Kaiser is perhaps the most-cited example of an integrated delivery system in history. Held up by many as the model of efficient healthcare delivery, the California-based system, from its inception, closed the loop on payer and provider battles over reimbursement rate increases through integration.
The point is, Harper and people like him have been operating under a truly integrated model for so long that it's second nature. He believes, and a lot of evidence would back him up, that it's a better, higher quality and more efficient way to deliver care. He's preaching the Gospel of Integration, and finally, people are listening.
No More Incentives to "Do More"
That doesn't mean Kaiser's way is perfect, but it does mean that its executives have unique perspective on how to deal with the basic model, which is rapidly proliferating across the US as employers, payers, and providers seek closer collaboration and shared risk/reward deals.
It boils down to this: The only way to really put a dent in healthcare costs is to have all sites of care working together to coordinate care. Perverse incentives to "do more" have been eliminated or at least significantly reduced by the practice of evidence-based medicine and the integration of data metrics that help providers make the best decisions.