In 1985, after mutually productive discussions, Chinese Hospital and its physicians in CCHCA became providers and a site of service for the Children's Hospital Health Plan.
The virtually integrated health delivery system uses CCHP as the third-party administrator for the Chinese Hospital and CCHCA, supporting their participation in mainstream health plans and the San Francisco Health Plan, which provides access for the Medicaid and healthy families population of San Francisco.
Recognizing the importance of educating the community on the benefits of Western medicine in a culturally sensitive manner, Chinese Hospital, CCHCA, and CCHP created Chinese Community Health Resource Center (CCHRC), a nationally recognized, bilingual educational and research organization based at Chinese Hospital.
Brown and Toland Medical Group has more than 1500 physicians, while CCHCA has 160 bilingual bicultural physicians.
CCHCA has no exclusivity requirements for participation in their medical group, which serves more than 27,000 mostly lower income, Chinese-speaking patients through several insurance plans.
When CCHCA agreed to talk with BTMG to see how physicians could continue to serve the Chinese community while participating in BTMG, it was a surprise that BTMG continued to coerce CCHCA physicians to resign from CCHCA during these conversations.
WHEREAS, The Chinese Hospital and CCHCA together serve San Francisco Health Plan (SFHP), the county Medicaid health plan, as the second largest non-county group provider serving over 7000 Medicaid, Healthy Families, and Healthy Kids members in the County; and,
WHEREAS, These three entities (Chinese Hospital, CCHCA, and CCHP) serve as an integrated delivery system (Chinese Integrated Health System) by providing health plan products and services to meet the special cultural needs of the Chinese American community in San Francisco, and providing these services at the lowest price in the local marketplace; and,
WHEREAS, Brown and Toland Medical Group (BTMG) is attempting to enroll over 50% of CCHCA physicians into their exclusive preferred network and thereby force their resignation from CCHCA thus seriously impeding the ability of the network from meeting the health care needs of members; and,
WHEREAS, The loss of a significant number of physicians from CCHCA would also seriously impede the ability of the CCHP to provide health care service to all plan members, including one of the largest Medicare Advantage programs in San Francisco many of whom are dual eligible (Medicare / Medicaid) members, and thereby may place its HMO license in jeopardy; and,
WHEREAS, The actions of BTMG, which threaten a loss of most of the CCHCA physicians and the potential inability of CCHP to continue to operate, would deprive the community of affordable, culturally competent care, and add to the burden of the County of San Francisco to care for these safety net patients; and,
WHEREAS, the only other IPAs competing in the San Francisco Market area CCHCA, Hill Physicians, and Physicians Independent Medical Group ("PIMG"), none of which have more than 200 affiliated physicians; and,