Isle doctors team up
on health care group
Started at the UH, the network
By Russ Lynch
now includes 1,800 physicians
Star-BulletinA merger of several physicians' organizations has created a new Hawaii physician-owned and -operated health plan network that says it has a significant side benefit -- the potential for major funding for the John A. Burns School of Medicine at the University of Hawaii. The care is provided by University Health Alliance, which recently was expanded to include Hawaii IPA, a newly formed combination of five independent physicians' associations, said Max Botticelli, the former UH professor of medicine who runs key parts of the organization.
After a year or more of changes that culminated in the formation of Hawaii IPA in June, the University Health Alliance now includes about 2,800 health care providers, including 1,800 doctors, according to Laura Kunewa, UHA's president and chief executive. (About 300 of the physicians make up Hawaii IPA and Botticelli said he expects that number to grow to around 600.)
More than 200 of the UHA physicians teach at the university part-time while maintaining their own practices.
Member organizations already have more than 40,000 people signed up for health insurance.
About 12,000 are in groups whose employers have signed up with UHA and another 30,000 in three labor union groups, self-insured by union trust funds with their medical care managed by UHA.
Kunewa said UHA competes with such other medical plan providers as Hawaii Medical Services Association, Hawaii Management Alliance Association and Queen's Island Care and sells medical plans to employers at competitive rates.
Botticelli said a key difference is that UHA is "physician-owned and directed health care system" that has evolved from a combination of for-profit and nonprofit organizations.
The physician ownership is crucial, Botticelli said, because it doesn't allow the commercial and corporate pressures that many doctors feel are adversely affecting some medical plans today.
Kunewa said that while she doesn't see this happening in Hawaii yet, corporate control of medical care in some cases on the mainland has resulted in profit pressures that can affect the quality of care.
UHA's direction by doctors helps prevent that, Kunewa said. "As the top business person in this, I very much am constantly reminded that we must maintain the quality of care."
UHA's additional benefit of providing financial support for the UH medical school is typical of what is happening at medical schools across the country, Botticelli said.
The University of California at San Francisco, for example, gets more than half its funding from a teacher-physician medical group plan, he said.
"One of the goals is to provide a stream of income for the medical school," which like all the schools at the University of Hawaii, is constantly under budget pressure, he said.
"If University Health Alliance is successful, U-Med (the alliance's for-profit management company) is successful," Botticelli said.
The nonprofit part that started it all, University Health Care Associates, owns stock in U-Med and as that increases in value and U-Med produces earnings, money will flow to the medical school, Botticelli said.
The organizational structure sounds complicated, Botticelli acknowledged, but a look at the history explains it:
Several years ago, physicians who teach at the university, most of whom have private practices and teach part-time, established University Health Care Associates (UHCA), a nonprofit educational organization through which the physicians funnel a percentage of their income to the medical school.
"They (Hawaii IPA) are purchasing some of the stock in U-Med," Botticelli said.
The result is a group managed by independent physicians structured in such a way that part of its income flows to the university.
