During his 10-year tenure as head of Kaiser Permanente, one of the largest and arguably most successful not-for-profit health plans in the country, physician-executive David Lawrence, 65, led the system through rough waters and emerged with a model for integrated care some viewed as the only workable form of managed care.
Unlike most managed-care plans, which operate as insurance policies and cover whichever doctors and hospitals will agree to their rates, Kaiser is a closed system. Its patients must use Kaiser physicians and facilities, and Kaiser's staff, hospitals and medical facilities exist almost entirely to serve members of the health plan. Through the structure, Kaiser administrators have been able to enact systemwide quality standards, information technology improvements and other innovations with fewer bureaucratic obstacles. Kaiser also accomplished the elusive: defining the standard of care for common diseases and injuries through its Care Management Institute.
Lawrence practiced medicine in the Peace Corps in the Dominican Republic before teaching public health at the University of Washington, working for a county public health department and then rising through the administrative ranks at Kaiser. Lawrence spent 21 years with the organization. Lawrence's major contribution was maintaining Kaiser's structure during the managed-care upheaval of the '80s and '90s, including several years of deep losses in the late '90s. But Lawrence ultimately righted Kaiser, leaving the system in strong financial health when he retired in 2002.