Case Rate per 1,000 Members 

3.14

4.04 Threshold

4.00 Target

3.87 Stretch

Most Improved

Kaiser Permanente Georgia 

Volumes -21% MoM
(1511 to 1198)

Drivers: The overall reduction was driven by decreases in all categories. While Health Plan complaints, especially those tied to Medicare supplemental benefits, remain an area of focus in Georgia, they increased slightly month over month, although KPGA slightly decreased complaints year over year.

Actions: More awareness to member abrasions through reading comments at meetings, by regional leaders, as well as department and MOB leaders, to review month-over-month complaint performance quarterly.  By sharing actionable data insights, increasing awareness of key drivers, and fostering cross-functional collaboration with departments, leaders are equipped to identify targeted improvement opportunities.

Service Area

Clinical Quality 

Volume  -23% MoM
(177 to 136)

Drivers: The decline in volume is primarily attributed to the Diagnosis, Treatment, or Care sub-category, which fell by -22% month-over-month (from 143 to 112).

Actions:  A focus on Care Coordination and ASQ scores

Shared Services

Health Plan 

Volumes -25% MoM
(295 to 221)

Drivers: Medicare-related concerns, as Medicare members continue to account for the majority of benefit-related complaints. The decrease is largely attributed to Medicare initiatives: Outreach calls, marketing materials, and everyone focused on ensuring Medicare Members’ service recovery efforts are immediate.

Actions:  The Medicare Operational teams across the enterprise have established specialized groups focused on examining every stage of the member journey to identify opportunities for improvement, including: Benefit Design and Cost Management, Member Education and Communication, Complaint Resolution and Experience, and Technology and Process Enhancements.