By Henry Dubroff Friday, September 20th, 2013

It’s true in football. And in life. And it quite likely is going to be true in health care.

Which is to say that human existence in Southern California really boils down to a single question — are you a Bruin or a Trojan?

The UCLA Bruins and the University of Southern California Trojans have a historic rivalry that plays itself out at the Rose Bowl every fall. Families, workplaces, even halls of government are split between Trojan-cardinal and Bruin-blue in a way that’s really incomparable in any city on either coast.

But beyond the goal posts and tailgate parties, USC and UCLA are enormously powerful brands in the business of health care. And my takeaway from a California Lutheran University panel discussion on the future of health care on Sept. 17 is that the Bruin-Trojan rivalry is going to be a huge factor in an almost universally expected wave of hospital consolidation.

To quickly review the lineups:

• Now called UCLA Health, the Westwood-based operation is a research and teaching behemoth with more than 2,000 physicians, a medical center named for former President Ronald Reagan and a gazillion donors including Hollywood bigwigs such as David Geffen, whose name is on the medical school. UCLA is among the top acute care hospitals in the nation, and its growing Southern California network has the vast political and economic weight of the entire UC system behind it.

• Even larger is USC, whose medical school has been a partner with Los Angeles County’s health department since the 1880s, running the biggest health care organization in all of LA. Marilyn Monroe was born in LA County hospital’s charity ward in 1926. Recently, USC has acquired two major hospitals, launched a $1.5 billion funding campaign and received a $150 million gift from the W.M. Keck Foundation. The renamed Keck School of Medicine is moving up fast in national research rankings.

Both have the financial clout to purchase hospitals, form partnerships and undertake expensive projects, such as electronic medical records, that are at the heart of Obamacare.
CLU panelist Greg Angle, CEO of Los Robles Hospital and  Medical Center in Thousand Oaks, predicted a “tremendous consolidation” in health care as “organizations are not able to make the transition” to new rules that reward practitioners wellness and not simply fees for services.

Panelist Steven Sell, western region president for insurer Health Net, said he expects large employers such as the UC System and CalPers to “narrow their networks” as Obamacare takes hold.

Panelist Matteo Dinolfo, M.D., the physician who is leading UCLA’s community clinic expansion, said that not every organization will be able to manage the transition to “being paid for keeping people well.” In part that means footing the bill for massive capital expenses and transition costs involved in electronic medical records. He said a plan being rolled out system wide to UC employees is “our first salvo” in the coming competition for patients who are getting health coverage for the first time or being dropped by their employer-based plans. “We think we will be pretty competitive,’’ he said.

What does this precisely mean for our region? In a world where consolidation truly ruled, it would be possible to see that every independent health care system would have to be aligned with either UCLA Health or USC-Keck to assure access to family practitioners, clinics, electronic records, the latest technology and research.

UCLA already has primary care clinics in Ventura County, a training alliance in family medicine with the county medical center and a built in group of potential new patients at UC Santa Barbara. As we enter the early going in the Obamacare rollout, it would appear to have the advantage.

But USC Keck could quickly gain ground. It has an emerging alliance with Dignity Health Central Coast to provide family physicians to Santa Maria and San Luis Obispo County, it has a vast alumni network to serve as a marketing base and it is just one deal away from a game-changing transformation of health care in the Highway 101 corridor.

One possible scenario would be an alliance between all of the Dignity Health organizations in the region with USC, and an affiliation of Cottage Health, Community Memorial and perhaps the Tenet organizations in SLO County with UCLA.

There is always a chance that another player, perhaps Mayo Clinic or Stanford, would find a creative way to partner with one or more of the Central Coast hospitals. But if consolidation is coming, and you have to believe it is, then the Bruin-Trojan rivalry will likely be playing out at a health care facility near you.

• Contact Editor Henry Dubroff at [email protected].