Just four major medical organizations dominate health-care landscape in San Diego County: Kaiser Permanente, Sharp HealthCare, Scripps Health and UC San Diego Health.
The relative dearth of competition has a definite impact on the compensation paid to solo practitioners and small independent clinics who contract their services with these providers.
But that could change when Regal Medical Group expands into the county Jan. 1.
The Northridge-based network is widening its coverage to include county residents 65 and older Jan. 1 who have signed up for the HMO’s 2020 Medicare Advantage Plan offering.
Regal says it will soon offer other plans as it widens coverage to include other population groups.
The health care group is an affiliate of Heritage Provider Network, which it claims to be the largest doctor-owned medical group in Southern California. HPN says it counts more than 600,000 members in Los Angeles, Riverside and San Bernardo counties.
Regal, meanwhile, has 2,557 primary care and 9,429 specialty doctors under contract, according to its website.
That number is expected to grow with the San Diego expansion.
“It was a natural extension for us as we continue to grow south into the heart of the San Diego County market,” said Jasmine Frank, senior vice president for network operations. “It’s not a quick process; it takes time.”
“You have to develop a network that’s going to meet the health plan’s network adequacy requirements, so it’s not something that’s done overnight,” she said.
Frank said it has signed 75-to-80 primary care physicians and 300 specialists to date, and that Regal will be adding to those numbers in 2020.
“All of our networks are developed through contracting efforts,” she said. “This is all done with independent physicians, such as single practitioners or groups of three to four.”
Since the four major health care groups also run most of the local hospitals in the county, one of the challenges will be bringing hospitals into its network.
“The hospital challenge is our biggest challenge,” Frank said. “Because we are full risk, we have to have adequate hospitals. They view us somewhat as a competitor, because they have their own affiliated physician organizations and networks.
“They certainly don’t want a new organization cannibalizing their existing affiliations,” Frank said. But said the hospitals also want the new business.
“It’s a bit of a catch 22 for them,” she added.
Frank said they’re still in discussions with many hospitals in the county and will add more as contracts are signed.
One service that it offers its doctors is what it calls H.E.L.P. Concierge Services when a patient needs urgent care and needs help with referrals to specialists.
The service is designed to steer patients away from unnecessary emergency room visits to less expensive urgent care centers.
Frank said Regal won’t know the exact number of residents who have signed on to their Advantage network till the end of December. These new members signed on during the recent open enrollment period that started in mid-October and ended Dec. 7.
Frank also said that by expanding into the San Diego market independent physicians will have another choice of affiliation. Regal’s success in its existing markets is due to the competitive rates that it pays providers for joining the network, she said.
“We wanted to give the physicians an alternative,” she said, and said that Regal offers “a number of benefits that existing networks might not have.”
Joining 14 Medical
Groups In the County
San Diego County Regal will join 14 existing medical groups in the county, according to data compiled by the state Office of the Patient Advocate’s 2019-2020 edition of its annual Commercial Medical Group Report Card.
“The new competition is always a good thing,” said a spokesman for the agency. But we can’t say much more than that.”
Regal is among 197 medical groups statewide that are rated by the agency.
The agency ranks Regal two out of five stars for its medical care and three out of five stars for a patient’s overall experience.
4.5 out of 5 Rating
The Centers for Medicare and Medicaid Services has given Regal a 4.5 out of 5 star rating for its Medicare Advantage plan.
The score is an indication of how well plans perform in several categories, including quality of care and customer service.
“We’re focused on the model of keeping patients happy as well as preventative care,” Frank said. “We want to keep our members out of the hospital, so our company has a lot of value-add programs that other organizations may not need.”
She said that many plans are pushing networks to reduce hospital stays for member, which requires Regal to emphasize preventative care.
“Because we’re full risk, we need to keep patients healthy and out of hospitals,” she explained. “Our model is to put resources on the front end and keep patients healthy. Going to a hospital is not always the best thing because of the exposure to added health risks.