Riverside/San Bernardino: Vast Region, Market Fragmentation Add to Access Woes

CHCF Regional Markets Issue Brief
September 2012
Laurie E. Felland, Ann S. O'Malley, Dori A. Cross, Isabel Perera

As part of the California Health Care Almanac project, the California HealthCare Foundation (CHCF) funded HSC to conduct interviews in six California communities in 2011-12 to assess how the organization, financing and delivery of health care are changing, including preparations for health reform.

The vast Riverside/San Bernardino region is recovering slowly from the economic downturn, and access to care continues to be a challenge. Key findings of the market report include:

• Improved overall hospital financial performance. Many hospitals maintain bargaining clout on payment rates because health plans must ensure access in each of the region’s many submarkets, some of which are underserved. This has helped maintain and even improve financial performance at the same time that hospitals have struggled with a declining payer mix as people lost private health coverage.
• Increased presence of Kaiser. Kaiser Permanente’s presence has expanded, with other providers—both hospitals and physicians—viewing the integrated delivery system as their biggest competitive threat.
• Growing concerns about physician supply. The per capita physician supply in the region is low compared with other California markets, and some observers reported that demand for physicians continues to outpace supply.
• Growing efforts by hospitals to align with physicians. Physicians remain largely independent in solo or small practices, although some are joining larger physician-owned organizations. Hospitals are seeking to align more closely with physicians—both to gain patient referrals and inpatient admissions and to prepare for new payment arrangements under national health reform.
• Increased pressures on safety nets. County-run safety net organizations face capacity and financial pressures to care for growing numbers of Medi-Cal and uninsured patients. Both counties are trying to work more with federally qualified health centers (FQHCs) and other private community clinics and health centers, especially as they prepare for reform.

Click here to access the Riverside/San Bernardino report at the CHCF Web site.