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Managing Care for Latinos : Network Focuses on Group It Sees as Misunderstood by Mainstream Medicine


When Manuel Sosa's employer switched medical plans last year, he and his wife, Sobyeda, had to pick a new doctor from the thick booklet provided by Blue Shield of California.

The Pico Rivera couple looked over the medical groups with pleasant-sounding names like "Friendly Hills" or "Bristol Park." They finally settled on a doctor who spoke Spanish--their principal language--and who worked for a fledgling medical group called LatinoCare.

LatinoCare was founded last year by Los Angeles internists Roberto Chiprut and Mario Rosenberg and health-care consultant Jose J. Gonzalez. Their idea was to found a network of doctors that would provide care tailored to Latinos, a population they contend is generally underserved and misunderstood by mainstream medicine.

LatinoCare has already signed up 750 doctors in Los Angeles, Orange and Ventura counties and has quickly grown into the nation's largest network composed primarily of Latino physicians.

The Santa Fe Springs-based company also has struck deals with about 200 doctors in Arizona and Florida, and it has plans for additional expansion, said Gonzalez, president and chief executive.

LatinoCare's growth comes as California's HMOs have stepped up efforts to woo ethnic minorities by recruiting physicians and training doctors and medical office staff to be more sensitive to cultural differences.

After years of what some critics say has been indifference to ethnic customers, HMOs have realized that the state's surging population of Latinos and Asians make these groups crucial to their growth.

In California, the bulk of these marketing efforts is directed at the state's 9 million Latinos. To a much lesser degree, the plans have also been recruiting doctors to better serve the African American, Chinese, Korean, Vietnamese and other communities.

Blue Shield is the insurer that has most closely affiliated with LatinoCare, by working on joint marketing projects.

"Up until a year ago, Blue Shield had no specific marketing efforts to target" ethnic groups, said Alonso Silva Jr., a former FHP Inc. executive who joined Blue Shield a year ago. Now the San Francisco-based managed-care company has a new ethnic marketing department, headed by Silva.

There are reasons beyond their large numbers for health-maintenance organizations' growing interest in Latino consumers. Latinos are generally healthier on average than whites, making them less expensive to treat, says David E. Hayes-Bautista, director of the UCLA School of Medicine's Center for the Study of Latino Health.

(In HMOs, doctors and hospitals are provided a fixed payment per person to provide all medical care, regardless of how much or how little care is needed.)

Bautista says the medical community, and insurers in general, have tended to wrongly perceive Latinos--and other minorities--as bad health risks. "The mind-set is that minorities have shorter life expectancies and higher death and disease rates," he says.

But research has shown that the Latino population, on average, is younger than the white one and has significantly lower death rates from cancer, heart disease and strokes--some of the most expensive-to-treat illnesses.

"What this means for managed care," Hayes-Bautista says, "is that Latinos will be using medical services a lot less without nearly the death rates" from some major diseases.

(Hayes-Bautista, who works as a paid consultant to LatinoCare, notes that Latinos do suffer from higher death rates from diabetes-related illnesses, certain infectious diseases and a lack of preventive health.)

LatinoCare executives are counting on convincing HMOs that the favorable health profile of Latinos should make them attractive customers. More than that, LatinoCare hopes to sell health plans on the notion of a comprehensive program carefully tailored to the needs of Latinos.

"If you don't know your patients, have honest communications and know the idiosyncrasies of the culture of the patient, you can't get to know the patient's illness," says Maria Gonzalez, LatinoCare's marketing director.

Since LatinoCare unveiled its program in December, six managed-care companies, including Blue Shield, Cigna HealthCare and Prudential Insurance Co.'s PruCare unit, have agreed to offer its physician network to their members. The company is in discussions with several other major HMOs, Jose Gonzalez says. And it has affiliations with about a dozen hospitals, including Cedars-Sinai Medical Center in Los Angeles, which has acquired a minority stake in the company.

So far, LatinoCare has signed up only 125 members--fewer than its number of doctors. But it's too early for that membership number to be meaningful. The first important test of LatinoCare's market appeal will come this fall, when many companies conduct "open enrollment" for workers' medical plans.

At least one HMO also has tried to tap the Latino niche of the managed-care market.

VivaHealth, a Monterey Park-based HMO, has been trying since 1994 to sign up small- and medium-size businesses for its health plan tailored to Latino workers. The plan has struggled financially, and, according to enrollment figures, had signed up only 750 members as of September 1995. LatinoCare officials contend that their physician network can avoid the problems that have plagued VivaHealth. Because VivaHealth is an HMO, they note, it has had to bid for employers' business against a host of powerful and cash-rich HMOs. Because LatinoCare is not an HMO, it has the flexibility of contracting with a variety of health plans.

Joe Luevanos, Cedars-Sinai's senior vice president and chief financial officer, says LatinoCare appears to have the right approach.

"There are particular needs of the Latino community that haven't been addressed," he says. "The goals of LatinoCare appear to be to address those needs, not just use them as a gimmick to attract patients."

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