Simon Stevens, Kaiser Permanente and Accountable Care
Organisations, Clinical Commissioning Groups, Integrated Care Boards
The Kaiser Permanente model
In Jan 2002 a BMJ article claimed the giant California health corporation,
Kaiser Permanente, achieved better performance than NHS at lower cost: through
managed care plans, more comprehensive, convenient primary care, and rapid access
to specialist services and hospitalisation...
It gave Physicians tighter gatekeeper powers, chronic conditions were managed
out of hospital, fewer hospitalisations (which are expensive)
but their statistics were hopelessly flawed
-costs were higher
-NHS patients older
-public health education not included
The authors claimed “this not for profit, highly-integrated system”
is “similar to NHS””
But-the physician group was directly linked to Permanente medical group-a privately
held, for profit, corporation, with CEO and a board of directors
The UK DoH and Kaisers adulated, shmoozed and regaled each other
In the US, Managed care Organisations reaped HUGE profits, US government gave
huge support, thinking they improved competition, efficiency, and would be an
incentive for employers-they provided 90% of health insurance
But, by 1998 made significant losses-saturation,scandals-especially patient-dumping
when their insurance ran out...
-began to lower benefits to patients, increase premiums, withdraw from certain
domestic markets, deselecting violent and poor areas by postcode
-expanded to global countries
-with pharmaceutical companies
The DoHs enthusiasm was part of a generalised global shift
Bevan's original NHS worked well for 40 years until Thatcher and Howe, Clark
disapproved, because every citizen paid in to the system, taxes could be raised,
and the risk was spread over the whole UK, and nobody works for profit..
If, say, a single GP fundholder in Hull, takes part, or say, an area like Goole,
the risk of a complex, expensive patient is higher because of the smaller risk
pool.
The Kaiser Permanente corporation makes huge profits because surgeons, doctors, big pharma, manufacturers of x-ray and scanners, owns the hospital, insures, excludes expensive patients, does not cover all conditions, raises premiums, co-payments and residuals…
This very system is being created, like Frankenstein, by
-Academy style hospitals, owned by United Health, Centene
-salaried doctors and surgeons who can be told what to do, not to do, set targets
and diktats set by the Academy Trusts-exactly as in the investment banker Savid
Javid’s latest wheeze
(Q-When was the last real doctor a Minister of Health? A-Dr David Owen (Lansley
deffo does not count!!!)
all to beachieved before the next election
and Labour by then will be unwilling and unable to renovate the real NHS and Social care…
Kaiser combines all three-insurance, hospitals, doctors as salaried employees (of Trusts-as in Javid’s latest wheeze)
so unified structures of NHS had to be dissolved
-separating insurance and delivery
-reassembled into managed care format (un-Accountable Care Organisations, dis-Integrated
Care Boards)
-hospitals and doctors needed to be decoupled (as in BT privatisation by Hewitt)
-Foundation Trusts- supervised by Monitor, only a licence for certain treatments
(This is why Lansley removed duty of S o S to provide comprehensive care)
Milburn spouted “community empowerment, staff involvement, democratisation,
no way could the bill be described as privatisation” -lie after lie, pure
spin..
From 2012 the Lansley “Monster” Health and Social Care Act, “Clinical Commissioning groups” (dominated by private profiteer groups) , and providers such as hospitals, (which are excluded from decision making, but obliged to cope with the CCG demands)..., obliged to put every contract out to tender-humongously expensive...
at end of 2014, CCGs had £150 million surplus, acute trusts £150 million deficit
CCGs demand fines if Trusts exceed A&E visits, emergency admissions...
GPs were pressured to decrease referrals, but Hunt urged more referrals..
In the end, GPs should represent the best interests of their patients, not profit for their contractual owners...
Simon Stevens, (alternately health advisor to Blair, CEO of United Health, chief exec of NHS England, repeatedly talks about “Integration”, (a valid obvious aim, but in reality, a con-trick’, an alias for US style “un-Accountable care organisations” (like Steven’s United Health) in “The Five Year Forward View” (without mentioning the real aim of privatisation and competition)
You have to admire their secretive chutzpah and sheer cunning, Baldrick…
-a mind blowing departure from the original model of the public NHS, but making radical hidden changes that the politicians dare not (ambiguous, lies, anodyne weasel-words)-ie politicians!!!
-“multi-speciality community providers” (“whenever I use a word it means exactly what I mean it to mean…”), “primary and acute systems” (PAC)s, exactly as “Accountable Care Organisations” modelled on Kaiser Permanente in the US
He’s got an acronym generating machine like ERNIE...
-a way to introduce private health insurance, allowing private multinationals to buy and run chunks of the NHS-which is why Reform and Academy Trusts are proposed-so they can be sold off… (Keep up!!!)
The 2012 HSCAct was indeed a wish list for privatisers, a hand grenade for the NHS…
but this Act did not allow the profiteers to make enough profits
hence the next reorganisation- the 2021 HSCAct...
The proposals mean that for the first time since 1948, parliament will not determine to whom NHS services must be provided. The bill removes the requirement for emergency services to be provided for everybody present in an area. No explanation has been given for getting rid of it.
Over the past three decades the funding, planning and provision of health services have become disconnected from each other and from people living in local areas. The bill takes this further. It gives a single budget pot to 42 new integrated care boards (ICBs) to commission most health services-not all, not comprehensive...
These won’t serve all people living in a local area, but a “group of people” who can be drawn from anywhere in England. The group will be allocated to the ICB under rules made by NHS England, without parliamentary process.
Each ICB will have “core responsibility” for its group of people.
This new concept closely resembles the US definition of a health maintenance organisation (HMO).
In the US, contrary to popular perception, the government funds most healthcare, much of it through private health companies such as HMOs and other “managed care organisations”.
These are responsible only for providing limited free services to a group of people who enrol as their “members”, not a local population. They provide a core or basic package of care paid for under a health plan. Additional services are paid for through more insurance or user charges.
US private health companies such as Centene (Operose) and UnitedHealth (Optum Health) offer publicly funded health plans in the US, and already operate in the UK's NHS. After a takeover earlier this year, Centene became one of the largest primary care providers in England, with 58 practices and more than 500,000 patients.
Within weeks of the deal, Samantha Jones, the CEO of Centene in the UK, had
resigned and was appointed Boris Johnson’s health adviser.
UnitedHealth has received a range of NHS contracts for more than a decade, and
in 2019 Optum was one of two companies awarded a four-year prescribing support
contract up to £100m.
The chief executive of NHS England was until recently Simon Stevens, the former vice-president of UnitedHealth. Stevens became a peer this year, and the bill is his brainchild.
From 2012 the Lansley “Monster” Health and Social Care Act, formed “Clinical Commissioning groups” (dominated by private profiteer groups) , and providers, such as hospitals, (which are excluded from decision making, but obliged to cope with the CCG demands...)
at end of 2014, CCGs had £150 million surplus, acute trusts £150
million deficit
CCGs demand fines if Trusts exceed A&E visits, emergency admissions...
The proposals mean that for the first time since 1948, parliament will not determine to whom NHS services must be provided. The bill removes the requirement for emergency services to be provided for everybody present in an area. No explanation has been given for getting rid of it.
Over the past three decades the funding, planning and provision of health services
have become disconnected from each other and from people living in local areas.
The bill takes this further. It gives a single budget pot to 42 new integrated
care boards (ICBs) to commission most health services-not all, not comprehensive...
These won’t serve all people living in a local area, but a “group
of people” who can be drawn from anywhere in England. The group will be
allocated to the ICB under rules made by NHS England, without parliamentary
process.
Each ICB will have “core responsibility” for its group of people.
This new concept closely resembles the US definition of a health maintenance organisation (HMO).
In the US, contrary to popular perception, the government
funds most healthcare, much of it through private health companies such as HMOs
and other “managed care organisations”.
These are responsible only for providing limited free services to a group of
people who enrol as their “members”, not a local population. They
provide a core or basic package of care paid for under a health plan. Additional
services are paid for through more insurance or user charges.
For many years, the government have stuffed Number 10 with PMs Health advisers-like Stevens, Penrose, and stuffed the D of Health with McKinsey advisers at £4000 a day, enrolled NHS Trust managers from the marketisers, profiteers, more throughput, Young Turks at huge salaries, ICB executives on £600,000 a year...
A public. no profit, NHS would be far cheaper, and give far better, truly integrated, collaborative care...
US private health companies such as Centene (Operose) and UnitedHealth (Optum Health) offer publicly funded health plans in the US, and already operate in the UK's NHS
After a takeover earlier this year, Centene became one of the largest primary care providers in England, with 58 practices and more than 500,000 patients.
Within weeks of the deal, Samantha Jones, the CEO of Centene in the UK, had resigned and was appointed Boris Johnson’s health adviser.
UnitedHealth has received a range of NHS contracts for more than a decade, and in 2019 Optum was one of two companies awarded a four-year prescribing support contract up to £100m.
The chief executive of NHS England was until recently
Simon Stevens, the former vice-president of UnitedHealth. Stevens became a peer
this year, and the bill is his brainchild.