Viva strives to bring managed care to the inner city; L.A.'s newest HMO is slated to open doors March 1.

L.A.'s newest HMO is slated to open its doors March 1

As the health care industry scrambles to reposition itself in anticipation of national health care reform legislation, one of those who expects to be in the forefront is Ruth Lopez-Williams, founder of L.A.'s newest health maintenance organization.

On Dec. 31, after seven years of negotiation, she received a license from the state Department of Corporations to start her own HMO. Viva Health Plan, which is scheduled to open its doors on March 1, has already contracted with 1,000 physicians.

Viva's concept, according to its founder, is to bring the health care delivery system of the future to the inner city. Managed care is the wave of the future and Lopez-Williams does not want East Los Angeles left out.

"The big HMOs claim to have tapped this market," she said. "However, they have not reached the heart of the community. They are not contracting with the doctors that have traditionally served the community."

Physicians groups and clinics that have traditionally served the inner city claim that large health maintenance organizations have snubbed them and their communities. In fact, that belief prompted the passage of a bill in the state Legislature last year which requires HMOs to make enrollment easier for small businesses. Several legislators and small-business advocates asserted that the new law would result in more health care coverage being provided to the inner city areas, where small businesses are prevalent.

Nonetheless, doctors' groups and clinics in the inner city claim that little progress has been made. At least, many say they have not been successful in contracting with the large HMOs. According to Rudy Diaz, executive director of the Community Health Foundation, an East Los Angeles-based medical clinic, only four of the 70 clinics that provide care in the inner city have contracts with HMOs.

Several of the largest HMOs in Los Angeles took issue with charges that they have snubbed the Latino community. According to Kandis Larkey, senior vice president of CareAmerica Health Plans, "one of CareAmerica's goals is to make CareAmerica the plan of choice for Hispanics."

In addition to retaining a heavily bilingual medical staff, a full 35 percent of CareAmerica's primary care physicians speak Spanish. Also, CareAmerica has bilingual literature, customer service agents and health education programs. CareAmerica's dedication to serving the Hispanic community, according to Larkey, makes good business sense given the size of the population in Los Angeles. "If you look at the demographics, 33 percent of the population in Los Angeles County is Hispanic," she said.

Likewise, Blue Cross of California Senior Vice President David Chernof contended that Blue Cross has reached out and will continue to reach out to L.A.'s Hispanic community.

"The large, growing Hispanic community is very important to us," he said. Blue Cross has contracted with half a dozen physicians' groups, he explained, and continues to work closely with Hispanic physicians' organizations to increase its exposure in East Los Angeles.

Kaiser Permanente spokeswoman Kathleen Barco echoed that Kaiser has also made efforts to increase its ethnic diversity by recruiting a "spectrum of doctors." She added that Kaiser maintains a medical office building in East Los Angeles, as well as a facility in Watts.

While Viva Health Plan is L.A.'s newest HMO dedicated primarily to delivering health care to inner-city residents, Lopez-Williams' idea is not a completely new one. Years ago, after the Watts riots of 1965, federal dollars blew into L.A. to establish a community health plan for Watts. The result was an HMO that is still alive and well and serving mainly inner city and heavily Medi-Cal patients all over Los Angeles. In fact, the Watts Health Foundation-run HMO, United Health Plan, has branched its service area out in recent years to include Orange, Riverside and San Bernardino counties.

The longevity of the United Health Plan, possibly the only other minority-owned HMO in the area, and the recent establishment of Viva at least give inner-city physicians a ray of hope for the future.

That, coupled with the fact that Los Angeles County looks to be moving its Medi-Cal patients into managed care, is a good sign at least to Castulo de la Rocha, president of Ulta-Med Health Services Corp., an East Los Angeles-based physician group. The plan to convert Medi-Cal to managed care calls for service providers to be bilingual, he said. There will also be a process of evaluation to assure the quality of care. "How can you have quality if the providers don't even speak the same language?" said de la Rocha.

"The traditional HMO markets have been the suburbs," said de la Rocha. "They have not incorporated the Latino community and much less the inner-city Latino community."

HMOs have tried to hire bilingual physicians, but most sources said their efforts were too little, too late.

Some minority physicians serving the inner city said they are glad to see HMOs like Lopez-Williams' Viva Health Plan organizing to compete with the more mainstream HMOs. Dr. Robert Beltram, a surgeon with the Hispanic Surgical Group in East Los Angeles, called it a matter of pride.

"There are few minority physicians who own these managed care groups," he said. "We don't want to be controlled by non-minority owners. People in this community are organizing in competing formats so they don't have to be under control of an entity that does not have minority representatives."

Beltram's arguments go beyond race relations, however, to what he considers the heart of the matter -- quality of care. It must be more than bilingual, he said. "Much of what I am called on to do is education," said Beltram. "The biggest problem facing minorities is lack of patient awareness of their medical needs or their medical problems."

Medical problems are often viewed from the perspective of the cultural traditions in which people are raised. Another concern of Beltram's, in his practice, has been that his patients' health concerns often take a back seat to other, more pressing concerns, such as making sure there is enough food to feed the family. Many have no phones and no transportation, which makes communicating with patients difficult.

All of these issues, said Beltram, are common and well-understood by physicians who work in inner-city areas.