Mills execs are guarding the lifeboat

In a telephone interview with the Vice President of Mills-Peninsula the following questions were asked in an attempt to find out two things: How the Medical Group maintains while others cannot: And what will be the process that these 10,000-12,000 new patients will go through during the transition of health care coverage.

Question: Does Mills-Peninsula have a different way of operating that contributes to its success ?

Answer: Yes. We have a very strong hospital relationship. We partner with the hospital to provide quality care.

got together with the goal of reducing emergency room visits by 20 percent and we were able to do it.

Q. It seems that many multiple trauma cases often go to Stanford for treatment. Does that have anything to do with the lowering of emergency room visits?

A. No. You would be surprised, but most of the emergency room visits are actually things like migraines. Or a mother may show up in the emergency room because her child has a 102 degree temperature and she doesn't know what to do. Many of these things can be handled out of the emergency room. We have a nurses hotline that walks people through these types of issues.

Q. Other than a good working relationship with the hospital, what are some other reasons Mills-Peninsula has been able to succeed?

A. Essentially, it's just that the hospital, the medical group and the doctors are all working together as oppose to against each other.

Q. What are some of the answers and solutions to the current health care crisis?

A. There is not enough money. So, its important to take care of your providers through this. In this capitation environment, it is also important that the new department of managed care's fiscal solvency board becomes active. (Capitation rate as opposed to a pay for service rate, essentially is the standard way that most HMO's managed care group work. Each member pays a premium. And the numbers with the revenues received in premiums and those paid out in services should all balance out for a health group to be financially solvent. Many of the complaints of the doctors is that the competitive capitation rate that they are working under is insufficient. HMO's on the other hand are contending that it is a competitive rate and that it is adequate and indicative of the over all financial resources that are available in the system).

Q. In this analogy of Mills-Peninsula Medical Group being a life-boat, how much weight is the group willing to take on to alleviate some of the stress that 60,000 newly uninsured people in San Mateo County can cause?

A. We are just not built to take on members from all across the county. Because we're the last one standing, we are expecting to get a lot of calls from Doctors who were in the IPA or who are scared of HMO's. But what we are dedicated to, is providing quality care for our community. We are in the process of transitioning approximately 10-12,000 members into service right now.

Q. One of the things that concern people is the detached nature of health care service, can you describe what this transition process will be like for patients.

A. That all depends on the health plan. I haven't seen every letter that each plan sends out, but hopefully they are sending out letters to notify their members. The seniors we will try to handles a lot more cautiously. Because they tend to have less of an understanding of what's going on, and also they tend to have multiple conditions. So they will be sent a letter notifying them there is going to be a change. They will also be given a list of other providers. There will be a number they can call for assistance. And in the more serious cases, there will be case manager's evaluating patients to see if the patient is indeed eligible for transition.

Q. What about cases where the patients have serious conditions?

A. No. Physicians don't want to take on new patients with multiple conditions. There will be some patients where it just wouldn't be appropriate to transition. If someone's in the middle of a complicated chemotherapy treatment, you just can't transition them into a new health care program and new doctor. For some of the patients hopefully all that will be lost is the heartfelt loss of a physician-patient relationship. But there are others who should not be moved.

Next week, we will interview Sen. Jackie Speier (D-San Mateo), author of the Patients Bill of Rights, and Daniel Zingale of the Department of Managed Care.