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Former Kaiser Medical Group CEO has concerns about Risant

Oakland, Calif.-based Kaiser Permanente has agreed to acquire Geisinger Health, a 12-hospital system headquartered in Danville, Pa., in a deal that would see Geisinger be the first to join Risant Health, a nonprofit launched by Kaiser Foundation Hospitals.

Risant Health, which will be headquartered in Washington, D.C., aims to expand and accelerate the adoption of value-based care in "diverse, multipayer, multiprovider, community-based health system environments." 

Pending regulatory approval, the deal is expected to close in 2024, with Geisinger CEO Jaewon Ryu, MD, moving to the role of Risant CEO as the closure approaches.

Ultimately, the deal aims to accelerate Geisinger's goal of making "better health easier for the communities we serve," Dr. Ryu told Becker's. "This path with Kaiser Permanente through Risant Health presented a great way to join with a fellow nonprofit, mission-aligned organization that is like-minded and focused on improving health outcomes, affordability and access." 

However, other industry stakeholders are curious about how such a deal would work, and if it can ultimately achieve what it is setting out to do. Can the proposed venture, announced in April, lead to improved care and reduced costs for patients, particularly in Kaiser's home state of California?  

Robert Pearl, MD, who served as CEO of The Permanente Medical Group from 1999 through 2017, has some concerns.

"The first one is that size matters. Kaiser Permanente is large, but it's a fifth the size of UnitedHealthcare. If you want to have a seat at the table at the federal level when decisions are being made — and decisions that have a massive impact on health systems — you better be bigger," Dr. Pearl told Becker's.

One key factor of Risant is that it's a way for Kaiser Permanente to grow. Geisinger comprises 10 hospitals and has a health plan with about 600,000 members, according to its website.

"If you multiply that by five or six, you get to about 3 million members — about a 25 percent increase in Kaiser's membership — and get to 50 or so hospitals," Dr. Pearl said. "That gives Kaiser some size. I think it will be really successful if they can find four or five other groups."

One potential drawback is that the medical groups were not mentioned in the proposed deal. 

"They're not part of Risant," said Dr. Pearl, who is now a clinical professor of plastic surgery at Stanford (Calif.) University School of Medicine and is on the faculty at the Stanford Graduate School of Business. "I think that's going to be a challenge. Geisinger is struggling because it had a monopoly, but [Pittsburgh-based] UPMC has come in, purchased a few medical groups and it's putting pressure on the organization. I don't see how this agreement will improve performance, and ultimately healthcare is about performance."

But the biggest question Dr. Pearl raised relates to Geisinger's hybrid model.

"As a health plan, it's capitated, but it also contracts a lot of insurance companies in fee for service. It has its own doctors but also lets patients go into the community," he said. "My experience as a former CEO is that a hybrid model never works. You get picked off on both sides. Fee for service can do it better than you can do it because you're not willing to make the bad trades that fee for service requires, and the capitation people come by because you have all the inefficiency of that side upon you."

Geisinger ended 2022 with an operating loss of almost $239 million, with its investment portfolio dragging down its overall loss to $842 million. Second-quarter results will be released imminently, but the system reported a first-quarter operating loss of $36 million as its expenses rose almost 7 percent in the period.

"Short term, the [proposed transaction] is going to help, because they'll get one or two billion dollars from Kaiser, but in the long term — unless they can improve performance — they're going to continue to struggle," Dr. Pearl said. "What's been published tells me that the deal will allow them to improve performance. My opinion right now is that we have to see what will happen, but I have a lot of question marks."

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