Johns Hopkins Medical Service is HMO with a different approach

One on one

August 12, 1991

One on One is a weekly feature offering excerpts of interviews conducted by The Evening Sunwith newsworthy business leaders. Dr. Richard Tompkins is president and chief executive officer of the Johns Hopkins Medical Services Corp.

Q. You're head of the Johns Hopkins Medical Services Corp. Could you explain how that came into being and what it consists of?

A.The corporation is the result of the combination of the provider groups [that had been part] of the Johns Hopkins Health Plan, which was recently sold to Prudential. And the other piece that came into the corporation was a multispecialty practice group practice known as Wyman Park Medical Associates. And so what we're doing is we're merging two doctor organizations into outpatient delivery systems that are spread all over the state in regional sites to provide mostly primary care and wide specialist services.

Q. How many doctors and other health care providers are involved, and are they staff members of the corporation or are they on contract?

A. There about 125 doctors right now, and over 500 non-physician employees who run our delivery system, about 18 clinical sites . . . All the doctors are full-time employees of Johns Hopkins and most have staff privileges at Johns Hopkins and Francis Scott Key hospitals, even though they may be working in communities that are outside Baltimore. They constitute a range of physicians in terms of their specialties. The majority are clearly primary care physicians and practitioners, generalists in internal medicine, pediatrics, obstetrics.

Q. As you said, you and Prudential have essentially cut an HMO in half. Prudential handles the insurance end, leaving the medical delivery to you. How common is that? Is this rather unique among HMOs?

A. I think it's the only one that I know of in which this has occurred. There are a lot of HMOs around the country who are what the Johns Hopkins Health Plan used to be, which is a combined staff and . . . network delivery system, and when they are sold . . . everything is sold; the delivery system goes with it. I don't know of any situations personally, although there may be some, in which this particular approach has been taken. It is difficult because you're not only selling something, the insurance piece, but you're also tearing an organization apart and having to rebuild part of it. For instance, when I started on April 1st, the entire management team that was with the Johns Hopkins Health Plan was going to leave on May 20th, and although I had a piece of a management team from the Wyman Park side of things, realistically we've been having to put together a whole new organization . . . . But it's been successful, and my guess is that for Hopkins, it was exactly the right thing to do. I don't think they would have really been comfortable to sell all of the delivery system to another entity.

Q. Do you expect conflict between the two organizations, with doctors on the one side and insurance executives and accountants on the other?

A. I think there will always be a dynamic tension there. I think that dynamic tension can be real creative. It's the way the world is, to be honest with you, and it's there even in staff model HMOs, where physicians are really part of the same organization. It's just that it's a little more hidden. The ability of an insurance company and a group of physicians to work together toward the same objectives -- predominantly high quality health care at an ,, appropriate price -- I think is something that all of us are really struggling with. . . . But we're in this for the long haul, as is Prudential, and I think that our values in terms of the kinds of care that we want to provide, once again high quality and a reasonable cost, are consistent with what Prudential wants to do. Although we may end up discussing how we go about doing that, I think we're on track together.

Q. You had mentioned keeping down prices as one of the objectives of HMOs. With the rise of HMOs, and in particular with the rise of utilization review, where insurance companies review medical procedures, people have been finding that it's more difficult to get treatment that they had taken for granted in the past. Do you see such restrictions on medical treatment as continuing, and where do you see it leading?

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