North Bay Business Journal

Monday, September 28, 2009, 2:30 am

Business Journal Q&A: Marin IPA Chief Executive Joel Criste


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    Joel Criste

    Joel Criste

    MARIN, SONOMA COUNTIES – As the provider of medical services to the largest population of insured patients in the North Bay outside of Kaiser Permanente, it is not surprising the 300-physician Marin IPA fills a uniquely powerful position in the North Bay health care business.

    Now in its 25th year, the association is the largest physician-owned primary and specialty medical group in the region, representing more than 60 individual offices in Sonoma and Marin counties. Members benefit from solid contracts with six health insurance carriers, providing a stable home for badly needed new recruits to the area.

    Recently, the independent practice association has repeatedly come up in board room discussions at Marin General Hospital, Petaluma Health Care District and others, and is thought by many to be the key to sustaining the doctor population in the future. Led by several committees of physicians, the group has also implemented innovative quality and wellness programs.

    Marin IPA Chief Executive Officer Joel Criste sat down with the Business Journal last week and discussed being the center of the North Bay health care conversation, fiscal challenges and planning for reform and the future.

    Q. How would you describe the IPA’s growth strategy over the years?

    A. Generally, in the past our growth has aligned with moving into a new geographic area — like when we added the Petaluma doctors a few years ago and Sonoma, we also include some [Redwood Regional Medical Group] and [Northern California Medical Associates] doctors. But recent growth has centered on attracting new physicians to the community. Many doctors will be retiring in the next five years, and we need to make sure we are increasing our base, especially in primary care. The Prima Medical Group has been the center of the effort by providing good insurance contracts and business management.

    Q. What else are you doing that is new?

    A. We have really focused a lot of efforts on increasing quality of care and expanding wellness programs both in scope and frequency of classes. We have the unique ability to measure and track the quality of care for our HMO population, and we’ve focused a great deal of energy on improving our preventative medical care and chronic conditions — diabetes, asthma, etc.

    Q. The Marin IPA keeps coming up in hospital meetings as forming some kind of collaborative agreement or partnership, why is that?

    A. The hospitals see that we have been successful in replacing or replenishing the physician population, which is really important for their business because they depend on referrals.

    There have been talks about how they can support us by supporting recruitment, including possible help with IT infrastructure or participating in quality improvement. There is a full spectrum of ideas out there right now.

    We are interested in working with our hospitals and health care districts, but some we are seriously considering and others we are not. We have not committed to any one of them, and we are not ready say anything other than there is enough of a spirit of collaboration that changes in the hospital patient population will more than likely involve the Prima group or the Marin IPA.

    Q. What are the advantages to being an independent physician organization rather than one affiliated with a hospital or larger health care organization?

    A. The advantage of being physician-owned is that the group centers decision-making around patient care improvement rather than a top-down, systematic profit-centered model. The physicians drive all clinical decisions.

    Q. What are Marin IPA physicians most worried about right now?

    A. Finances, the increasing cost of care and the stable or decreasing revenues, threats of declining reimbursement and how we are going to address it. We have supported our state and national associations in the effort, but so far efforts have been minimally successful.

    Q. What do you see as the most important result of health care reform?

    A. The reimbursement system is skewed right now. They charge for procedures over quality of care, and they severely undervalue primary care, which is probably the biggest factor causing the shortage of primary care physicians.  … I think there is recognition that the system is unbalanced, but there has so far been extreme resistance to any change. I think the idea is, yeah, this needs to be fixed, but not out of my pocket.

    I think the government is in the position to be the greatest driver of this change, but not necessarily by creating a whole new payer. This doesn’t address the uninsured population or variance in utilization, but it is a major part.

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