other quality measures, and has shown more innovation than most providers of its size and almost every health plan in terms of patient care, disease management programs and its IT initiatives.

Despite its well-publicized problems, particularly its big losses in 1997-8, Kaiser has been a massive net positive in the Western US health care system. Its success in the 1980s and 1990s certainly ushered in managed care–and there would be those that argue that wasn’t such a good thing–but you can’t blame Kaiser for what were almost all the failings of other managed care plans. You can credit Kaiser for delivering more cost-effective and higher quality care on a mass scale than almost anyone else in America, and for making the investments to ensure that they’ll be able to do that in the future.

Sure there’ll be problems as the new system is rolled out. Sure a new advertising campaign — while arguably needed to promote the organization’s viability — is no panacea and perhaps the money could be better spent elsewhere. But nothing I’ve seen from the detractors so far persuades me to believe that, silly ad campaign or not, Kaiser needs to do anything else than keep on its current course.