October 9, 2009

UCSF Launches Website to Help Ease Transition to Hill Physicians

UCSF has launched a website with information about its new affiliation with Hill Physicians Medical Group, the largest independent physician association in Northern California.

The website provides faculty, staff and trainees with information and resources, such as links to HMOs.

In August, UCSF Medical Group and Hill Physicians Medical Group announced that they formed a new affiliation to provide access to high-quality primary and specialty health services for HMO members whose primary care provider is based in San Francisco.

The new health care option takes effect Jan. 1, 2010, when UCSF’s long-standing relationship with Brown & Toland, an independent practice association in San Francisco, ends.

Mark Laret, chief executive officer of UCSF Medical Center, and Sam Hawgood, MBBS, dean of the UCSF School of Medicine, answered some key questions in an open letter to the UCSF community. That letter is posted below and on the new website.

Dear Colleagues:

In the past two months you have likely heard a great deal about Brown & Toland and UCSF’s new relationship with Hill Physicians. We want to give you some background and important facts about these changes.

How Brown & Toland Worked: When UCSF and the California Pacific Medical Group joined to form Brown & Toland in 1997, the concept was simple: patients in San Francisco who selected an HMO (other than Kaiser) could select a primary care physician from either group and be referred to any specialist in either group. This was called “open access” and it worked very well for patients who had full choice of where to get their care.

What Happened: Last December, Brown & Toland chose to terminate its long-standing partnership with UCSF. Brown & Toland explained to UCSF that it wished to keep more specialty care referrals “in the community” (and by extension, not at UCSF). For our employees who are enrolled in Health Net or Blue Cross Plus. as well as for HMO patients in the community who wished to retain unfettered access to UCSF specialists, we needed to develop a new relationship, which we have done with Hill Physicians.

Who is Hill Physicians? This is a highly respected, well-run group of 3,000 physicians covering the whole East Bay and Central San Joaquin Valley. Their network includes a large presence at Alta Bates Summit, John Muir, Valley Care and other hospitals in the East Bay that often refer [patients] here for tertiary care. Hill Physicians had a small presence in San Francisco, but now with UCSF, its San Francisco physician network is approximately the same size as Brown & Toland’s.

Why has UCSF run TV ads about this? Because health care issues like this are so confusing, we conducted a series of focus groups with patients this summer. The focus groups told us a few things: they were angry that “open access” to specialists was ending; they wanted to know how to retain access to world-renowned UCSF specialty care; and they wanted to know what steps they needed to take to make this happen. Our TV and print ads have been designed to do this, and have accomplished this goal.

Brown & Toland says that I can still see UCSF specialists without leaving their network. Is this true? State law requires that in the case of a change of medical group or HMO coverage, patients in six categories of care are guaranteed continuity of care with their provider for up to one year. These categories include pregnancy, patients in active treatment for a disease, end of life care and more. This means that Brown & Toland patients receiving this kind of intensive care from UCSF can continue their care for up to one year without additional authorizations from Brown & Toland.

In addition, there will likely be a special arrangement with Brown & Toland for access to UCSF pediatric and obstetric specialists, allowing those patients to be seen by UCSF specialists without prior authorization. Aside from these cases, Brown & Toland has been very clear that their goal is to keep patients in their own network: “If patients require care that is not available in the community, we will help physicians facilitate what is best for the patient at UCSF or elsewhere.” This is why we have publicized that the only way that patients can ensure that they have unfettered access to UCSF is to join Hill Physicians.

I have Health Net or Blue Cross Plus. What do I need to do? If you are currently seen by a primary care physician at UCSF, in January Health Net will automatically change you to Hill Physicians with your same UCSF physician. Blue Cross will handle this differently, requiring enrollees to call and change physician groups. If you are currently seen by a primary care physician in the community, and you wish to have complete access to UCSF specialists, you can ask your primary care physician if he or she has, or will, join Hill Physicians (this could be in addition to Brown & Toland). Otherwise, in order to maintain that open access to UCSF specialists you would need to select a primary care physician from the Hill Physicians roster. You can change from Brown & Toland to Hill Physicians throughout the year – not just during open enrollment – but to ensure your easiest and fastest access to UCSF specialists after January 1st, 2010, it is best to make the change now.

I have more questions! We have a website with many more questions and answers for faculty, staff and housestaff. Or call our UCSF call center, at 888/689-UCSF.

Please let us know of other questions and issues you have during this significant transition. Our concern has been and remains that our patients will continue to receive the care they need now and in the future.

Sincerely,
Mark Laret, CEO, UCSF Medical Center

Sam Hawgood, Dean, UCSF School of Medicine

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