Your insurance premiums at work

The juxtaposition of these Kaiser stories in the news today were a striking disconnect from what we hear about skyrocketing insurance premiums due to higher medical costs. Are premiums being spent most effectively for health care, as card holders might believe, or are politics and financial interests afoot?

Eight hospitals in southern California are sueing Kaiser Permanente for $25 million in unpaid emergency room services provided to Kaiser members. According to the press release from Prime Healthcare Services, the Chino-based hospitals: “Many providers believe that Kaiser’s aggressive and intractable approach is part of a larger decision on Kaiser’s part to pad its bottom line by simply denying payments due to outside providers by hook or crook.” It also stated that doctors in Kaiser’s Emergency Provider Response Program, staffed by the Southern California Permanente Medical Group, pressure providers at hospitals that do not contract with Kaiser to declare a patient “stable” so that the patient might be transferred back more quickly under Kaiser’s care.

Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and their subsidiaries announced today they’d had “total operating revenue for the fourth quarter ending December 31, 2007 of $9.6 billion, which compares to $8.7 billion for the fourth quarter of 2006, and a net loss of $233 million for the quarter... Items impacting fourth quarter net loss include additional expenses associated with the opening of new facilities, higher retirement costs, other increases in hospital and medical costs, and increased spending for community benefit programs... Total revenue for the year, ended December 31, 2007, was $37.8 billion, which compares to $34.4 billion in 2006....in 2007, KFHP/H provided an estimated $1 billion to fund community benefit programs.”

Speaking of those community benefit programs, today, Kaiser also announced $29 million in grants given out in the fourth quarter of 2007 — the largest amount of money ($16 million) went to Colorado to “fight obesity” for its “LiveWell Colorado” wellness program. Readers may remember that Colorado ranked absolutely bottom in the country for “obesity” and also at the bottom for diabetes, hypertension and inactivity (50th, 50th and 48th, respectively), according to the Robert Wood Johnson Foundation-sponsored Trust for America’s Health F as in Fat 2007 Report. It is also one of the wealthiest states in the country.

Kaiser Permanente, as readers remember, is one of the largest health-maintenance organizations in the country and has partnered with the Robert Wood Johnson Foundation, CDC, American Association of Health Plans, Health Partners, and the National Business Group on Health to develop the national agenda to address a “public health crisis of obesity” and create a roadmap for action, despite the fact its own researchers had conducted the largest review of the evidence on obesity interventions in young people for the U.S. Preventive Services Task Force and found them insupportable and potentially harmful. Kaiser had also created the anti-childhood obesity video game, "The Incredible Adventures of the Amazing Food Detective" distributed to elementary children across the country through Scholastic, Inc., which epitomized fat prejudices and myths about fat children and had received a rash of negative feedback. Kaiser also produced the version for healthcare professionals distributed through Discovery Health’s continuing education program. As a follow-up, readers might be interested in another bit of news.

Today, Kaiser Permanente received two awards for its "The Incredible Adventures of the Amazing Food Detective" children’s video. It was awarded the 2008 Best Products by iParenting Media Awards and Best in Class by the Interactive Media Awards. According to the press release, 79% of elementary school teachers had found the game “effective, useful and fun.”