Providers focus on prevention, eldercare, alternative medicine.

The future of Los Angeles health care is nearly synonymous with the future of managed care.

And that future will be increasingly tied to fewer managed care organizations, greater scrutiny on premiums and more emphasis on service and preventive care.

Health care premiums hit new lows in 1996, and while industry analysts predict they will creep up modestly in the new year, pressure from business alliances and large employers will remain intense to keep costs down.

With almost standard pricing, HMOs and other health care organizations will put unprecedented emphasis on promoting their quality of care.

To that end, report cards by business alliances such as the Pacific Business Group on Health, and accreditation by the National Committee for Quality Assurance, will play a growing role in the ability of health care organizations to attract new members. In turn, HMOs and physician groups will be drawn to those hospitals perceived as providing the best care.

Because health care is increasingly customer-focused and market driven - and the physician plays an ever smaller role - alternative medicine will gain wider support as patients make their wishes for treatment known.

Acupuncturists, herbalists, massage therapists, chiropractors and other alternative medicine specialists will be represented in increasing numbers in managed care and through hospitals in 1997.

Managed care will also place increased emphasis on prevention and eldercare, as the government turns over responsibility for most of its Medicare and Medi-Cal recipients to HMOs.

The new year will see further consolidation of the managed care industry, with proposed mergers of Foundation Health Corp. and Health Systems International, and PacifiCare Health Systems and FHP International likely to receive government and shareholder approval in the first quarter.

That will put 9 million of California's 13 million HMO members in one of three megaplans, the third being Kaiser Foundation Health Plan.

Also expect more clearly defined alliances between hospitals, physician groups and insurance companies, as health care organizations evolve toward managing care from start to finish.

Such so-called vertical-integration, whether through all-out mergers, joint ventures or simply coordinated marketing, will further winnow the number of players locally.

"A common thread is that you're going to see rationalizing of health care financing and delivery systems so that they're more of a system, rather than a conglomeration of operating entities," observed Jim Barber, president of the Healthcare Association of Southern California.

To integrate the often disparate databases of hospitals, insurance companies and physician groups, new "information platforms" will be implemented, helping cut costs and streamline operations.

As presaged in 1996 by partnerships between Kaiser Permanente and St. Vincent Medical Center, and the expected merger of Tenet Healthcare Corp. and OrNda HealthCorp, Los Angeles hospitals in 1997 will further evolve from loose "strategic affiliations" to fully integrated health delivery organizations.

Los Angeles County hospitals, including the mammoth County-USC Medical Center, will continue to shift treatment to outpatient community clinics, as dictated by the 1995 federal bailout of the county's health care system. The county may also contract out management of an additional one or more hospitals, as it did this year with High Desert and Rancho Los Amigos hospitals.

The new year could be the beginning of the end for County-USC Medical Center, as the County Board of Supervisors begins to consider a report it commissioned on the facility's future. Look for the board to agree on replacing the center with a smaller, 650-850 bed facility to be complete by 2000.