Prescription for Survival : Physicians in Ethnic Areas Form Networks to Compete in HMO Era

After completing their training at UC San Diego’s School of Medicine, Drs. Nwachukwu and Vicki Anakwenze opened a medical clinic in a renovated former nightclub across the street from the poverty-stricken Nickerson Gardens housing project in Watts.

“We wanted to have an impact,” Nwachukwu Anakwenze said. “We felt that Watts had the greatest need and the largest collection of sick people.”

Working nights and weekends over the past decade, the Anakwenzes (pronounced ANA-QUINCYS) have built a thriving practice that includes their three Quincy Care Medical Clinics and 25,000 patients.

But they worry that the practice they worked so hard to establish is imperiled. Increasingly, patients’ employers are pushing them into health maintenance organizations, which require them to go to the HMO’s own doctors and clinics. The Anakwenzes have never done business with HMOs.

Another cause for concern is the state Department of Health Services’ decision to double the managed care enrollment among the state’s roughly 5 million Medi-Cal beneficiaries by 1995. Sixty percent of the Quincy clinics’ patients receive Medi-Cal benefits. The Anakwenzes fear they will lose their Medi-Cal patients to large managed care groups.

The Anakwenzes have responded to the threat by forming a large network of doctors that, if successful, would use its strength in numbers to land managed care contracts. Although networks of doctors of all stripes have grown dramatically in the past decade nationwide, the Anakwenzes’ group is still a rarity: a minority-owned physician network that serves inner-city neighborhoods. Their strategy is one that is becoming highly popular with minority doctors throughout Southern California.

“We are seeing a cascading of the movement,” said Clyde W. Oden, president of United Health Plan, a 92,000-member HMO operated by the nonprofit Watts Health Foundation.

Behind the effort is fear among many ethnic doctors in private practice that they will be locked out of physician groups and HMOs.

“The health plans are not open for the doctors who are standing by themselves in South Central or East L.A.,” said the Nigerian-born Anakwenze. “We can’t just sit in one place and continue bleeding.” Added Dr. Robert A. Beltran, a general surgeon in East Los Angeles: “Trying to survive in private practice is a nightmare.”

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Beltran said he reluctantly joined an independent practice association, or IPA, when he began losing patients to large, integrated health care companies such as Mullikin Medical Centers. He joined an IPA formed by Latino and Asian doctors who work in predominantly Latino areas. The groups are linked to hospitals owned by American Healthcare Management and to a larger physician network organized by the Hospital of the Good Samaritan.

These networks of minority doctors so far have had varying degrees of success in winning managed care contracts.

Dr. Jeffrie Miller, chief executive of Healthquest 2000, the first African American-owned physician network in Los Angeles County, concedes that the year-old group has been “not very successful.” It has struck a deal with only one managed care firm: Maxicare Health Plans. The network includes 140 doctors in Inglewood, Hawthorne, Compton, Culver City and South Los Angeles, 75% of whom are African Americans.

Miller, who is also director of the health services research center at Charles E. Drew Medical Center in South Los Angeles, said new IPAs face significant competition from more established medical groups, often affiliated with a hospital. “The HMOs say they are not that interested because they already have providers in the area,” he said.

For Maxicare, the link with Healthquest is part of a plan to “open some geographic areas and neighborhoods that have been underserved by managed care in the past,” said Ed Coghlan, a spokesman for the Los Angeles-based company. The deal with Healthquest should also help Maxicare with a new marketing venture announced last week: a health plan for Medi-Cal patients.

Another new group that has had more success is a 30-doctor network in San Diego called the Multicultural Primary Care Group. Since starting last year, the group has become a provider to a countywide health network operated by University of California, San Diego and is close to a deal with Blue Cross of California, said Dr. Rodney G. Hood, the group’s president.

A major obstacle for these minority doctor networks is that they are latecomers to the managed care game. Medical groups have been forming and growing for 20 years in Southern California, and many groups have deeper pockets and far more experience.

United Health’s Oden believes that the inability of minority doctors to get involved in managed care has more to do with their own stubbornness than with racial discrimination.

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“Many of the physicians of color who have worked in the inner city have resisted group practice,” said Oden, who recalled a speech years ago to a group of African American doctors who booed him when he began discussing managed care. As a result, many minority doctors now forming groups aren’t yet ready to compete for managed care contracts, he said.

To help these doctors cope with the fast-changing health care system, United Health later this year will sponsor something Oden calls “managed care college,” a program for physicians.

Doctors who work in minority communities believe their experience is crucial to improving care for the poor. They point out that many patients feel more comfortable when their doctor is sensitive to their culture, speaks their language and comes from the same community. And that will be a selling point as minority doctors seek contracts with managed health care firms.

“One way to target (a minority) population is to reach physicians who already deal with those patients,” said Hood, the San Diego doctor. “More and more patients are saying, ‘I want a female doctor, an African American doctor or one who speaks Spanish.’ ”

Hood believes that health care reform at the state and national level is prompting HMOs to look more seriously at how to market to minority populations.

“I’ve been taking care of Medi-Cal patients for 17 years, and during those years most of the health insurers had no interest in taking care of those patients, and now they do,” he said.

“It’s very clear why,” he said, noting that in San Diego County alone there is at least $1 billion worth of Medi-Cal claims per year.

ETHNIC PHYSICIAN GAP

African-Americans make up nearly 12% of the U.S. population, but account for only 3.6% of all doctors and dentists. Latinos comprise 9% of the nation’s population and 4.9% of physicians.

United States

% of all physicians White: 80.5% Asian/Pacific: 10.8% Hispanic: 4.9% African American: 3.6% American Indian: 0.1% Other: 0.2%

California

% of all physicians White: 86% Asian: 9% Hispanic: 2% African-American: 1% Other: 2%

Source: California Medical Assoc. telephone survey, November, 1993. (Survey has margin of error of plus or minus 4%)

No. of physicians White: 472,351 Asian/Pacific: 63,552 Hispanic: 28,782 African American: 20,874 American Indian: 868 Other: 289

Source: 1990 U.S. Census