Best HMO or managed care system you've used

[Boose]

What's the best example (quality and seamless delivery) of managed healthcare that you've experienced in any place you've lived? Can be pre- or post-Medicare.

DH and I are still trying to figure out where to live, and healthcare is one metric. Here, docs and specialists are affiliated with Mass General Hospital, but everyone is under their own practice and communication/referrals are disorganized. I can't believe I miss having to use the lab and specialists that shared the building with my old primary (Scripps). But sometimes less choice is better?

 

[Dash man]

I’m in SE PA, and while not required to, we mostly use the Mainline Healthcare system. Great doctors, great hospitals. Been using them for 24 years now pre and post Medicare. Never had them as an HMO, just PPO or Medicare. My PCP is in a building that also has a lab and an Imaging center. I get results quickly and can see them through my app. Wait times are minimal. Back in 2004 they saved DW’s life when diagnosed with ovarian and uterine cancers.

 

[mountainsoft]

SE Washington state. We've been with Kaiser Permanente for at least 30 years and have been quite happy with them. Of course, my wife's employer has a really good plan, so copays and other coverages are better than most. We had a baby, went through a variety of health issues, and Kaiser has always been good to work with. We can get appointments quickly, and care seems to be of good quality (nothing to really compare it with). I do like that most things are in the same building, doctor, lab work, pharmacy, etc. I've exchanged many emails with my doctor, saving the time and hassle of making appointments. They do seem to be leaning towards virtual visits these days, which so far I have avoided doing. Chatting on a tiny cell phone screen is just not my thing.

Kaisers dental services are a bit harder to work with. Few offices, no online appointments, harder to schedule with, etc. But the actual work and standard of care has been fine.

My mom is with PacificSource because she insisted on "specialists". So while the coverage is good, it means driving to numerous locations to get her needed care. That's kind of a pain, but otherwise it has been a good plan too.

 

[Scrapr]

Agree on Kaiser. Easy to get in to your Dr. Xrays & labs in the same building....clinics or hospital. See everything online for past visits or upcoming appts. If you don't like your doc it's easy to change & your chart follows easy.

 

[Another Reader]

They don't exist. Kaiser is the worst. These days, all the large providers, such as Sutter and Stanford in the Bay Area, are largely controlled by insurance protocols. Cost is the driver in these organizations. Many times, cost control directly conflicts with what is best for the patient. The concierge medicine alternative evolved as a result.

 

[RetiredAndLovingIt]

Another Kaiser fan here. I love everything being in the same building and if I have a 9.30 appointment, I get seen at 9.30 sometimes even a few minutes before.
It's also only 5 minutes from my house so that's a definite plus as well. I can be home in a l little over an hour with my prescription and all my tests done.

 

[Another Reader]

You Kaiser fans probably never have had chronic cancer or a complicated heart surgery. It works ok for vaccinations and routine issues. Complicated and expensive? Good luck!

Kaiser has been horrific to their Long Covid patients. They deny specialist referrals and send people to "healthy recovery" classes, which emphasize diet, exercise, and a "positive mind set." Heart damage, pulmonary issues, brain damage, POTS, and the other serious sequelae? You are out of luck.

These systems are generally fine for routine care. Patients are happy with them because of the routine care convenience. The complicated and expensive stuff? Not so much.

 

[mountainsoft]

You Kaiser fans probably never have had chronic cancer or a complicated heart surgery. It works ok for vaccinations and routine issues. Complicated and expensive? Good luck!

It may vary by area. Around here, Kaiser is one of the leading hospitals for cardiology and heart care.
https://health.usnews.com/best-hospitals/rankings/cardiology-and-heart-surgery/portland-or

My wife was supposed to go to Sunnyside when she got her pacemaker a few years ago, but the ambulance took her to our local PeaceHealth hospital instead because it was closer (Kaiser contracts with them so we paid the same). All follow up care has been with Kaiser and has been excellent.

One of my sister-in-laws has had cancer and received good care through Kaiser also.

The only possible negative I have encountered is Kaiser tries to handle things at the lower levels (PA's or primary doctor) before progressing to more costly specialists. Yeah, this adds time and can be a pain in some cases, but most conditions can be handled adequately without paying for the specialists.

 

[Irishgirlyc58]

I had Kaiser for about 25 years and love Kaiser.
I only switched in 2021 because I actually live outside the service area but I was eligible through employer.
I retired last year so the switch was to prepare for that and Medicare in 18 months.
Switching was painful and I still miss Kaiser.
I would go back in a heartbeat if they moved just a little closer. Seriously they are only 40 minutes away now.

 

[Irishgirlyc58]

I saw specialist with Kaiser without any problems.
I had melanoma and received immediate great care. They also ensure you make your follow up appointments which I like.

One day I had a visit with my pcp and mentioned seeing light out of the side of my eye. He said that’s not right- sit here and I will get you into the ophthalmologist. Confirmed with me that I could wait a few minutes and he got me right in. I walked downstairs and the ophthalmologist lasered my torn retina.

I had surgery in 2015 and had my own room. They kept apologizing for how small it was. I’m like fine with me. I like not sharing.

I like how coordinated and organized Kaiser is.
Of course mostly it’s about the doctors you see but my experience was the majority of them were great caring people.

They are focused on prevention but prevention is much easier than fixing. So everyone benefits.

 

[Turbo29]

A while back (more than 20yr ago) I had Kaiser from a few different employers. Not all Kaiser regions are the same. I found Northern California Kaiser excellent; Southern California Kaiser was just so so.

 

[Scrapr]

You Kaiser fans probably never have had chronic cancer or a complicated heart surgery. It works ok for vaccinations and routine issues. Complicated and expensive? Good luck!

Kaiser has been horrific to their Long Covid patients. They deny specialist referrals and send people to "healthy recovery" classes, which emphasize diet, exercise, and a "positive mind set." Heart damage, pulmonary issues, brain damage, POTS, and the other serious sequelae? You are out of luck.

These systems are generally fine for routine care. Patients are happy with them because of the routine care convenience. The complicated and expensive stuff? Not so much.

My wife was in Kaiser hospital 94 days before a C section. 1 copay. She also had esophageal cancer which she passed from 3 years ago. The most caring nurses & docs in the oncology section. I take gifts to the radiation doc, staff & oncology ward at the hospital. Several surgeries in between & it was all explained beforehand & after. Took as much time as we needed for questions.

I had gall bladder surgery & bowel resection (Crohn's). I loved my GI doc after having one I didn't like at all. I switched & she was the best doc as we were figuring out how aggressive to be on my Crohn's. She was actually advocating for the more expensive treatment. Biologics would be max copay on the first visit. I wanted to work my way up to that

I'm sorry you have had poor experience. I've heard some bay area docs are hard to find in the Kaiser system.

 

[savory]

5 years ago, we moved to a Kaiser serviced area. We decided to give it a go. The coordinated service, great record keeping and availability, and more. No major problems but all issues handled and recommendations for preventative care were always well done and worked out.