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Faced with heated competition from network-model managed care plans, KP corporate headquarters jointly conducted a study with a major consulting firm and affirmed its commitment to the cost-leadership strategy.

The consulting firm encouraged KP to think about market share as an important success factor. The conventional wisdom was that with a good economic base, marketplace presence was a key factor. At the time, KP—Carolina had just reported its first profitable year and had priced its product above the average for the market in order to reflect its true costs of operation including service on the start-up debt.

Again, the opinions on the wisdom of this corporate decision differed. As one CPMG leader stated:. We were encouraged, to use a mild word, to reduce our operating infrastructures enough to support a 15 to 20 percent lower price point. But we were unable to cover the cost of what we were doing.

The solution was applied uniformly across the organization, which I think in retrospect everybody believes was a problem. Current and former KP national executives disagreed, arguing that the problem was not the wisdom of the strategy but, rather, its poor execution by the medical group.

Corporate executives cited the inability or unwillingness of regional leaders—especially in the CPMG—to build a sustainable business model based on tight cost control. These constraints were said to include limits on plan and benefit design as well as on advertising, sales, and marketing. Interview participants disagreed about whether the failure to achieve the requisite operating efficiencies to sustain this corporate objective resulted from problems of ability, willingness, or circumstances.

The general business literature indicates, however, that simultaneously achieving revenue growth and cost control in a start-up is daunting even under ideal market circumstances e.

Like many organizations, KP routinely transferred personnel laterally in order to shift needed expertise from one region to another and to enhance career development. Several interview participants reported, however, that this did not work well in the case of KP—Carolina. Not surprisingly, senior KP—Carolina managers disagreed, contending that the lack of entrepreneurship stemmed not from inexperienced management but from national corporate constraints on innovation.

As one said:. The original leadership brought in to start this region was supposed to replicate, not innovate. The job was to replicate the KP model in North Carolina.

There was no room for entrepreneurship, nor would it have been welcomed. We were given binders of material that we were supposed to use—staffing ratios, financial reporting formats, marketing materials, benefit plans, graphic standards, staff training tools, even floor plans. They wanted us to stick to the recipe.

It was the Oakland way—or no way. As the competition from less restrictive managed care products intensified, KP—Carolina tried to complement its group-model HMO with a point-of-service product and an IPA-model product.

Two problems immediately arose. First, KP—Carolina did not have the organizational capability to effectively manage an extensive network of contracted providers. Its business systems could not track members as they moved through a more open, networked delivery system, pay claims in a timely and accurate manner, or monitor utilization across loosely affiliated physicians and hospitals.

As one former CPMG employee noted:. We didn't know how to pay a claim. We hadn't had to pay very many claims. We had a lot of capitated and prepaid specialty arrangements and all of a sudden we started getting claims in, and I remember when 50,, you know, six months of claims went unpaid. It was outrageous.

KP—Carolina managers and medical directors found it hard enough to build the familiar group-model delivery system from scratch under less than hospitable market conditions. Simultaneously creating and managing a network model so far removed from KP's core competence proved impossible. Moreover, by trying to straddle the gap between staff-model and network-model product markets, KP—Carolina diverted precious resources from its core product and its core constituencies.

The original group-health model concept did not get the attention that it needed and started to deteriorate. This seemed a good way to build enrollment, increase volume, and counter the growth of competing products.

Reflecting on KP's flirtation with network models in North Carolina and other regions, several interview participants commented that the flawed strategy nearly cost the company its soul. Perhaps this is the most important internal lesson that KP as an organization could learn from its North Carolina experience.

It is easy for outside observers to be critical of a business strategy and outcome after the fact. However, reflecting on our analysis of the North Carolina experience, David Lawrence, KP's CEO at the time, concluded that the regional failure was due to an internal corporate failure to understand how to expand:. KP expanded with a missionary zeal that substituted for careful, thoughtful planning and development of the core modules required to incrementally build a viable business.

We did not learn from other industries, follow established pathways for successful expansion that have occurred in other industries, etc. It is an important lesson for us. We operated with a California bias and had no real understanding of what was required to accomplish, execute a start-up, and to build a successful business.

I do not think the model was wrong; rather, it was in the execution. Stated differently, I do not believe we have tested whether or not the model can be successful yet.

We thus conclude that the KP experience in North Carolina illustrates in microcosm the complex interdependencies that determined the fate of a KP expansion effort, not to mention similar efforts by other PGPs around the country. The demise of several KP regional expansions reinforces the importance of the numerous interlocking pieces that are necessary to foster a market in which a prepaid group practice can exercise its competitive advantage.

It is clear that in North Carolina none of the important factors was pointing in the right direction. However, while KP used to be able to charge less for more comprehensive benefits than others were charging for less comprehensive benefits, KP now has a smaller price advantage.

KP's historical business model attempts to build efficient-scale operations and vigorously pursue cost control while maintaining acceptable levels of quality and service. Achieving low overall costs requires enough enrollees to support the internalization of most specialties into the medical group as well as access to production inputs e. By achieving low overall costs through efficient, high-volume operations, KP can offer low premiums and low out-of-pocket expenses as well as more comprehensive benefits.

Furthermore, in its fully perfected version, the Kaiser model would offer more coordinated care delivery through a group-practice culture and internal coordination among medical and hospital service providers in exchange for a more restricted choice and, sometimes, less convenient access. The historical business model clearly did not succeed in North Carolina.

Where KP has been successful in entering markets, an important factor has been strong backing from influential local organizations e. Local sponsors such as unions have provided an enrollee base and lent important political support. On the West Coast and in Colorado, Kaiser had strong backing from the AFL-CIO, which liked its emphasis on comprehensive benefits and preventive medicine and demanded that employers offer Kaiser as an alternative to traditional insurance.

Regional expansions have also been successful in Georgia with more than , members and in the Washington, D. While there were widespread losses in the competitive Atlanta market, KP's ability to consolidate allowed it to reach a critical mass of enrollees.

Kaiser has also continued to grow steadily in Colorado, Hawaii, and on the West Coast. It was able to build on the West Coast from the s through the s, when the managed care industry was young, and independent competing medical groups were scarce. It achieved a network scale and scope that would be difficult to replicate today, when the industry is mature and competitors abound.

When Kaiser expanded outside its core markets in the s, as was the case in North Carolina, the industry was maturing, and sophisticated competitors were plentiful. The North Carolina case illustrates the difficulties of replicating the vertically integrated model in new geographic markets under these circumstances. Kaiser Permanente maintains a dominant position on the West Coast, and hybrid entities that embody some but not all the elements of prepaid group practice can be found in many metropolitan areas.

In its most recent report, Kaiser Permanente's national membership in nine states and the District of Columbia remained flat at 8. But the trend in the health care marketplace generally is toward broad-network insurance products divorced from provider systems, retrospective rather than prospective payment, a purchasing framework that emphasizes copayments at the time of service rather than a cost-conscious choice at the time of insurance enrollment, and an institutional framework hostile to the principles and practices of managed competition.

In six of the eight geographic regions that Kaiser Permanente serves, the two largest customer groups are state and federal employees. In the other two, the largest enrollee groups are federal employees and a public school system. In the FEHBP, the benefits are not as standardized, but the Office of Personnel Management has required that the benefit packages offered be fairly comprehensive.

However, not all is perfect even in the ideal purchasing environment. In the CalPERS program, Kaiser is concentrated in urban areas in California, where health plan competition still works, which means that with a statewide premium, the PGPs enjoy the luxury of not having to operate in rural areas that are costly because of local provider monopolies but where the self-funded PPOs do operate. It is likely that certain markets, such as most rural or commuter areas, may not have the geographic conditions to sustain a profitable private-sector PGP, even when these conditions are met.

What can private employer and public policymakers do to make market environments more hospitable to the PGP model of care delivery? The essential insight of managed competition, as a reform, is to divide the provider community into competing economic units and then to offer employees a responsible choice with premiums that reflect the differences in per capita cost, in order to give them an incentive to choose the efficient providers Enthoven If a critical mass of employers were able to do this in any market area, managed competition advocates still claim, they would create the environmental conditions in which efficient delivery systems could enter, market their superior value for the money, and achieve economies of scale.

The following elements must be present if a PGP is to have access to the employee not just employer market: a broad choice of health plans; risk adjustment to mitigate adverse selection; an employer contribution that allows employees to retain any savings resulting from an economical choice; a level regulatory playing field among HMOs, insurers, and self-insured plans; and reliable, comparable information about the quality of care and consumer satisfaction.

Recent research has shown wide variations among providers in the resources used to treat the same conditions and produce the same outcomes Fisher et al. Employers might offer employees a price-sensitive choice among existing HMOs and encourage HMOs to develop selective networks to improve their performance. The all-inclusive network favored by employers in the single-source model is sure to be ineffective. Alternatively, under the protection of the Employee Retirement Income Security Act, employers might develop several selective PPOs, each of which would offer the preferred services of a different network of providers.

If there are effective IPAs in a market, employers might build their choices on them or even share the gains created by the most efficient providers by offering them bonuses for achieving performance goals. The focal points for these networks would likely be different hospitals and their staffs. The idea is to be sure that those employees who choose efficient providers realize the savings generated by their choices.

Despite the high expectations, PGPs have fared poorly in the market in recent decades. Group- and staff-model HMOs have survived only where they constitute a large portion of the local market, offer an adequate choice of physicians, and gain from economies of scale similar to those of nonintegrated competitors Hurley et al. PGPs have had a great impact on the American health care system and continue to offer high-quality, cost-effective care to millions of patients in particular regions and communities.

Yet their future remains unclear. KP was not the only HMO to have faced competitive challenges. Nationally, no group- and staff-model HMOs have performed well over the past two decades. In June , the group and staff models had 7. By July , with In July , group and staff models served 7. Membership in staff models actually declined, while membership in group models mainly Kaiser Permanente grew slowly and lost market share to faster-growing models, such as IPAs and mixed models.

The models that rely on established providers and facilities can grow much faster than group and staff models that must recruit and develop their own doctors and facilities. By the early s, some group- and staff-model HMOs, seeking to attract employers that wanted a single source of health insurance, sought innovations and merged with or acquired wide networks of traditional providers to offer alongside their groups.

After experiencing three years of no growth, it brought another group into its network and created a wide network of fee-for-service, solo-practice doctors. In these cases, market conditions created by the employer single-source and employee contribution policies that did not highlight cost differences forced health plans to abandon the pure staff model InterStudy Some health plans have tried to combine the virtues of organizational integration with the attractions of contractual promiscuity by wrapping a network of independent physicians around a core of an integrated group practice.

In Washington and Idaho, however, the Group Health Cooperative has combined a core prepaid group practice with a contracted network of solo and small-group practices, thereby preserving its market share.

But it has not been able to leverage the distinct virtues of integrated efficiency and broad choice into a comparative advantage and so remains a niche player in a market increasingly dominated by broad network-insurance products and fee-for-service payment Robinson As a vertically integrated organization that combines an insurance entity with multispecialty group practices and, in some regions, hospitals, KP possesses particular strengths and weaknesses.

A PGP cannot be built overnight. For decades, KP and the Group Health Cooperative have been working out the kinks and links in the financing and delivery systems.

Hence, the most general lesson of our analysis is that the successful introduction and proliferation of prepaid group practice into markets with little or no experience with the model depend on the conjuncture of several supportive conditions.

These include employers willing to offer a choice of carriers because PGPs cannot succeed as a single source ; employers willing to structure the offering to employees so that the employee making the choice gets most, if not all, of the savings; a framework that mitigates adverse selection; a regulatory framework that imposes equal burdens on PGPs and their competitors; a supply of high-quality providers hospitals and specialists willing to contract with PGPs on terms similar to those granted to others; and a high enough population density to permit the enrollment of a critical mass of members within a referral area sufficient to support the multispecialty group practice with most of the secondary care specialists represented.

All this suggests that while PGPs can play an important role in market-driven reform, without the right mix of supporting factors, a variety of other, more flexible and robust models will also be needed. We gratefully acknowledge the numerous interview participants who gave generously of their time and insights, especially Dr.

The Kaiser Permanente Institute for Health Policy provided grant support and information, but the analysis and conclusions are solely our own.

James Bernstein, M. William Brandon, Ph. Christopher Conover, Ph. Ray Coppedge, M. June 20, Allen Feezor, M. Claudia Ghianni, M. Bill Gillespie, M.

Nancy Henley, M. Eugenie Komives, M. May 6, Anna Lore, B. Don Madison, M. Joe Morrissey, Ph. Sandra Newton, M. Lynette Omar, M. Derek Prentice, M. March 19, Pam Silberman, Ph. Lynn Spragens, M. Jill Steinbruegge, M. Stephen Stemkowski, Manager, Premier, Inc. Herman Weil, Ph. Glenn Wilson, M. Wilson was a leader in the organization and financing of eight community-sponsored prepaid direct-service group medical practices, including the Community Health Program, Cleveland, Ohio, which eventually became Kaiser Permanente of Ohio KP-OH March 19, These comments are cited as KP Institute May 6, Milbank Q.

Author information Copyright and License information Disclaimer. Regulators, Purchasers, and Providers What were the barriers to building a viable prepaid group practice? Regulatory Uncertainty after Market Entry In the mids, KP—Carolina, as one of the first HMOs and the first prepaid group practice in the market, faced a fluid and uncertain regulatory environment.

The Politics of a Purchaser: The North Carolina State Health Plan KP achieved some of its greatest successes in other regional expansions by enrolling large numbers of members from either private-sector unions or public employee systems. Open in a separate window.

Resistance from the Medical Community Cohesive physician organizations can find ways to inhibit the entry and growth of prepaid group practices. Carolina Permanente Medical Group and Organizing the Provision of Medical Care In addition to meeting the two-tiered marketing challenge, KP's success depended heavily on efficiently providing medical care through the group-practice model. As one interview participant noted: In those markets where [KP] had created a favorable cost structure, the local medical group has essentially taken and executed the responsibility for making that happen.

KP Institute 2. National Corporate Constraints Like other organizations with multidivisional structures, KP's corporate headquarters struggled to find the right balance between giving new regions the flexibility and autonomy they needed to respond to local market conditions and advancing KP's corporate goals and maintaining consistent policies. As one CPMG leader stated: We were encouraged, to use a mild word, to reduce our operating infrastructures enough to support a 15 to 20 percent lower price point.

UNC Inexperienced Regional Management Like many organizations, KP routinely transferred personnel laterally in order to shift needed expertise from one region to another and to enhance career development. As one said: The original leadership brought in to start this region was supposed to replicate, not innovate.

A Mismatch of Model and Market? Prepaid Group Practice, Whither the Future? Acknowledgments We gratefully acknowledge the numerous interview participants who gave generously of their time and insights, especially Dr.

David Coulter, M. June 19, June 10, References Enthoven A. New England Journal of Medicine. The History and Principles of Managed Competition. Health Affairs. Annals of Internal Medicine.

Excelsior, Minn. HMO Directory, 5. HMO Directory, 6. HMO Directory, 7. HMO Directory, 8. Oakland, Cal. Meeting notes, May 6.

The Balanced Scorecard. Boston: Harvard Business School Press; Rhetoric and Evidence. HMOs, Competition and Government. In: McKinlay John B. Raleigh, N. April 1. Enrollment by Health Plan Option. The Limits of Prepaid Group Practice.

This prompted the state attorney general to threaten to revoke the organization's license. The organization also sold its unprofitable Northeast division in The Ohio division was sold to Catholic Health Partners in In , Kaiser Permanente celebrated its fiftieth anniversary as a public health plan.

Two years later, national membership reached nine million. In , the organization established an agreement with the AFL-CIO to explore a new approach to the relationship between management and labor , known as the Labor Management Partnership. Going into the new millennium, competition in the managed care market increased dramatically, raising new concerns. The Southern California Permanente Medical Group saw declining rates of new members as other managed care groups flourished.

This information technology failure led to major changes in the organization's approach to digital records. Under George Halvorson's direction, Kaiser looked closely at two medical software vendors, Cerner and Epic Systems , ultimately selecting Epic as the primary vendor for a new system, branded KP HealthConnect.

Although Kaiser's approach shifted to "buy, not build," the project was unprecedented for a civilian system in size and scope. Early in the 21st century, the NHS and UK Department of Health became impressed with some aspects of the Kaiser operation and initiated a series of studies involving several health care organizations in England. The management of hospital bed-occupancy by KP, by means of integrated management in and out of hospital and monitoring progress against care pathways has given rise to trials of similar techniques in eight areas of the UK.

In , a controversial study by California-based academics published in the British Medical Journal compared Kaiser to the British National Health Service , finding Kaiser to be superior in several respects.

Second, its doctors are salaried rather than paid per service, which removes the main incentive for doctors to perform unnecessary procedures. Thirdly, KP attempts to minimize the time patients spend in high-cost hospitals by carefully planning their stay and by shifting care to outpatient clinics. This practice results in lower costs per member, cost savings for KP and greater doctor attention to patients.

Alleged violations of California's timely access laws included failures to accurately track wait times and track doctor availability amid evidence of inconsistent electronic and paper records. It was also found by the DMHC that patients received written materials circulated by Kaiser dissuading them from seeking care, a violation of state and federal laws. DMHC also issued a cease and desist order for Kaiser to end the practices.

The report found Kaiser had put systems in place to better track how patients were being cared for but still had not addressed problems with actually providing mental health care that complied with state and federal laws.

It also issued a statement which denied much of the wrongdoing. In Kaiser settled five cases for alleged patient dumping —the delivery of homeless hospitalized patients to other agencies or organizations in order to avoid expensive medical care—between and Los Angeles city officials had filed civil and criminal legal action against Kaiser Permanente for patient dumping, which was the first action of its kind that the city had taken.

At the time that the complaint was filed, city officials said that 10 other hospitals were under investigation for similar issues. In , Northern California Kaiser Permanente initiated an in-house program for kidney transplantation. Upon opening the transplant center, Kaiser required that members who are transplant candidates in Northern California obtain services exclusively through its internal KP-owned transplant center.

However, patients who needed a kidney were less likely to be offered one. At other California transplant centers, more than twice as many people received kidneys than died during the same period. Unlike other centers, the Kaiser program did not perform riskier transplants or use donated organs from elderly or other higher-risk people, which have worse outcomes.

Northern California Kaiser closed the kidney transplant program in May As before, Northern California Kaiser now pays for pre-transplant care and transplants at other hospitals. This change affected approximately 2, patients. Kaiser operates a Division of Research, which annually conducts between and studies, and the Center for Health Research, which in had more than active studies. Kaiser's bias toward prevention is reflected in the areas of interest—vaccine and genetic studies are prominent.

The work is funded primarily by federal, state, and other outside non-Kaiser institutions. Kaiser has created and operates a voluntary biobank of donated blood samples from members along with their medical record and the responses to a lifestyle and health survey.

De-identified data is shared with both Kaiser researchers and researchers from other institutions. Kaiser Permanente announced its plan to start a medical school in December, , and the school welcomed its inaugural class in June, The Kaiser Permanente Bernard J.

The school will waive all tuition for the full four years of medical school for its first five classes. In order to contain costs, Kaiser requires an agreement by planholders to submit patient malpractice claims to arbitration rather than litigating through the court system. This has triggered some opposition. Wilfredo Engalla is a notable case. In , Engalla died of lung cancer nearly five months after submitting a written demand for arbitration.

Watchdogs have accused Kaiser of abusing the power imbalance inherent in the arbitration system. Kaiser engages in many cases whereas a customer will usually engage in just one and Kaiser can reject any arbitrator unilaterally, thus they can select company-friendly arbitrators over those that rule in favor of customers. As a large organization, Kaiser can also afford to spend much more on lawyers and orators than the customer, giving them more advantages.

The degree to which this office is actually independent has been questioned. Patients and consumer interest groups sporadically attempt to bring lawsuits against Kaiser Permanente. Recent lawsuits include Gary Rushford's attempt to use proof of a physician lie to overturn an arbitration decision.

In one case, Kaiser attempted to significantly expand the scope of its arbitration agreements by arguing it should be able to force nonsignatories to its member contracts into arbitration, merely because those third parties had allegedly caused an injury to a Kaiser member which Kaiser had then allegedly exacerbated through its medical malpractice.

The California Court of Appeal for the First District did not accept that argument: "Absent a written agreement—or a preexisting relationship or authority to contract for another that might substitute for an arbitration agreement—courts sitting in equity may not compel third party nonsignatories to arbitrate their disputes. While Doctors of Medicine M. KP's California operations were the target of four labor strikes in and — two September , January involved more than 20, nurses, mental health providers, and other professionals.

The workers were dissatisfied with proposed changes to pensions and other benefits. On November 11, , up to 18, nurses went on strike at KP hospitals in Northern California over Ebola safeguards and patient-care standards during union contract talks. Jamie Court, president of the Foundation for Taxpayer and Consumer Rights has said that Kaiser's retained profits are evidence that Kaiser policies are overpriced and that health insurance regulation is needed.

State insurance regulations require that insurers maintain certain minimum amounts of cash reserves to ensure that they are able to meet their obligations; the amount varies by insurer, based on its risk factors, such as its investments, how many people it insures, and other factors; a few states also have caps on how large the reserves can be.

Kaiser has been criticized by activists and state regulators for the size of its cash reserves. From Wikipedia, the free encyclopedia.

American integrated managed care company. Headquarters the Ordway Building in downtown Oakland. Net income. Main article: Kaiser Permanente Bernard J. Tyson School of Medicine. Kaiser Permanente. Archived from the original on April 16, Retrieved August 2, Retrieved October 10, Kaiser Foundation Health Plan. Retrieved November 17, Lawrence, M. San Francisco Chronicle. Retrieved January 22, Los Angeles Times.

Archived from the original on June 9, Retrieved May 1, The New York Times. November 11, Retrieved December 31, Retrieved October 15, Retrieved February 9, July 31, Retrieved August 28, November 22, Delaware business entity number The entity is registered with the California Secretary of State. Retrieved February 4, Fall Permanente Journal. Kaiser Permanente Ventures. Archived from the original on January 29, ISBN Reader's Digest. The Reader's Digest Association. Retrieved June 17, December Milbank Quarterly.

PMC PMID In The Northeast". Crain's Cleveland Business. San Francisco Business Times. Healthcare IT News. January 19, British Medical Journal. BBC News. January 17, The British Journal of General Practice. ISSN California Office of the Patient Advocate. The Economist. July 15, Retrieved March 22, Craft for the Sacramento Bee. All Things Considered. Retrieved January 23, ABC News. Archived from the original on October 24, NBC News. Associated Press. October 22, Retrieved November 8, Kaiser Permanente Research Bank.

Kaiser Health News.

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Centene stok New York: Jossey-Bass; Anna Lore, B. Unlike some other public employee health programs, the State Health Plan pools retirees and active employees. No, there is charlottd like Kaiser in NC. Vohs was appointed CEO in and chairman inand he would serve until his retirement in This seemed a good way to build enrollment, increase volume, and counter the growth of competing products. Tyson School of Medicine.
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Cigna dhmo dental plan View detailed profile Advanced or search site with. The historical business model clearly did not succeed in North Carolina. People were looking to the health plan where they could maintain their provider iin. Inhttps://carpetcleaningbradford.com/cigna-vision-coverage/11706-cvs-health-motivation-and-empowermnet.php organization established an agreement with the AFL-CIO to explore a new approach to the relationship between management and laborknown as the Labor Management Partnership. A PGP cannot be built overnight.
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Centene corporation in arizona InKaiser established the Henry J. The SHP concluded that the people exiting the indemnity plan were younger, and thus presumably pernanente, than those remaining enrolled. However, patients who needed a kidney were less likely to be offered one. Anna Lore, B. During this period, a substantial amount of growth came from union members; the unions saw Kaiser Permanente care as more affordable and comprehensive than what go here available at the charlottw from private physicians under the fee-for-service system.
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Proudly working as one for a healthier today and tomorrow, we all have the power to shape the future of care. We proudly serve Discover the perfect place to leave your mark.

Explore Our Locations. Learn More. We appreciate how amazing our people are every day. Meet a member of the Kaiser Permanente team at an upcoming career or professional event. See All Events. KP is a major contributor to the overall health of our communities Full Review. Skip to main content. Lead the front lines of total health. Drive the business of total care. Shape a new system of total wellness. My Profile Saved Jobs 0. Help Our Locations We proudly serve The Holy Roman Emperors — called themselves Kaiser , [10] combining the imperial title with that of King of the Romans assumed by the designated heir before the imperial coronation ; they saw their rule as a continuation of that of the Roman Emperors and used the title derived from the title Caesar to reflect their supposed heritage.

From to , except for the years —, only members of the Habsburg family were "Holy Roman Emperors". In , the Holy Roman Empire was dissolved, but the title of Kaiser was retained by the House of Habsburg , the head of which, beginning in , bore the title of Emperor Kaiser of Austria.

Despite Habsburg ambitions, however, the Austrian Empire could no longer claim to rule over most of Germany, although they did rule over large areas of lands inhabited by non-Germans in addition to Austria. According to the historian Friedrich Heer, the Austrian Habsburg emperor remained an "auctoritas" of a special kind. He was "the grandson of the Caesars", he remained the patron of the holy church, but without excluding other religions.

In this tradition, the Austrian emperor saw himself as the protector of his peoples, minorities and all religious communities. As a result of this centuries-long uninterrupted tradition, today family members of the Habsburgs are often referred to as Imperial Highnesses German: Kaiserliche Hoheit and, for example, the members of the Imperial and Royal Order of Saint George as Imperial Knights.

There were four Kaisers of the Austrian Empire who all belonged to the Habsburg dynasty. They had an official list of crowns, titles, and dignities Grand title of the emperor of Austria. Karl von Habsburg is currently the head of the House of Habsburg. With the unification of Germany aside from Austria in , there was some debate about the exact title for the monarch of those German territories such as free imperial cities, principalities, duchies, and kingdoms that agreed to unify under the leadership of Prussia , thereby forming the new German Empire.

In the end, his chancellor Bismarck 's choice Deutscher Kaiser "German Emperor" was adopted as it simply connoted that the new emperor, hearkening from Prussia, was a German, but did not imply that this new emperor had dominion over all German territories, especially since the Austrian Kaiser would have been offended as Austria, inhabited by Germans, was still considered part of the German lands.

All of them belonged to the Hohenzollern dynasty, which, as kings of Prussia, and had been de facto leaders of lesser Germany Germany excluding Austria. From Wikipedia, the free encyclopedia. German word for "emperor", associated with rulers of the German Empire — For other uses, see Kaiser disambiguation.

This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. Main articles: Emperor of Austria and German Emperor.

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