Physicians can refer patients to outside specialists for rare or complex conditions within managed care systems like Kaiser.

“if you have a child that's born with the most obscure congenital cardiovascular uh malformation they might just say you know what that's something we will just send up to UCSF because they've got the right person there I mean my personal example my mother had a rare form of brain cancer we had terrific oncologists at Kaiser who were incredibly dedicated and knowledgeable about oncologic care who without hesitation sought expertise from UCSF when they needed it for the more sophisticated parts of her care including letting her go there”