Tag: Gary Mendoza

Building Virtual Kaisers: Transcending Healthcare’s Tower of Babel

The Tower of BabelTwenty years ago this month, California created an organizational architecture for integrated delivery systems taking global capitation—the restricted Knox-Keene (RKK) license.

At its creation, I envisioned the RKK as a pathway to virtual Kaisers.

This post distills the RKK’s guideposts for provider organizations on that pathway.

It also summarizes a straightforward path to transcend the biggest barrier to fluid, integrated care—healthcare’s Tower of Babel.

Organizational architecture for full risk. Many provider organizations do a very good job delivering patient care; very few have the systems or experience to effectively administer benefit arrangements.

Taking full risk for patient care requires both.

RKK provider organizations meet all Knox-Keene standards governing the provision of healthcare services, including requirements to provide continuity of care, assure timely access to healthcare services and separate medical decisions from fiscal management.

Without a strong financial footing, provider systems taking full risk put their patients at risk for care disruptions.  RKK licensees must maintain a minimum net worth and assure that incurred-but-not-reported claims are reflected in the organization’s books and records.

Licensees also need grievance systems to address patient and non-contracting provider complaints.

Continue reading…