The 1999 UCLA Health Care Symposium addressed the current state of health care in California and the challenges that lied ahead. We looked to address possible solutions to the crisis at hand: how can we provide a health care system that is accessible, cost effective, and of high quality? As we have seen in the past, California has consistently been a frontier for major health care reform. Such reform has been highlighted by the predominant shift from a fee-for-service health care industry to one that is governed by managed care organizations. The changes implemented in California have often acted as catalysts and, at times, blueprints for reform elsewhere in the nation. For this reason, an objective evaluation and an educated appraisal of the challenges facing health care delivery today were imperative to meet the needs of tomorrow's patients.
The transition from the traditional fee-for-service (FFS) to managed care health care delivery has impacted no other state as extensively as in California. In fact, well over 55% of all Californians and 90% of employer-insured Californians are members of an HMO or PPO plan. California "represents the state of the art in prepaid managed care," whereas many areas of the U.S. health care markets are just entering the early phases of managed care. Thus, it is time to consider the role California plays in leading other states into the Managed Care Era and to assess the advantages, shortcomings and the challenges that await in the near future. Does Californian Health Care Delivery represent the model system for the rest of the United States? More importantly, is the system meeting the needs of Californians by providing a solution to the health care crisis -- by providing health care that is accessible, cost-effective, and of high quality? If not, how can we change health care delivery to meet these needs?
Approximately 40 million Americans have little or no access to health care. This problem may be attributed to the cost inflation under the traditional FFS system, mediated by uncoordinated abuse of the freedom this system provided by insurance companies, other third party payers, and certain physicians. In addition, the shift to managed care as the primary means of health care delivery in Southern California is the product of a variety of sociological, technological, and economical transformations that have occurred in the 20th century. Such transformations have necessitated a more accessible, cost-effective, and comprehensive health care system for all, regardless of prior or present health, social, and economic status. A shift from FFS to prepaid managed care in California is not only a product of social and market forces, but is also seen as a step closer towards cost-effective health care delivery.
Managed care systems, such as Health Maintenance Organizations (HMOs), have solved some of the shortcomings of the traditional FFS model. They have proven to be more cost-effective and provide greater accessibility to some populations. These systems also encourage a greater emphasis on preventive care and routine check-ups that are not normally covered in the traditional FFS system. Managed care proponents claim that more efficient and cost-effective care can be provided through the use of "utilization management reviews," which advocate discharge planning, case management, and less expensive alternatives. This is promised without any subsequent loss in the quality of care provided to patients.
Nonetheless, managed care systems also have serious shortcomings. For example, this model places new limitations on patients' freedom in terms of selecting their desired services and/or physicians. In addition, the preoccupation with cost may create lower quality health care, which may jeopardize the integrity of the doctor-patient relationship and restrain physicians from providing adequate care as they deem necessary. The ultimate concern is that health care is being provided by corporations that are more concerned with the financial interest of their stockholders rather than patient care. Thus we are challenged with new questions: Will cost be maintained at the expense of patient care? And will physicians' autonomy in treating patients the best way possible be compromised?
As we dawn upon a new millenium, we may need to consider alternative systems or reforms that will eliminate some of the problems associated with the existing form of health care delivery -- managed care. The history of health care delivery in this country has been one of "resolutions that create problems which requires new solutions." Are we once again stepping into this vicious cycle with a managed care system in place of FFS? As health care providers, we are challenged with a number of difficult questions: Is the concept of having a quality, cost-effective, and accessible health care delivery system just a myth, or can we reach this goal? What are the necessary reforms and how can they be achieved? Whose job and responsibility is it to deal with our current problems and who should be the decision-makers leading the future of this country's health care delivery system?
Registration and Continental Breakfast
Grand Horizon Room, Covel Commons
Gerald Levey, MD, Provost, Medical Sciences, and Dean, UCLA School of Medicine
Keynote Address I: "Cost, Quality, & Access"
The keynote address will be delivered by Antonio Villaraigosa, Speaker, California State Assembly
The ABCs of Health Care: "Where is California now?"
This session will serve as the foundation to the rest of the conference, providing definitions of commonly used health care terminology as well as descriptions of currently available health care options (i.e. PPO, HMO, IPA, etc.)
This discussion will be led by Barton Wald, MD, MBA, Chief Medical Officer and Senior Vice President of Medical Affairs, UniMed Physician Practice Management Company
Debate I: The Health Care Crisis: "Cost, Quality, Access: Pick Two"
This debate will host representatives from different health care perspectives. Each participant will address the following question: Can you provide all three? And if not, which aspect is compromised?
This debate will be moderated by Ross Miller, MD, MPH, CPE, Medical Director, Quality Management, CIGNA HealthCare of California; and Steven Kwon, Medical Student, UCLA School of Medicine
Bruce Chernof, MD, Medical Director, Health Net;
Richard Dixon, MD, FACP, Director of Physician Practice Services, The Lewin Group and Medical Director, The National IPA Coalition (NIPAC);
Patrick Dowling, MD, MPH, Executive Chair, Dept. of Family Medicine, UCLA School of Medicine;
Leslie Schlaegel, Senior Vice President in Corporate Personnel, Bank of America;
Expert Roundtable Luncheon
Attendees will be seated with a health care professional, a debate panelist, or a keynote speaker. The expert will be encouraged to speak about how the shifts in health care delivery have impacted his/her career.
Grand Horizon Room, Covel Commons
Alen Cohen, Medical Student, UCLA School of Medicine
Keynote Address II: "The Physician's Role in the Managed Care Era"
The keynote speaker will address the evolution of the physician and identify the various roles for physicians in the changing health care environment ahead of us.
The keynote address will be delivered by Arthur Southam, MD, MBA, MPH
Debate II: Health Care Decision-Making: A Physician's Prerogative?
Debate participants will address the following questions: What should a physician's responsibilities be? What are the limits of this responsibility? Can they and should they reclaim the duties of administrators? What roles exist for the physician outside of being a clinician? What type of training is necessary? What did you, the panelist, choose to pursue your direction (e.g. earn an extra degree) - what do you see in the future of medicine that warrants this? Does being involved in administration take away from patient contact? Can one be both a clinician and administrator?
This debate will be moderated by J. Thomas Rosenthal, MD, Vice Provost and Director, UCLA Medical Group; and Nima Fahimian, Medical Student, UCLA School of Medicine
Eric Brass, MD, PhD, Chair, Department of Medicine, Harbor-UCLA Medical Center, and Professor of Medicine, UCLA School of Medicine
David Hartenbower, MD, FACP, President/CEO United Physicians Association of Santa Monica and Santa Monica Medical Center Medical Group; Adjunct Associate Professor of Medicine, UCLA School of Medicine; and Chairman, Los Angeles Foundation for Medical Care
Arthur Southam, MD, MBA, MPH;
Paul Torrens, MD, MPH , Professor, Health Services, Director, Executive MPH Programs in Health Services Management and Co-Director, UCLA Center for Health Services Management;
Raffle and Closing Remarks
Winnie Cheung, Medical Student, UCLA School of Medicine
Darice Liu, Medical Student, Drew-UCLA Medical Education Program
MERCK & Co., Inc.
UCLA MEDICAL CENTER
UCLA School of Medicine
Medical Student Council
UCLA SOM Class of 2001
Winnie W. Cheung is a second year student at the UCLA School of Medicine. She received a B.S. in biochemistry from UC Davis in 1997, graduating with highest honors. She was a coordinator for the Paul Hom Asian Clinic of Sacramento, a student-run free clinic, and received the 1997 Charles Hess Community Service Award. Through her leadership in the health care symposium, she hopes to encourage other students to take an active role in shaping medicine in the 21st century.
Alen N. Cohen is a second year student at the UCLA School of Medicine. He received a B.S. in Neuroscience from UCLA in 1997, graduating summa cum laude. During his undergraduate career he was co-founder and president of Bruins for the Homeless. Through his leadership in the health care symposium, he hopes to raise awareness among his fellow colleagues regarding the critical skills necessary for any professional involved in health care delivery.
Nima A. Fahimian is a second year student at the UCLA School of Medicine. He received a B.S. in Biochemistry and Sociology from UCLA in 1997, graduating magna cum laude from the College of Honors. He was the founder of Saturday Youth Outreach Program, director of the UCLA/Sociology Tutorial Project, and co-author of the Tutoring Matters: Everything You Always Wanted to Know About How to Tutor. Through his leadership in the health care symposium, he hopes to inspire activism in public health policy.
Steven I. Kwon is a second year student at the UCLA School of Medicine. He received a B.S. in Biochemistry from UCLA in 1997, graduating magna cum laude with College and Departmental Honors. He received the Merck Index Award acknowledging his research in atherosclerosis. Through his leadership in the health care symposium, he hopes to provide individuals with the tools necessary to critically appraise the various health care systems and to encourage active participation in the evolution of health care delivery.
Darice Liu is a second year student in the Drew-UCLA Medical Education Program at the UCLA School of Medicine and Charles R. Drew University of Medicine & Science. She received a B.A. in Peace and Conflict Studies from UC Berkeley in 1997, graduating with Honors. She was a Health Education Coordinator at the Suitcase Clinic for the Low-Income and/or Homeless. Through her leadership in the health care symposium, she hopes to empower herself and other medical students about health care issues. Her interests include healthcare for the underserved, human rights, health care policy, and community empowerment through health education.
Bruce Chernof, MD
Medical Director, Health Net
Executive Director, Venice Family Clinic
Ron Halbert, MD, MPH
Director, Clinical Operations of Quality Initiatives
Michael Karpf, MD
Director Vice Provost, Hospital Systems
Ross Miller, MD, MPH, CPE
Medical Director, Quality Management, CIGNA HealthCare of California
Neil H. Parker, MD
Senior Associate Dean, Student Affairs, UCLA School of Medicine
J. Thomas Rosenthal, MD
Vice Provost and Director, UCLA Medical Group
Vice Provost, UCLA School of Medicine Deans Office
LuAnn Wilkerson, EdD
Associate Dean for Education, UCLA School of Medicine