GET STARTED OUR HEARING THIS
MORNING. WAS A GOOD MORNING AND
WELCOME TO THE ASSEMBLY HEALTH
COMMITTEE IS INFORMATIONAL
HEARING ON COST CONTAINMENT
PROVIDING HEALTHCARE TO ALL WHO
CALL CALIFORNIA HOME HAS BEEN A
GOAL OF MINE SINCE I WAS
ELECTED. THE ACA'S MADE GREAT
PROGRESS IN CALIFORNIA BY
REDUCING THE NUMBER OF PEOPLE
WHO ARE UNINSURED. RECENTLY WE
EXPANDED MEDICAID OUT AND
INCREASED THE COVER OF THE
AFFORDABILITY OF HEALTH CARE.
POWER TO MANY FOR NAN'S HEALTH
CARE ROOM. ON AFFORDABLE AND
REMAIN AND MANY REMAIN
UNINSURED. WE CANNOT REACH
SCHOOL OF HEALTH CARE FOR ALL
WITHOUT ADDRESSING HEALTHCARE
COSTS. HEALTHCARE SPENDING
CONTINUES TO RISE FROM ALL
SOURCES OF COVERAGE JOB BASED
MEDI CAL MEDICARE AND PRIVATE
INSURANCE AND CONSUMERS ARE THE
ONES FEELING THE PINCH.
ACCORDING TO A RECENT SURVEY OF
AN CALIFORNIA RESIDENTS RATE
MAKING HEALTH CARE MORE
AFFORDABLE AS A EXTREMELY
IMPORTANT OR VERY IMPORTANT
PRIORITY FOR THE GOVERNOR AND
THE LEGISLATURE TO ADDRESS IN
TWENTY TWELVE. MANY STRUGGLING
TO PAY THE- CALIFORNIA IS NOT
ALONE IN THIS PREDICAMENT
VIRTUALLY ALL STATES ARE
STRUGGLING TO CONTROL HEALTH
CARE SPENDING STATES LIKE
MASSACHUSETTS IN OREGON AND
RYLAND IST OUT COST CONTAINMENT
COMMISSIONS TO MEASURE MONITOR
AND SET TARGETS TO CAN WELL
HEALTH CARE CAUGHT PRECIP. COST
CONTAINMENT. HAS BEEN A WILL
COST USING IT'S ALL HERE CLAIMS
DAY. TO ESTABLISH RAY FOR ALL
SERVICES. SEVENTEEN STATES HAVE
ALSO IMPLEMENTED ALL PAY CLAIMS
DATABASE. ARE CALLED EIGHT C.
D.'S THE CARD HEALTH INSURANCE
CLAIMS IN FOR. FROM ALL
HEALTHCARE. AMIR'S OTHER STATES
THERE IS AN URGENCY TO ADDRESS
COSTS. RECENTLY WE SECURED-
FUNDING FOR CALIFORNIA START
BUILDING ITS OWN HEALTH
PAYMENTS DATABASE AND I'VE
INTRODUCED A BILL TO ESTABLISH
THE FRAMEWORK FOR THIS
DATABASE. WHAT THIS DATABASE TO
BE OPERATIONAL SOONER RATHER
THAN LATER. IN GOVERNOR
NUISANCE BUDGET PROPOSAL THIS
YEAR HE PROPOSED THE
ESTABLISHMENT OF THE OFFICE OF
HEALTH CARE AFFORDABILITY TO
DEVELOP OF CARE COST TARGET. AS
THIS PROPOSAL AS THE
LEGISLATURE EVALUATES VARIOUS
EFFORTS IN APPROACHES TO
CONTROL HEALTH CARE SPENDING.
OPRAH IF WE'RE TO UNDER AND THE
OF HEALTH CARE'S. AND LOOK THE
EXPERT OF OTHER STATES WHO
SUCCESSFULLY IMPLEMENTED COSCO
TARGETS AS A MODEL FOR OUR
STATE. I'D LIKE TO ACKNOWLEDGE
AND THANK ALL OF OUR SPEAKERS-
IN ADVANCE THIS MORNING
ESPECIALLY THOSE WHO TRAVELED A
LONG JUST. TO FIGHT AND I KNOW
THAT THIS SPECIAL TIME ZONES
THAT SAY THAT'S A CHALLENGE SO
AT THIS POINT AS I SEE IT OUR
MEMBERS ANY ANY OTHER HAVE
ANYWHERE. COMES THE- SCENE.
MOVE THE BILL OKAY ALL RIGHT.
WE DON'T HAVE A QUORUM AT THAT
SO WILL BILL TO DO THAT SO IF
POINT I'D LIKE TO GO AHEAD AND
START WITH OUR OR FIRST SPEAK
LARRY LEVITT. COME ON UP. LARRY
IS THE EXACTLY BY PRESIDENT FOR
POLICY FOR THE K. FOR
FOUNDATION. AND SOMEONE WE KNOW
WELL. GOOD MORNING SIR. MEMBERS
THE COMMITTEE THE OPPORTUNITY
TO TEST TODAY YEAH THE CHAIRMAN
SAID HEALTHCARE J. IN THE COST
FOR THE BILL OF HEALTH CARE'S.
AS A TOP PRIORITY FOR BOTH
AMERICANS AND CALIFORNIANS- I'M
GOING TO START THE BIG PICTURE
OF HEALTH CARE COSTS- WE IN THE
UNITED STATES SPEND THREE POINT
SIX TRILLION DOLLARS ON
HEALTHCARE HERE. PRESENT
EIGHTEEN. ME MORE THAN THOUSAND
DOLLARS PERSON IN DOUBLE THE I
OF WHAT OTHER COUNTRIES SO.
ADDITIONAL LOT OF FOCUS ON A
DRUG PRICES BOTH HERE IN THE
CAPITAL AS WELL AS THE CROSS
THE COUNTRY- AND IT'S CERTAINLY
APPROPRIATE DRUG PRICES HAVE
BEEN SIGNIFICANTLY- PROMINENT.
LIFESAVING DRUGS LIKE INSULIN-
WHERE THE PRICES HAVE RISEN US
IN PEOPLE HAVE IN SOME CASES
DIED FROM FROM FROM NOT TAKING
THE DRUG THE- BUT THE REALITY
IS RETAIL FOR. DRUG THAT JUST
NINE PER. OF THE THREE POINT
SIX DOLLARS IN HEALTH CARE
SPENDING- CONTRAST THAT WITH
OVER HALF OF HEALTH CARE
SPENDING GOING TO HOSPITALS. OF
PHYSICIANS INCLUDE- SO IF YOU
WANT TO DO SOMETHING ABOUT
HEALTHCARE COSTS CERTAIN THE A
FOCUS ON PRESCRIPTION DRUGS
IMPORTANT BUT A FOCUS ON THE
MUCH BIGGER. GOING TO SPITTLE
AND SHINS AT IS EVEN IMPORTANT.
NOW I WOULD KNOW THIS NATIONAL
DATA A CAL LOOKS QUITE SIMILAR
TO THE HEALTH SYSTEM AND NOW
BUT FRANKLY DON'T HAVE GOOD
DATA ON MUCH WE SPEND ON HEALTH
IN IN THE STATE. THE MOST
RECENT DATA FROM FEDERAL. WHICH
TRACKS AT HEALTH CARE SPEND ON
YOU OBEY IS FROM TWENTY
FOURTEEN- FORWARD STATES AND
INCLUDING CALIFORNIA. SIX YEARS
AGO IT WAS JUST EASIER CARE ACT
WAS WAS TAKING A FACT WITH ME
CHAIN. ON HEALTH CARE I'M. WE
REALLY DO A GOOD PICTURE WE'RE
WE'RE SPENDING. YEAH ON ON
HEALTH CARE AND- NOW CERTAINLY
THEY HAVE PERSON ON THE STREET
IS GONNA CARE MUCH OF. THAT
DATA AND BUT BUT THE TWO OF THE
MATTER IS IT'S HARD TO MAKE
PROGRESS ON HEALTH COSTS IF WE
DON'T EAT KNOW WHAT. COSTS ARE
TO. KIND EFFORTS THURMOND WITH
WAS TALKING ABOUT TO COLLECT
BUT DATA TO PUT US. ON
HEALTHCARE COSTS IN
AFFORDABILITY- IN THE STATE
WOULD BE CONTRA. NOW I DON'T
AND MINIMIZE THE- OF HEALTH
COSTS CITIES FOR. A BIG PROBLEM
WHICH I'M GOING TO TALK MORE
ABOUT- BUT IT'S IMPORTANT
UNDERSTAND THAT THE GROWTH IN
HEALTHCARE COSTS- HAS IN FACT
SLOWED. DRAMATICALLY OVER TIME-
IN THE NINETEEN SEVENTIES AND
EIGHT IS DOUBLE DIGIT INCREASES
IN HEALTHCARE SPENDING WERE
QUITE ROUTINE AND- MUST
INCREASES. FAR OUT IS THE
GROWTH A THE A- OVER. IN THE
KERN DECADE SPENDING IS AB.
LESS FOUR PER. JOE BARELY
GREATER THAN THAN. P. THE-
ISN'T FRANK NO CONSENSUS ON
HEALTH CARE SPEND GROWTH HAS
SLOWED MUCH SOME PASTA. AND A
LOW AND LOW GROWTH IN PRICES IN
ECONOMY GENERALLY. A SORE. NO I
DON'T WANT TO LEAVE YOU WITH A
SENSE THAT THE PICTURES ALL
ROSY- WELL HEALTH SPENDING
GROWTH REACHED A LOW POINT-
EARLIER IN THE DECADE IN TWO
THOUSAND THIRTEEN IN TWO
THOUSAND FOURTEEN- IT'S BEEN
RISING SUBSTANTIALLY FAST.
SINCE THEN AND INSTEAD OF
GROWING OVER 5% PER YEAR
SIMILAR TO WHAT WE SAW IN THE
NINETEEN NINETIES AND TWO
THOUSANDS. HEALTHCARE IS
GROWING FASTER THAT PLACE MUCH
FASTER THAN WORK. JUST A SO WE
STILLHAVE A IG HEALTH CARE
COST AND AFFORDABILITY PROBLEM
IS LIKELY TO GET WORSE RATHER
AND THAT. SOME EVIDENCE THE
HEALTH CARE COST. PROBLEM IS
EVEN WORSE I CALIFORNIA THEN
THEN IT IS IN THE REST OF THE
COUNTRY- IT'S USEFUL TO FOCUS
HERE ON EMPLOYER BASED
INSURANCE THAT'S WHERE MOST
PEOPLE- GET. FOR MORE PEOPLE
THAN ANY. OTHER SOURCE GET GET
COVERAGE- AND WHILE THE
AFFORDABLE CARE ACT A LOT TO
ADDRESS AFFORDABILITY FOR
PEOPLE WHO DON'T HAVE ACCESS TO
EMPLOYER COVERAGE. I DID LITTLE
FOR THE MUCH LOWER GROUP OF. TO
GET EMPLOYER AND PRINCE. BUT
STILL HAVE TROUBLE FOR. CROSS
THE- BRIDGE IS THOUSAND SIX
HUNDRED AND SIXTEEN DOLLARS
MOST OF WHICH IS PAID BY
EMPLOYERS- BUSINESSES AND
CALIFORNIA THE PREMIUM THE
AVERAGE PREMIUM IS ABOUT 6%
HIGHER THAN THAT AT ALL TWENTY
THOUSAND DOLLARS AND OF COURSE
THE PREMIUM DOESN'T TELL THE
WHOLE STORY SINCE PEOPLE HAVE
SUBSTANTIAL AND GROWING OUT OF
POCKET COSTS AS WELL- WHEN
YOU'RE OUT OF ALL THE COSTS FOR
FAMILY FOR- WITH INSURANCE PAID
BY EMPLOYERS WERE. TAKEN OUT OF
THEIR PAYCHECKS AND- I AM WITH
A OUT OF. DOUBLES IN COPAYS. OF
THAT NOW TOPS TWELVE TWO
THOUSAND DOLLARS A YEAR ON
AVERAGE FOR A FAMILY. OF
FAMILIES THEMSELVES ARE NOW
SPENDING ALMOST EIGHT THOUSAND
DOLLARS A YEAR FOR THAT UP 67%
OVER THE LAST LAST DECADE. BUT
STILL AS MUCH AS FAMILIES ARE
PAYING THE LION'S SHARE OF
THESE INSURANCE COSTS ARE STILL
PAID NINE. YEARS AS A GROWING
COST BURDEN FOR BUSINESSES AND
A DRAG ON WAGES AS MORE OF
COMPENSATION GOES TO HELP.
RATHER. THE. DEDUCTIBLES IN
PARTICULAR HAVE RAISED
AFFORDABILITY CHALLENGES FOR
PATIENTS AND DEDUCTIBLES AN
EMPLOYER BASED PLANS ARE UP A
HUNDRED AND 62% IN THE LAST TEN
YEARS MEETING AT WHICH THE
DOCTOR BILLS ARE NOT MORE THAN
TWO AND A HALF TIMES WHAT THEY
WERE A DECADE AGO OVER THAT
SAME WORKERS THINGS ARE UP JUST
TWENTY SIX PERCENT. SO
DEDUCTION INCREASD SIX TIMES
FASTER THAN WILL WORK MAVERICK
YOU'RE MAKING A LEADING TO AN
AFFORDABILITY CAPPED AT CAP FOR
WORKERS IN IN A PIECE OF GOOD
NEWS OR MAYBE LESS BAD NEWS-
FOR CALIFORNIA DEDUCTIBLES ARE
ONE AREA- WE'RE CALIFORNIANS
ARE SOMEWHAT BETTER OFF- FORTY.
6% OF CALIFORNIANS HAVE A
DEDUCTIBLE MUCH LOWER THAN THE
85% NATIONALLY YOU TO DO AN
EMPLOYER BASED PLANTS- AND THE
AVERAGE DEDUCTIBLE IN
CALIFORNIA'S FOURTEEN HUNDRED
AND TWO DOLLARS. HIGHLY LOWER
THAN THE NATIONAL AVERAGE. PART
OF THE REASON FOR THIS IS A
MUCH HIGHER PENETRATION OF HMO
IS IN THE STATE- FORTY FIVE
PERCENT- IN CALIFORNIA VERSES
15% NASH NATIONALLY- IN IT
THOSE ARE. LESS LIKELY OF
DOCTOR BILLS- THEN- OTHER TYPES
OF PLANS LIKE PPO IS. I'M IN
CALIFORNIA DEDUCTIBLES HAVE
GOTTEN OT. FOR HUNDRED DOLLAR
DEDUCTIBLE CAN FEEL LIKE NO
INSURANCE AT ALL- WHEN YOU HAVE
NEXT TO NOTHING IN THE BANK-
SAVE FOR A RAINY DAY AS IS THE
CASE FOR MANY CALIFORNIANS.
ACCORDING TO FEDERAL RESERVE
ABOUT 40% OF AMERICANS WOULDN'T
BE ABLE TO COVER A FOUR HUNDRED
DOLLAR EMERGENCY- WITH CASH
SAVINGS. OR CREDIT CARD CHARGE
THAT THEY CAN QUICKLY PAY OFF-
SO- AND THAT'S MUCH LESS THAN
THE AVERAGE DEDUCTIBLE SO AGAIN
THIS FOR MANY PEOPLE MAY FEEL
LIKE- LIKE ALMOST NO INSURANCE
AT ALL. NOW TO AS BAD AS AN AN
OUTDATED AS THE DATA STATEWIDE
ON HEALTHCARE COSTS ARE- IT'S
FRANKLY EVEN WORSE REGIONALLY-
WE DON'T KNOW A LOT ABOUT HOW
HEALTHCARE COSTS VARY ACROSS
THAT. VERY LARGE STATE- BUT
THERE ARE SOME INDICATIONS THAT
HEALTH CARE BECAUSE DO VERY
TREMENDOUS. IF FOR EXAMPLE AT.
YOUR PREMIUMS OVER CAL IN LA-
THE LOWEST COST BROWN'S PLAN
FOR FORTY YEAR OLD THIS YEAR IS
LESS THAN THIRTY THREE HUNDRED
DOLLARS- THAT'S IT'S
SUBSTANTIALLY HIGHER IN
SACRAMENTO AND SAN FRANCISCO-
EVEN HIGHER IN THE FAR NORTH OF
THE STATE- INSURANCE AND EUREKA
FOR EXAMPLE. 52% MORE
EXPENSIVE- THAT EL NOW THIS IS
VERY LIKELY TIGHT UNDERLYING
COST OF HEALTHCARE IN THESE
DIFFERENT COMMUNITIES- IT'S
PROBABLY NOT THE CASE THAT
PEOPLE IN SAN FRANCISCO OR
SACRAMENTO OR EUREKA. THAT MUCH
SICKER THAN PEOPLE IN LOS
ANGELES- MORE LIKELY IS THAT
HEALTHCARE PRICES ARE SIMPLY
MUCH HIGHER IN THOSE
COMMUNITIES AND THAT'S DUE IN
PART TO. SOLID ATION AMONG
HOSPITALS PROVIDERS. I IN THE
AREA SACRAMENTO. IS PROVIDED
HAVE MUCH GREATER LEVERAGE TO
DEMAND HIGHER PRICES- IN IN
RURAL PARTS OF THE STATE- WHERE
THERE ARE MANY FEWER PROVIDERS
LEVERAGE CAN BE EVEN MORE
PRONOUNCED. I'M REALLY IN OUR
HOT GROWING PRICE ARE THE
FACTORY. INCREASING HEALTH CARE
COSTS- THE FACT THAT WE SPEND
DOUBLE PER PERSON WHAT OTHER
COUNTRIES SPEND IS NOT BECAUSE
WE ARE SICKER WE USE MORE CARE.
THAT'S BECAUSE WE HAVE. HIGHER
PRICES FOR THE CARE AND
PRESCRIPTION DRUGS WE USE- WE
HAVE A PRICE PROBLEM IN THE
UNITED STATES BUT IT'S REALLY A
PRIVATE PRICE PROBLEM- HI.
THERE IT'S TRADED IN PRIVATE
INSURANCE WERE PRICE GROWTH HAS
BEEN FAR OUTPACING- MEDICARE.
AND MEDICAID OR MEDICARE
HEALTH- WE'RE PRICE INCREASES
HAVE BEEN MUCH MORE MODEST
ESTIMATES VERY GENERALLY
SPEAKING PRIVATE INSURERS PAY
ABOUT DOUBLE FOR HOT WHAT. TO
MAKE THIS A LITTLE MORE
TANGIBLE THE PRICES PAID BY
PRIVATE INSURERS FOR KNEE
REPLACEMENT HAS INCREASED FOR
EXAMPLE FROM UNDER TWENTY
THOUSAND DOLLARS IN TWO
THOUSAND THREE AT OVER THIRTY
FOUR THOUSAND TWENTY. AGAIN
THAT INFORMATION. WELL NOT AS
BIG A DRIVER OF HEALTH CARE
COST GROWTH IS PRICES- THE
ADMINISTRATIVE OVERHEAD IN OUR
HEALTHCARE SYSTEM IS ALSO GROWN
SIGNIFICANTLY OVER TIME AT THE
SHARE OF HEALTH SPENDING
DEVOTED TO INSURANCE OVERHEAD
TWO AND A HALF AN OF OVERALL
HEALTH SPENDING A DECADES AGO
TO OVER 7% THIS IS DAVID
MINISTER. WITH MEN DIFFERENT
ENSURE- ANDTHAT AND THAT COST
IS NOT JUST THE OVERHEAD AND
PROFIT FROM INSURERS THAT WE
SEE HERE BUT IT ALSO LEADS TO
HIGHER COSTS IN IN- BILLING
DEPARTMENTS AND HOSPITALS AND
PHYSICIAN OFFICES WHICH ARE IN
ADDITION- NUMBERS. OKAY NOW
ALTERNATELY WHY CARE ABOUT
HEALTHCARE COSTS IS BECAUSE
WHAT IT MEANS FOR AFFORDABILITY
FOR GOVERNMENT FOR BUSINESSES
AND OF COURSE FOR PATIENTS. A
RECENT SURVEY FROM THE
CALIFORNIA HEALTHCARE
FOUNDATION FOUND THAT 51% OF
CALIFORNIANS POST. SCRIPT HERE
IN THE LAST YEAR BECAUSE OF
CAUGHT. IN THE SAY THAT HAVE
THEIR HEALTHCARE GOT WORSE AS A
RESULT OF. IN THE NATIONAL WE
DID WITH EMPLOYER BASED
INSURANCE WE FOUND WIDESPREAD
AFFORDABILITY CHALLENGES. A 40%
HAD SOME TYPE OF PROBLEM
AFFORDING HEALTH CARE IN THE
LAST YEAR INCLUDING PROBLEMS
PAYING MEDICAL BILL PAYING FOR
DEDUCTIBLES. HANDLING COPAYS
FOR DRUG. OR PAYING THEIR THEIR
MONTH. AND THIS IS OF COURSE.
PROBLEM HEALTH DUE TO THE BUT
IT'S ALSO POINT TO REMEMBER
THAT THE INABILITY TO AFFORD
HEALTH CARE ALSO LEADS TO
FINANCIAL AND SECURITY MORE
GENERALLY MANY PEOPLE SAID THE
PROBLEM SUPPORTING CARE IN THE
LAST YEAR REPORTER PAINS OF
SACRIFICES SUCH AS PUTTING OFF
MAJOR PURCHASES CUTTING
SPENDING ON FOOD PULLED ITEMS
CAN CURRENT CARD DEBT-
INCREASING UP ALL OUR MISTER
THERE'S- I REMEMBER THIS IS.
JOB AND WITH AND IN MANY CASES
OF. SO THE QUESTION THINK UP
THE COST HEALTHCARE IT'S ALWAYS
IMPORTANT BRING BACK I THINK TO
WHAT IT MEANS FOR PEOPLE AND
WHAT IT MEANS PORTABILITY. BOTH
PEOPLE'S AND FOR PEOPLE'S
ECONOMIC SECURITY AT REDUCING
HEALTHCARE COSTS IS HARD
INVOLVES DIFFICULT TRADE
OFFICES I KNOW MEMBERS OF THIS
COMMITTEE- NO WELL. THAT IS
QUOTES CONSTANT TO AND SOME TO
REMEMBER. THANK QUESTIONS.
QUESTION. I APPRECIATE THIS IS
REALLY GREAT INFORMATION- I
KEEP CAN GOING BACK TO MANY
PEOPLE ARE SENIORS AND TRYING
TO FIGURE OUT THE AFFORDABILITY
OF CARE AND- TO THE
CONSEQUENCES AS WE TRY TO
ADJUST ANY THIS IS REALLY I
THINK THREATENING TO SOME SEEM.
IS THERE ANY. I KNOW WORKING ON
GAME DAYS DO THE YOU MIGHT HAVE
ON SENIORS I MEAN I DO KNOW IN
YOUR ORGANIZATION- DOING
PREVENTATIVE CARE AND SENIORS
ARE GOING. YOUR FACILITIES WE-
CANNOT. FORGET AS WE GET OLDER
WE STILL NEED PREVENTIVE CARE.
SO IS THERE ANYTHING THAT YOU
HAVE ALL ALONG WITH THE SENIOR
POPULATION- AT I SHOULD CLARIFY
ONE THING I'M FROM THE- KAISER
FAMILY FOUNDATION WHICH IS
TOTALLY SEPARATE FROM KAISER
PERMANENTE. GETS WHICH NAME SO
IT IS KIND BUT WERE A TOTALLY
SEPARATE ORGANIZATION BUT WE DO
HAVE QUITE A BIT OF DATA ON-
OUT OF POCKET COSTS FOR SENIORS
AND I'D BE HAPPY. TO ADD HERE-
AND I THINK YOU KNOW WE SAW.
FORGET UP TO CLEAN THE CONTACT
OF- THE DISCUSSIONS OF MEDICARE
FOR ALL WHICH WOULD EXPAND.
MEDICARE LIKE PROGRAM IT THREE
ONE THAT IN. THE CURRENT MEDIC
PRO INVOLVES SUBSTANTIAL COST
SUBSTANTIAL PREMIUMS-
SUBSTANTIAL OUT OF POCKET
COSTS- FOR SENIORS AND- YOU
KNOW MANY PEOPLE BUY
SUPPLEMENTAL INSURANCE BECAUSE
THERE'S A LOT. OF MEDICARE
DOESN'T FOR SO HERE. WE HAVE A
LOT OF DEBT ON ON THE- BURDEN.
SENIOR BE HAPPENING. THANK. A
COUPLE COUPLE IN FIRST UP MUCH
APPRECIATE THE IN IS A AND
EVERY TIME YOU SPEAKER HERE
SPEAK I LEARN SOMETHING NEW-
AND- BUT A COUPLE COUPLE SHINS-
IN YOUR WHEN YOUR FOR YOUR
SECOND BY- YOU TALK TO. WITH
ONE OF THE EARLY FIGHTS YOU
TALKED ABOUT DRUGS BEING NINE
PERCENT- I'VE HEARD OTHER WORDS
WE HAD A HEARING HERE THAT 9%
SO. WHAT IS AT 9% IS THAT WITH
THE CONSUMERS AND AT THE AT THE
PHARMACY BECAUSE- I'LL JUST LAY
IT OUT THERE. I DON'T BELIEVE
THAT INCLUDES WHAT WHAT-
AMATORY SURGERY CENTER SPAN OR
HOSPITALS OR- OTHERS OTHER
KINDS OF OUTPATIENT FACILITIES
SO IS THAT A FAIR
CHARACTERIZATION NO THAT'S A
VERY FAIR CARE PATIENTS OF
DIAPERS REPRESENTS DREW. SPEND
AT RETAIL PHARMACY BOTH WHAT
CONSUMERS BàN. SHIRTS OR AT
MEDICARE MEDICAID I STAND IT
DOES NOT INCLUDE- AS YOU SAID
YOUR DRUGS MR PHYSICIAN OFF IS
JALAL. HOSPITAL SO YOU KNOW
THAT'S- THE YOU KNOW COULD BE
AS AS DEL. NUMBER AND IN IN
THOSE DRUG I MEAN. CONSUMERS
DON'T MESS SEE THE COST OF SOME
OF DRUGS DIRECTLY THEY SHOW UP
IN A HOSPITAL BILL- BUT THEY
THEY CERTAINLY REPRESENT-
SUBSTANTIAL EXPENSE. YES THE
NUMBER WE HAD HEARD WAS CLOSED
ABOUT CLOSE TO TWENTY WHICH IS
BUT DOUBLE YEAH THAT'S RIGHT AS
ONE OF THAT THAT YEAH THAT IS
NOT NINE PERCENT. FOR OVERALL
AND I THINK THAT'S AN IMPORTANT
CARES THAT CERTAINLY I THINK
THE INDUSTRY WOULD LIKE TO
THINK IT'S A NINETY CENT. BUT
THE REALITY IS IT'S MUCH MORE
IT'S ALSO GREAT IS JUST PUT IN
DIFFERENT PLACES SO- WE WERE
TALKING ABOUT THE COPS YOU KNOW
HOW WE AND SEVEN. DIRECTION
SPENDING THE RATE INCREASE WAS
HIGHER HIS BEEN YOU KNOW KIND
OF DAHLE COST AVERAGE IT FOR
THE FACT THAT MAYBE THINGS WERE
REALLY CHEAP IN NINETEEN
SEVENTY. VERSES NOW WE MRI EYES
AND- CAP GAINS IN NINETEEN
SEVENTY SO. DATA EVER BEEN I
STILL. THE REAL. NUMBER IS
PERSISTENT. BECAUSE MY IN AS A
KID I REMEMBER. MY FOLKS EVER
COMPLAINING ABOUT. DO AND I YOU
KNOW AS A KID I REMEMBER MANY
TIMES BEING AN EMERGENCY ROOMS
FOR STUPID THINGS. THAT I DID.
AND IT BUT I DON'T EVER
REMEMBER THAT BEING AN ISSUE
AND- AND- YEAH I KNOW NOT WHAT
I WAS SAID I WAS FRANKLY KIDS
TEND TO I WAS NOT STARTING
HEALTH POLICY. BUT THERE ARE- I
MEAN THE SEVENTIES WERE. WITH
VERY HIGH INFLATION RIGHT SO
JUST JUST GENERALLY SO A DOUBLE
DIGIT INCREASE IN HEALTHCARE
COSTS DIDN'T QUITE FEEL LIKE
THE SAME WAY IT DID DID TODAY.
YEAH INSURANCE LOOKED VERY
DIFFERENT THAN- YOU KNOW PEOPLE
DIDN'T FACE BIG DEDUCTIBLES- SO
FOR A FROM A FAMILY'S
PERSPECTIVE- THE OUT OF POCKET
COSTS SHOULDN'T FEEL LIKE SUCH
A BURDEN AS AS IT DID TODAY- IN
IN SINCE THEN HEALTHCARE COSTS
HAVE RISEN DRAMATICALLY FASTER
THAN PEOPLE'S WAGES. SO YOU
KNOW WHEN WE TALK ABOUT HEALTH
CARE COST SLOWING DOWN- IF WE
IS ARE SLOWING DOWN EVEN MORE-
IT DOESN'T NECESSARILY FEEL
GOOD GUY TO A FAMILY- NOW I
THINK THE PARTY QUESTIONS IS.
KIND OF WHAT WHAT WE GET FOR
THIS EXTRA MONEY- OF EUROPE WE
DIDN'T HAVE MRI BACK THEN-
RIGHT NOW WITH ALL THE SPEND AN
MRI TODAY. WHILE NOT CLEAR. BUT
A LOT OF CASES WHERE WE GET
BETTER AT CARE TODAY WE YOU
KNOW. OF DRY THAT PEOPLE'S
LIVES IN SOME CASES SAVE THEIR
LIVES- SO WE CERTAINLY ARE
GETTING MORE HEALTH HEALTH CARE
TODAY- BUT BUT THE BUT THE BIG.
THERE IS EVEN HEALTHCARE WE GOT
BACK THAT NOW COST A WHOLE LOT
MORE. AND I GUESS THE FINAL IS
JUST MORE OF A POINT I THINK
THAN A QUESTION I MEAN I
REPRESENT EUREKA AND THAT SITE
THAT'S PROBABLY NO ACCIDENT
THAT SOME ICE ON THAT SIDE
THEY'RE- IT IS PRETTY. ACCURATE
SEE THAT. WE'RE PAYING 50%
HIGHER PREMIUM 50% HIGHER
PREMIUM THAN SOUTHERN
CALIFORNIA. AND WHILE YOU MAY.
HOSPITAL CONSOLIDATION. AS
BEING A PART OF THAT- I THINK
THAT THERE'S ALSO I THINK
THERE'S AFFILIATED MEDICAL
GROUPS THAT DRIVE RATES AS
WELL. WHICH BECOME A PART OF
PART OF THAT A PART OF THAT
FACTOR AS WELL- AND THEN YOU
GET TO KNOW YOU GET UP INTO
YOUR RIG. AND THEY'RE THEY'RE
SIMPLY. A LOT. FOR BY. BUT A
LOT. OF CHOICE THERE AND I WILL
I WILL YOU KNOW. TRUST ME AT.
FORTY NINE HUNDRED DOLLARS IN
EUREKA VERSUS FORTY SEVEN
DOLLARS AND CISCO. A LOT OF.
WAIT TO SEE YOU MAKE AN
FRANCISCO TO THE BY. IN IN RE.
CALIFORNIA IS REALLY BIG AND
PAINFUL FOR A OF PEOPLE WHO
ALSO HAVE TO TRAVEL LONG
DISTANCES TO GET. A LOT OF
SPECIALTY CARE SOMETIMES STUFF.
SO APPRECIATE- ONCE AGAIN IT
WAS MORE OF A POINT IN
EDITORIAL- BUT- BUT IT IS THE
STRUGGLE THAT THAT WE FACE
SENATE'S ONE OF THE THINGS THAT
DRIVES ME TO. TO LOOK AT HOW DO
WE MAKE THINGS MORE PORTABLE
PEOPLE IT BECAUSE IT'S CLEARLY
NOT IN IN IN PARTS OF OUR STATE
HI I WOULD SAY HAVEN'T I MEAN
EUREKA STANDS OUT YOUR
PERSPECTIVE OF IT. HUNTING
PARTY DISTRICT BUT THE- THE
PROP IN IN RURAL THE COST IN
RURAL AREAS ARE ARECOMPLICATED
YOU KNOW ON THE ONE HAND.
SPITTLE ISSUE. WHERE THERE'S
NOT A LOT OF THEY HAVE LEVERAGE
TO TRY CHARGE HIGHER PRICES AB
IT'S NOT NECESSARILY A THE CASE
THAT THE PROVIDERS ARE YOU KNOW
FLOOD WITH MONEY EITHER SO IT'S
YOU KNOW IT'S A TOUGH IT'S A
TOUGH PROBLEM TO SOLVE. WELL
THANK YOU VERY MUCH AND IF
THERE ISN'T. QUESTIONS WE'RE
GOING TO GO AHEAD MOVEMENT THEY
CRIED THANK YOU REALLY
APPRECIATE IT SO. OUR OUR NEXT
SPEAKER IS JAMIE KING. AND TALK
ENTREE AND APPROACHES TO HEALTH
CARE INDUSTRY CONSOLIDATION
SHE'S AN ASSOCIATE DEAN. I'M BY
ON M. GREGORY IN BUSINESS WHAT
THE UNIVERSITY CALIFORNIA
HASTINGS COLLEGE OF LAW. THANK
YOU. MORNING. WE'LL GET MORE
THANK YOU SO MUCH FOR THE OP TO
BE I'M REALLY EXCITED SO I
ALWAYS LIKE TO FOLLOW BECAUSE
HE'S ME OFF REALLY WELL BUT DO
NOT IN ORDER TO SET THE STAGE A
LITTLE BIT MORE AND WANT YOU TO
THINK ABOUT IT WOULD GIVE YOU A
COMPARISON OF OUR- PLANS WOULD
COST THEY HAD INCREASED AT THE
SAME RATE BETTER HEALTH CARE.
WOULD TODAY FORTY EIGHT DOLLARS
IF THEY INCREASE AT THE SAME
PRICE SAME RATE AS HEALTH CARE.
A DOZEN EGGS FIFTY FIVE
DOLLARS. AND A GALLON OF MILK
AND NOT A GRASS FED ORGANIC
GALLON OF MILK JUST A REGULAR
GALLON OF MILK. ACOSTA AND
THIRTY FOUR DOLLARS RIGHT. AND
SO WHAT THIS TELLS US IS THERE
SOMETHING REALLY HAPPENING WITH
OUR CARE PRICES AND IT'S VERY
DIFFERENT THAN WHAT'S HAPPENING
IN OTHER NATIONS. AREAS THAT
CAN SEE. I CAN SPEND ON OUR
TWICE AS MUCH AND SOMETIME TWO
AND A HALF TIMES AS MUCH WHAT
PEOPLE AND COMPARED IT NATION'S
ALSO IS FOR THE SAME HEALTH
CARE GOODS AND SERVICES. ACES
ARE THE PRIMARY REASON WHY THE
US SPENDS MORE ON HEALTHCARE
THAN IN ANY OTHER COUNTRY. AND
THE QUESTION IS WHY. ME SO I'M
GONNA TALK IN THE IN THE REALM
OF COMPETITION THERE ARE OTHER
THINGS THAT HAVE HAPPENED BUT
I'M GONNA TALK PRETTY
EXCLUSIVELY ABOUT CONSOLIDATION
COMPETITION BECAUSE IT IS THE
BIGGEST DRIVER OF THE PROBLEM
AND THERE'S A FEW THINGS THAT
WE FAIL TO DO AS A NATION.
FAILED TO. THE S. AND LIMóN
SPUR FREE MARKET ESPECIALLY
RELATED AROUND PRICE
TRANSPARENCY WE FAIL TO PROTECT
COMPETITION AND RIGOROUSLY
ENFORCE OUR ANTI TRUST LAWS.
WHEN WE TO REGULATE TO CONTROL
PRICES WHEN COMPETITION NO
LONGER EXISTED. SO LET'S START
WITH THE FAILURE TO PROTECT
PRICE TRANSPARENCY AS MANY OF
YOU KNOW WE'RE TALKING ABOUT
SURPRISE BILLING- THROUGHOUT
THE NATION. TWO THIRDS OF
AMERICANS DON'T KNOW THE PRICE
OF THEIR HEALTHCARE THEY CAN'T
PLAN FOR IT THEY CAN'T. GET
AROUND IT THIS THAT THE PRICES
ARE NOT OEN AND AVAILABLE TO
THEM. THE MOST PART FURTHERMORE
THIS IS BASED THROUGHOUT THE
UNITED STATES A CATALYST FOR
PAYMENT REFORM. AT PUTS OUT A
PRICE TRANSPARENCY REPORT CARD
AND WHAT YOU CAN SEE IT IS THAT
THE MAJORITY OF STATES
INCLUDING CALIFORNIA GET A
FAILING GRADE ON PROVIDING
PRICED. PARENTS DO TO THEIR
CONSUMERS. BUT THE POINT I MEAN
TO YOU TODAY ABOUT PRIDE. ABOUT
PRICE TRENDS. ARE PER PARENTS
STRAWBERRY. IS REALLY MARKET
POWER GLORY ALL. IT'S ABOUT THE
BILL. I PROVIDER OR- AND SHE
ORGAN WITH A LOT OF MARKET
POWER TO KEEP THOSE PRICES
SECRET TO INCLUDE GAG CLAUSES
IN THEIR CONTRACTS TO KEEP THEM
SECRET AS WE SAW IN THE CENTER
CASE BUT ALSO TO KEEP THEM
SECRET USE OF TRADE SECRETS
PROTECTIONS. I MIGHT ADD
THEY'RE NOT SHALL AND I DON'T
THINK THAT THEY WOULD ALWAYS
STAND UP IN COURT BUT THE
ANOTHER BEING USE AND SO THE
QUESTION IS HOW DO WE GET THIS
MUCH MARKET POWER WHAT YOU CAN
SEE ON THIS SLIDE IF YOU CAN
READ IT HOPEFULLY YOU HAVE IT
IN YOUR NOTES. IS THE-
BASICALLY FROM. NINETY ONE TO
TWENTY ELEVEN. OVER TWENTY
YEARS. THE FTC DIDN'T WIN A
SINGLE HOSPITAL MERGER CASE. HE
DIDN'T WIN ONE AND IT COULD BE
SICKLY COMES DOWN TO WHAT WAS A
MISMATCH BETWEEN OUR ANY TRUST
LAWS IN THE WAY THAT WE WERE
LOOKING AT THEM WHAT WAS REALLY
HAPPENING IN THE HOSPITAL
MARKET BUT WHAT IT MEANT WAS
THE FTC STOP BRING. KEITH
SOURCES FOR THE- BUT THE SECOND
THING THAT HAPPENED AS A RESULT
OF THAT IS WE ENDED UP WITH
HEALTH CARE MERGER MANIA
EVERYBODY STARTED CONSOLIDATING
WITH EVERYBODY ELSE AND SO WE
SAW HOSPITAL'S MERGING WITH
OTHER SPITTLE MERGING WITH
OTHER HOSPITALS FORMING HEALTH
SYSTEMS AND THEN WE THOSE
HEALTH SYSTEM STARTING TO
ENGAGE IN VERTICAL MERGERS
WHERE THEY WERE ACQUIRED
FISHING GROUPS AND CLINICS AND
STARTING TING. I KIND OF
VERTICAL LINE AND NOW WHAT'S
GROWTH ACROSS MARKET MERGERS
WHERE. YOU KNOW HEALTHCARE
SYSTEM IN SAID CISCO OR
NORTHERN CALIFORNIA STARTS TO
ACQUIRE KEY PROVIDER
ORGANIZATIONS ARE KEY HOSPITALS
IN SOUTHERN CALIFORNIA. AND
WHAT W KNOW ABOUT ALL OF THIS
CONSOLIDATION FROM THE DATA. IS
IT THE PRICES GO UP AND THE
QUALITY STAYS THE SAME OR IN
SOME CASES GOES DOWN. SELECT
TELL YOU A LITTLE BIT MORE
ABOUT THAT. WITH HORIZONTAL THE
DATA IS VERY CLEAR WE SEE
INCREASE PRICES ACROSS THE
BOARD OF TWENTY 2404% FOLLOWING
THE MERGER. WE SEE REDUCE
QUALITY THESE MURDERS ARE
STRONGLY ASSOCIATED WITH
REDUCTIONS IN QUALITY INCLUDING
IN. HIGHER QUALITY. I'M TO SEE
A PREMIUMS OF THIS IF DIRECTLY
WHAT CONSUMERS PAY FOR THEIR
PRICE FOR THEIR PREMIUMS ON THE
ACA MARKET. AND ALSO REDUCTIONS
IN WAGE GROWTH FOR NURSES AND
ENVIRONMENT THIS WORKING IN
THESE ORGANIZATIONS. FOR A
VERTICAL MERGERS WE ALSO SEE
HIGHER PRICES WE SEE HIGHER
PHYSICIAN PRICES AFTER
ACQUISITION HIGHER CLINIC
PRICES SOMETIMES AS MUCH AS
FORTY SEVEN PERCENT. AFTER
ACQUISITION WE ALSO SEE THE
WIRING HOSPITAL OUR HOSPITAL
SYSTEM ALSO INCREASED THEIR
PRICES AS FOLLOWING AN
ACQUISITION OF A KEY PHYSICIAN
GROUP. AND REALLY HERE IS WE
SEE LIVE TO NO. AND WHAT THAT
REALLY MATTERS IS SOMETIMES
THESE VERTICAL MERGERS ARE
JUSTIFIED ON THE BASIS OF THEIR
GOING TO PROVIDE MORE
EFFICIENCIES WHICH MEANS IS
SUPPOSED TO MEAN LOWER PRICES
THEY'RE SUPPOSED TO GO ON.
DON'T SEE THAT. AND WE- AND
JUST. MICHAEL IMPROVEMENT GOING
TO STREAMLINE ALL THESE PROCEED
IT'S GONNA BETTER FOR EVERY.
BUT WHAT THE DATA TELLS US AS
WE DON'T SEE THAT HAPPENING WE
ONLY SEE HIGHER PRICES AND
EITHER THE SAME OR NAY QUALITY
IMPROVEMENT. THE OTHER THINK
IT'S REALLY IMPORTANT TO FOCUS
ON WITH VERTICAL MERGERS. IS IT
THE IN LIKELY TO TRIGGER. ANY
VIEW IF YOU'RE ACQUIRING A
PHYSICIAN GROUP IT DOESN'T AND
TIMES IT THE THRESHOLD FOR THE
HEART DINO ELLING SO THEY DON'T
IT OFTEN DOESN'T. QUITE BY TO
HAVE THIS TO THE FEDERAL. IN
CALIFORNIA SO THE FLY BELOW ANY
TRUST RATE ARE A LOT OF TIMES
AND THIS CAN LEAD TO WHAT'S
KNOWN AS STEP. VALIDATION WHERE
GROUPS ARE AMASSING MARKET
WITHOUT A LOT OF ANTI TRUST AND
NOTICE OF IT. SO LET ME ALSO
TALK A LITTLE BIT ABOUT CROSS
MARKET MERGERS BECAUSE THE BEEN
GROWING A LOT IN NUMBER AND
HISTORICALLY INTERESTING FORCES
HAVE THOUGHT THAT THERE'S NO
POSSIBLE WAY THAT ACROSS MARKET
MURDER COULD. PRICE INCREASES
OR ANY COMPETITOR THEY HAVE
PAID LITTLE TO NO ATTENTION TO
THEM. BUT WHAT THE DATA TELLS
US IS THAT UNDERSTANDING IS NOT
QUITE ACCURATE OR AT LEAST IT
SUGGESTED THAT IT'S NOT
ACCURATE AND WELL. BEING
FOLLOWING THESE MARKET MEASURES
IS INCREASE PRICES SEVENTY
SEVEN. 9% FOR THE HOUSE THAT
ARE REQUIRED. LET'S IS THAT
THERE'S SOMETHING GOING ON
HERE. MORE DATA AND MARK ON
THIS BUT THERE'S DEFINITELY
HAPPENING THERE THAT WE SHOULD
BE PAYING INTENT. THE OTHER
THING REALLY SAYING IS WE- THE
FACT ON. IN MARK WHERE THE
INDEPENDENT. ACQUIRED INDEED.
QUITE BUT IT PASSED ALSO FOUND
IN THE MARK TO THEN IN THEIR
PRICE I AND SO HE'S MERGERS ARE
CAUSING PRICES OCCUR THE BOARD
NOT IN JUST A AFFECTED HOSPITAL
AND OBVIOUSLY NEED MORE DATE
THAT BUT IT IS SOMETHING THAT
HAS BEEN FOUND. SO INCREASED
WHEN HE HAS BEEN INCREASING IN
CONSOLIDATION FAIRLY
CONSISTENTLY AND YOU CAN WE
WERE SORT OF MODERATELY
CONSOLIDATED IN NORTHERN
CALIFORNIA IN TWO THOUSAND AND
TEN BUT BY TWENTY SIXTEEN WE
WERE VERY SIGNIFICANTLY AND
HIGHLY CONSOLIDATED IN NORTHERN
CALIFORNIA. NO THAT NO AS LARRY
POINTED OUT BEFORE THIS LEADS
TO ANY AN INCREASE PRICE
DIFFERENTIAL BETWEEN NORTHERN
AND SOUTHERN CALIFORNIA ON
AVERAGE OF ABOUT THIRTY THREE
PERCENT. 3% HIGHER PRICES IN
NORTHERN CALIFORNIA- IN LARGE
PART DUE TO THIS CONSOLIDATION.
FURTHERMORE WE SEE THAT THE
DRIVER OF PRICE IS OUR
HOSPITAL. IN A LARGE LARGEST.
AND SO WE WERE THE HIGHER A
CORRELATED ASPECT AS WELL AND
SO WE'RE ALL OF THIS LEADS US
HE IS IT OVERALL AS A NATION
NINE OVER 90% OF OUR HOSPITAL
GETS ARE HIGHLY CONCENTRATED.
LOS PERCENT ORANGE MARKETS ARE
HIGHLY OR SUPER CONCENTRATED
BUT IT DOESN'T STOP WITH JUST
INSURERS AND HOSPITALS RIGHT
OUR SPECIALIST POSITIONS ARE
OVER 60% HIGHLY OR SUPER
CONCENTRATED. AND THE NUMBER
AND THE- TIONS THAT ARE
BECOMING HIGHLY OR CONSUMER
CONSOLIDATED IS ALSO GOING UP
AND THAT'S REALLY IMPORTANT
BECAUSE THEY MAKE A LOT OF
REFERRALS AND SO THEY BECOME
THAT THE TARGET FOR A LOT OF
WHAT'S- SO THE QUESTION NOW IS
WHAT. TIME FIRST HAVE TO GET
YEAH AND SO I REALLY APPLY THE
EFFORT TO CREATE AN ALL HERE
CLAIMS DATABASE IN CALIFORNIA I
THINK IT'S EXTRA IMPORT TALK A
LITTLE MORE ABOUT THAT SECOND
WE NEED TO ENHANCE OUR ANY INFO
MEN. AND WE NEED. A PLACE FOR
COMPOSITION AND GET OF THE IS
SO LET'S START WITH UP HERE
CLAIMS DATA. SO ORIGINALLY ALL
CLAIMS DATABASE WHERE DOES TO
PER. BETTER IN. TO CONSUMERS TO
HELP THEM MORE EFFECTIVELY SHOP
FOR HIGH VALUE SERVICES. WILL
WE SOON FOUND OUT WAS THAT THIS
WAS WAY MORE USE FOR POLICY IN
ENFORCEMENT. AND THE REALITY IS
THE STATE OF CAN PROVIDE VERY
ACCURATE INFORMATION ON THE
FUNCTIONING OF OUR MARKET THEY
CAN TELL US WHAT'S GOING RIGHT
AND WHAT'S WRONG. THE FIRM.
MERGER ASSIST VIEW AS WE'VE
SEEN IN MASSACHUSETTS HEALTH
POLICY AND USE THEIR DATA VERY
DELETED CHALLENGE MURDERS. THE
AND IF I. THE COST TRACTATES. A
NATION. TRACK UTILIZATION AND
PRICE TRENDS. AND HELP IDENTIFY
THE USE OF LOW VALUE SERVICES
SO THAT WE CAN HELP PREVENT
THAT AS WELL. THE WHOLE HOST OF
THINGS THAT THE STATE CAN BE
USED FOR I THINK IT WONDER
WE'RE GOING AT IT. NOW THAT.
CAN CONSERVE SO ONE OF THE
FIRST. NEED TO DO YOU AS A
STATE. IT IMPROVE OUR PRIMA
ISLAND WE NEED TO PREVENT THIS
KIND OF CONSOLIDATION BEFORE IT
HAPPENS BUT IN ORDER TO DO THAT
WE HAVE BETTER NOTIFICATION OF
MERGERS AND HEALTH CARE
HAPPENING AND NOT JUST LITTLE
MERGERS BRIDGES ACROSS THE
BOARD SO WHETHER IT'S A OF A
POSITION OR SOMETHING ELSE.
OVERSIGHT BRED SO BETTER VIEW
PROCEDURES AND THINGS LIKE THAT
BUT THAT CAN BE VERY EFFECTIVE
IT JUST PREVENTING THE
CONSOLIDATION ANYMORE
CONSOLIDATION BEFORE IT
HAPPENS. THE SECOND IS. CLEARLY
NOT GONNA BE ABLE TO PREVENT
EVERY MERGER FROM HAPPENING IN
THIS SPACE GOING FORWARD BUT
THERE ARE THINGS WE CAN DO WHEN
EMERGING. GO THROUGH TO GRANT
OVERSIGHT AND ENSURE THAT SOME
OF THE NEGATIVE EFFECTS OR SEEN
HAPPEN. I CAN BE YOU. THE USE
OF CONSENT PLEASE WHICH IS VERY
AFFECT. REAL LET. OF DURING
MESSAGES YOU PM SEE IT HIGH
RECENT. AND THE C. H. DID MANY
CASE HE CAL. AND SO SOME OF THE
THINGS THAT STATES ARE LOOKING
AT AS A PART OF CONSENT AGREES
AND BOB PERRANCE AND CATHERINE
GOOD X. AND SOME OTHER CALL
RISE MURRAY OTHER COLLEGE. PUT
OUT A PAPER THAT A TYPE. OF
CONSENT DECREE. AND WE FOUND
THAT STATES FOR YOU THESE
CONSENT DECREES TO IMPOSE AN-
ACCESS TO BINDING ARBITRATION
TO PUT PRICE CAPS IN PRICE.
PREVENT PRICE INCREASES OVER A
CERTAIN PER INCH TO. ANY
COMPETITIVE CONTRACT CLAUSES IN
THE CONTRACT OF THESE ENTITIES
OR WHETHER THAT WAS FAVORITE
NEED CLAUSES THE GAG CLAUSES I
WAS PREVIOUSLY TALKING ABOUT.
CHOIR AND THE- CITY FROM INFO
NON CAN CLAUSE IN THIS HE BE
VERY IMPORTANT. FOR EMPLOYEES
AND ALLOWING COMPETITION HE
SPACES AND THEY CAN BE USED TO
ENSURE ACCESS TO LOW INCOME
INDIVIDUALS. FINALLY WE NEED TO
CONTINUE CHALLENGING ANY
COMPETITIVE BEHAVIOR AT THE
CALIFORNIA AG JUST SUCCESSFULLY
DID IN THE SUTTER CASE AND SO
WE NEED TO KEEP BRINGING THOSE
CHALLENGES TO POST MERGER
ENTITIES BETTERING USING THEIR
MARKET POWER IN ANY COMPETITIVE
WAYS. SEEN AS BOTH INSIDE AND
IN EACH CASE AND SOME OF THE
TERMS OF THE SETTLEMENTS FROM
CASES I JUST WANT TO HIGHLIGHT
SO FIRST AND MOST PROHIBITS ALL
OR NOTHING I'M TRACKING FROM.
GOING THE LARGE HEALTH CARE
SYSTEMS FROM NEGOTIATING AS ONE
WHOLE AND REQUIRING THAT YOU
TAKE THE END HIGHER DHEA.
ENTITY IN THE CONTRACT OR NINE
OF. THE VERY COMPELLING IN
TERMS OF HAVING A PRICE IT'S A
LETTING IT UP THE OPTION
ALTHOUGH I DON'T THINK IT'S AT.
SO USE IT IS MEANS TO PER ANY
THE USER COMPETITOR CONTRACT
TERMS LIKE ANTI TEARING AN ANTI
STEERING WHERE IT PROHIBITS AN
INSURANCE COMPANY FROM
FIGHTING. IT'S IN ROLE TO
HIGHER VALUE PROVIDERS A LOT OF
TIME THESE CONTRACTS PREVENT
THEM FROM SIGNALING WHO ARE
HIGHER VALUE LOWER. FIGHTERS
INTO PROHIBIT THOSE TERMS. YOU
CAN ACQUIRE THE BEST OF. ITS OR
ABANDONMENT OF THE MERGER ALL
TOGETHER. AND THEY CAN ALSO
PROVIDE MONEY RELIEF AND IN THE
CENTER CASE WHICH- I BELIEVE
THEY JUST DELAYED THE REPORTING
OF THAT SETTLEMENT. BUT IS
SUPPOSED TO BE AROUND FIVE
HUNDRED AND SEVENTY FIVE
MILLION DOLLARS SO. ALL OF
THESE THINGS ARE GOOD THINGS
THAT CAN COME OUT OF THESE
CASES. BUT THE POINT I WANT TO
MEET THAT'S REALLY IMPORTANT
HIS VICTORIES IN LITIGATION
ARE. THEY'RE GREAT THEY'RE
REALLY IMPORTANT BUT THEY ARE
NOT THE ONLY THING WE CANNOT
DECLARE VICTORY AT THE THOUGHT
R. K. AND WALK AWAY FROM WHAT
WE SEE IN CALIFORNIA. IT IS. WE
TEND. PROP IN ONE. IN WHAT T.
REX. WHAT WE'RE LOOKING FOR IS
THAT WE WANT TO DO THAT IN
CASES WHERE THINGS GET REALLY
BAD BUT YOU ALSO NEED TO HAVE
THINGS THAT ADDRESS THE
ENTIRETY. OF THE STATE AND- IF
YOU THINK HEALTH EDUCATION AS
TENDING TO ONE PLANT. TENDS THE
TIRE FARM YOU WANT YOUR GET THE
ENTIRE FARM ENTRY WELL SO I
THINK IN THAT. CASE WE LOOKING.
FROM THE WE DO THINGS
LITIGATION WE NEED TO LOOK
TOWARDS LEGISLATION. AND WHEN
WE LOOK ACROSS ALL FIFTY STATES
WHAT WE SEE IS THAT STATES ARE.
KIND OF COMBINING THERE.
EFFORTS ON THE AND LEGISLATIVE
SIDE INTO THREE BUCKETS SO THE
FIRST IS TARGETING VERY
SPECIFIC MARKET IMPERFECTIONS
AND THESE ARE.LIKE THE ANY
COMPETITOR CONTRACT PROHIBITING
THOSE. WORD AN- THINGS LIKE
THAT AND THEN ALSO THINGS LIKE
SURPRISE BILLING LAWS RIGHT IN
TRYING TO. GET VERY. SICK AND
IF YOU. GET BUT ALSO TO IMPROVE
MARKET FUNCTION AND THIS IS BY
INTRODUCED PRICED. INITIATIVES
ALL HERE CLAIMS DATABASES AND
ALSO ENHANCING THEIR MERGER
REVIEW SO IN CALIFORNIA. OUR
MERGER REVIEW IN HEALTH CARE IS
SORT OF DIVIDED UP DEPENDING ON
THE ENTITIES THAT ARE MERGING.
IF IT'S NONPROFIT HOSPITALS THE
HE LOOKS AT IT IF IT'S DOMESTIC
INSURERS CITY I LOOKED AT IT IF
IT HEALTH SERVICE HEALTH
SERVICE PLAN CMHC LOOKED AT IT.
BUT WHAT WE SEE IS THERE. WE
DON'T HAVE ANYBODY THAT LOOKS
SPECIFICALLY A FOR PROFIT
MERGERS WE DON'T HAVE ANYBODY
THAT LOOKS. AT WHEN. HEALTH.
THERE IS A BEFORE. PROVIDE AND
THE WHERE WE'RE SEEING SOME AND
WE DON'T HAVE A- NOTICE OF
THOSE THINGS. AND SO SOMETHING
FOR CALIFORNIA COULD LOOK AT IN
ENHANCING ITS MERGER REVIEW
PROCESS WOULD BE TO REQUIRE
NOTIFICATION TO THE STATE AG AS
ALL RIGHT- RHODE ISLAND AND
HAWAII HAVE DONE. THEY REQUIRE
NOTIFICATION OF ALL TYPES OF
HOSPITAL MERGERS. AND THEN IS.
IN CONNECTICUT WASHINGTON A
MASSACHUSETTS REQUIRE
NOTIFICATION OF ANY MATERIAL
CHANGE TO THIS INCLUDES A
MERGER AND ACQUISITION BUT IT
ALSO INCLUDES. THOSE CONTRACT
AFFILIATIONS WHICH ARE JUST
SHORT OF A MERGER BUT THEY ARE
REALLY IMPORTANT FOR
NEGOTIATING PURPOSES AND I
THINK THAT'S REALLY IMPORTANT
FOR US TO BE PAYING ATTENTION
TO. THE OTHER THING THAT WE
COULD DO IS WHAT RHODE ISLAND
AND HAWAII HAVE ALSO DONE TO
REQUIRE BOTH NOTIFICATION ALSO
APPROVAL OF SOME STATE ENTITY
FOR CERTAIN TYPES OF MERGE THEY
REQUIRE FOR ALL TYPES OF
HOSPITAL MERGERS BUT WE COULD
REQUIRE IT- FOR THE GOLD MIND
HOSPITALS. AT THAT AND THEN
FINALLY WE NEED TO BE THINKING
ABOUT MARKET REGULATION IN
AREAS WHERE MARKET HAS NOT-
WE'RE COMPETITION NO LONGER
EXISTS AND YOU COULD THINK
ABOUT RATE REVIEW AS THEY
HAPPEN RHODE ISLAND. RATE CAPS
FOR WRITERS. THAT IS SOMETHING
OF INTEREST I INTRODUCING MORE
COMPETITION THROUGH A PUBLIC
OPTION OR- DIRECT CONTROLLING
PRICES THREE SINGLE PAYER. SO
OPTIONS CONSIDERATION WOULD BE
TO REQUIRE AG NOTIFICATION AND
APPROVAL OF ALL HEALTH CARE
CONSOLIDATION ACTIVITY- BUT YOU
COULD TEAR IT BY LEVEL OF
IMPORTANCE ARE POTENTIAL RISK
TO COMPETITION. AMENDING THE
STATE ANTI TRUST LAW THE CARD
RIGHT ACT TO ALLOW THE AG TO
CHALLENGE MURDERS IN STATE
COURT UNDER STATE LAW AND THEN
STRENGTHENING A POST MERGER
REVIEW THIRTY THREE YEAR
CONSENT DECREE- MONITOR THINGS
LIKE THAT. CALIFORNIA HAS LET.
THEIR PRICES OVERALL LITIGATION
LIKE THIS SUTTER HEALTH CASE
ALONE CANNOT MITIGATE THE
EFFECTS OF ANY COMPETITIVE
CONSOLIDATION. AND INCENTIVES
LIKE THE INITIATIVES LIKE THE
CREATION OF A P. CD'S AND
INCREASED- CALIFORNIA AG PRE
MERGER OVERSIGHT WILL HELP
LIMIT CONSOLIDATION ACROSS THE
BOARD. THANK YOU WELCOME.
THAT'S GREAT THANKS VERY MUCH
YEAH QUESTIONS AND- QUESTION
COUPLE QUESTIONS QUESTIONS YOU
TALKED ABOUT THE REASON THAT
HEALTHCARE COSTS ARE SO HIGH IS
HIS AT HIS PRICES SO- ONE OF
THE CHALLENGES IS OF THE
CONSUMER REALLY CAN'T FIND THE
PURPOSES RIGHT- AS A WHEN I DID
A- TREATMENT PLAN FOR A PATIENT
I WAS VERY. VERY CONSCIOUS
ABOUT OKAY IS WHAT IT'S GOING
TO COST THIS IS WHAT YOUR
INSURANCE IN A COVER SO MY
PATIENTS NEW UP FRONT WHAT YEAH
WHAT. THEIR OUT OF POCKET COSTS
IS GOING TO BE THAT DOES NOT
HOP HAPPEN WITH WITH MEDICINE
AT ALL I CAN'T REMEMBER. HER
BEING IN A DOCTOR'S OFFICE FOR
THE DOCTOR SAID YEAH THAT'S
GOING TO BE THIS OR WHAT. NO
VIDAK: OFTEN NOW THEY ARE YEAH
THE END AND WAS BECAUSE OF
THEIR THEIR AND SO I HAD OLDER
SO. RECENTLY I'M STILL WAITING
THE BILLS TO COME IN BY IDEA
WITH ANYTHING IT'S GOING TO
COST- I DIDN'T KNOW THAT I WAS
AT IN IT. IN THE COST. YES AND
I'M- SURPRISED BUT WE WERE GET
IT WE GET THEM IN CALIFORNIA
BUT EVEN CHANGES TO THINGS LIKE
SURPRISE BILLING. HAS HAD AS
YOU SEE ON A NATIONAL LEVEL HAS
LED TO ALL SORTS OF- THE WORLD
WILL COME TO. AND SORT OF THING
AND THAT'S BEEN. THAT'S OF THAT
CHANNEL SHOPPER CONSUMERS. WHEN
YOU TALK ABOUT- SO. SEE TALK
ABOUT PRICE INCREASES. THAT
DOESN'T NECESSARILY. THERE
NECESSARILY REFLECT THE
NEGOTIATED RATE. PLAN SO WE SEE
THE PRICE GOING UP. BY THE
PLANS ARE ALSO NEGOTIATING FOR
SO I'M NOT TALKING ABOUT YEAH.
WHEN I TALK ABOUT PRICES I'M-
LARGELY TALK ABOUT THE
NEGOTIATED PRICES OKAY NOT
JUST. MASTER. BUT LOOK. THINGS
ON THAT ACTUALLY TALKING ABOUT
ACTUALLY SPENDING THE PRICES
NEGOTIATED PRICE AT THE DOESN'T
IS THAT WAS THAT AND THAT CLEAR
TO ME AND I THINK THE SHADOW
INCREASE THE SHADOW PRICING- I
THINK WE'RE SEEING THAT IN
OVERSEE THAT IN NORTHERN
CALIFORNIA- RATES FOR CERTAIN
PROVIDER. I'M WAS BEEN
HISTORICALLY LOWER THEY KEEP
THEIR A LITTLE BIT LOWER YEAH
BUT THE REALITY IS THERE STILL
GENERATING PRETTY HUGE PROFITS-
COMPARED TO WHAT THEIR
COUNTERPARTS IN SOUTHERN
CALIFORNIA ARE DOING SO THAT'S-
THAT IS THAT'S ALSO A DRIVER
THAT'S THAT'S THAT'S PRETTY
PRETTY FRUSTRATING- YOU
MENTIONED- PRIMARY CARE
CONSOLIDATION I'D LIKE YOU TO.
TALK A LITTLE BIT MORE ABOUT
THAT BECAUSE- IN MY WORLD WE
DON'T HAVE WE HAVE WE STRUGGLE
TO GET PRIMARY CARE PROVIDERS
LET LONG TOLERATE THEM SO. CAN
YOU TELL ME. JUST THOSE
PROVIDERS ARE BECOMING PARTS OF
PHYSICIAN GROUPS THAT ARE AND
THEN THOSE GROUPS ARE ALSO
BEING ACQUIRED BY. LARGER
HEALTH SYSTEM SO IT'S MORETHAT
BUNCHING OF THEM TOGETHER AND
IT'S LARGELY TO HELP THEM OFFER
THINGS LIKE IT'S VERY
ADVANTAGEOUS FOR THEM BECAUSE
IT HELPS THEM WITH THEIR
ADMINISTRATIVE COSTS THEY OFFER
THEM. ELECTRONIC MEDICAL RECORD
SYSTEM THEY OFFER THEM BUILDING
DENS AND EIGHT CAN GROUP THAT
TOGETHER BUT THEN THEY
NEGOTIATE IS AND HE'S A WHOLE.
AND THEN YOU MENTIONED THAT A
LOT A LOT OF THESE LITTLE
MERGERS OF GROUPS AND THINGS
ARE ALL HAPPENING BELOW THE
RADAR SO ONE OF THE THINGS YOU
MENTIONED. AS A AS A
POSSIBILITY FOR SOMETHING TO
LOOK AT WOULD BE TO READ
REQUIRING IT SHOULD YOU KNOW
NOTIFICATION OF CHANGE AND
THAT- AND THAT'S A THAT'S A
THAT'S A VERY VERY INTERESTING
POINT. HANK YOU THAT TO MY WAS
ENDING THE TRUCK. WE WENT
THROUGH A BILL LAST YEAR
RELATED TO- PAY FOR DELAY AND
THE F. T. C. AND THE CHALLENGES
WE IS THERE. IT IT FEELS IT
FEELS LIKE WHEN YOU SEE THE-
RELATED TO MERGERS AND YOU SEE
THE- THE- THE STRING OF LOSSES
THAT THE FTC HAS. THAT THE
STACKED AGAINST US AND IS
CERTAINLY STACKED AGAINST
CONSUMERS AND THAT'S- LOVE TO
KNOW HOW WE UNRAVEL THAT
SWEATER- QUITE FRANKLY. ALSO I
THINK WE'RE DOING A LITTLE
BETTER I MEAN WE'RE STARTING TO
SEE SOME VICTORIES I THINK
WE'RE STARTING TO UNDERSTAND-
THROUGH. QUITE HONEST. ADVANCES
IN ECONOMIC MODELING OF HEALTH
CARE. WE'RE STARTING TO BE ABLE
TO EXPLAIN HOW- HORIZONTAL
MERGERS WERE ANTI COMPETITIVE
AND NOW WE'RE LOOKING AT TRYING
TO DO A BETTER JOB OF
EXPLAINING MODELING ABOUT WHY
VERTICAL. ARE SAID HE THINKS
THAT I CANNOT. THE END OF EVERY
THAT THAT TOP. THAT THEN WE'RE
GOING TO BE ABLE TO. DO BETTER
IN THE COURT ROOM GREAT GREAT
WELL THANK YOU VERY MUCH IS
VERY VERY INTERESTING
PRESENTATION OF A LOT OF GREAT
INFORMATION THANK YOU SO MUCH
THANKS. SO OUR. NEXT OUR NEXT
PANEL X. IS ACTUALLY WAS
ACTUALLY PANEL WE GOT TO HAVE
THREE THREE SPEAKERS ON THIS
CAN BE LOOKING AT STATE MODELS
AND THE COMMISSION'S THEY'RE
RELATED TO- LOOKING AT. COST
FIRST WILL BE EIGHT GLEN
MELNICK- FROM BLUE CROSS OF
CALIFORNIA THE CHAIR AND
HEALTHCARE FINANCE. THE USC-
SCHOOL PUBLIC POLICY SEE PRICE
DEPOSITS OF A CALL SIX GIVES
ME. FOR THE MASSACHUSETTS
HEALTH POLICY MISSION DAVID
CELTS. EXECUTIVE DIRECTOR- IN
THE FROM THE OREGON. HEALTH
AUTHORITY JEREMY VAN HE-
DIRECTOR TO HELP US IN
ANALYTICS DIVISION OREGON
HEALTH AUTHORITY. OF POLICE-
COME ON UP. SO DOCTOR MOUNT IS
GOING TO GIVE US A NO AND HE'S
GOING TO. HILL WILL WRAP IT UP
AT THE END WITH THE WITH OTHER
STATE MODELS AND THEN WE'LL
HEAR FROM OUR FOLKS IN. THIS IS
IT'S AN AN OREGON. IF YOU NEED
TECHNICAL ASSISTANCE I THINK IF
YOU HAVE YOUR SLIDES ARE
ALREADY LOADED THEIR WILL GOOD.
IF NOT I CAN'T HELP YOU. THE
TECHNICALLY CHALLENGED COMES.
THE GOOD MORNING OF THE BLOOD
BUILDING PROFESSOR OF PUBLIC
POLICY AT USC AND A SENIOR
FELLOW AT RAND AND UP MUCH OF
MY RESEARCH IS FOCUSED ON
IMPROVING THE PERFORMANCE OF
HEALTHCARE SYSTEM FOR CONSUMERS
I'D LIKE TO THANK DOCTOR WOULD
IN THE COMMITTEE MEMBERS FOR
HOLDING THIS REALLY CRUCIAL
HEARING AND FOR THE OPPORTUNITY
TO- CONTRIBUTE TO THIS
IMPORTANT PUBLIC POLICY AREA.
AND THREE. WE GO MY COMMENTS
TODAY DRAW A PROJECT THAT WAS
FUNDED BY THE CALIFORNIA
HEALTHCARE FOUNDATION AND A
REPORT BY MYSELF AND MY
COLLEAGUE SUSAN MURKY WHERE WE
SUMMARIZE WHAT'S HAPPENING IT
FOR OTHER STATES THAT HAVE-
COST HEALTHCARE COSTS
COMMISSIONS. THESE OTHER STATES
HAVE CREATED COMMISSIONS AND
THEIR EXPERIENCE SO FAR SHOWS
THAT THESE AGENCIES CAN PROVIDE
POLICY MAKERS WITH EFFECTIVE
MECHANISMS TO SLOW COST GROWTH
AND POSSIBLY CHIEF A WHOLE
BUNCH OF A BENEFIT IS THAT WE
WOULD LIKE TO SEE HERE IN ORDER.
SLOW GROWTH WAS. IS THE COST.
THE COVER. YOU BROUGHT LEAVE
THE MILLIONS OF. AS WE HEARD
STRAW WITH PREMIUMS IN OUT OF
POCKET COSTS. IT WOULD YOU SEE.
HELP BUDGET BELIEVE. THE OTHER
SERVICE OTHER THAN HAVE OTHER
WOULDN'T THE YOU WELL BEING OF
CALIFORNIA'S WORKERS AND THEIR
FAMILIES AND THE NEXT SLIDE
ACTUALLY PROVIDES A AND A
COUPLE OF THAT USING DATA. LOOK
MANY LIVES OF THE FOUR STATES
THAT WE LOOK AT USED-
BENCHMARKS SUSTAINABLE COST
GROWTH BENCHMARKS SO WE'LL IS
STRAIGHT HERE FOR EXAMPLE ON
THE LEFT HAND SIDE OF. THE
PANEL CALIFORNIA'S. FROM FIFTY
THREE AND FIFTY THOUSAND
DOLLARS TO AROUND SEVENTY
THOUSAND DOLLARS OR ABOUT
THIRTY THREE PERCENT. OVER THE
TIME PERIOD THE NEXT ROW SHOWS
CALIFORNIA'S PREMIUM FOR A
FAMILY OF FOUR GREW BY A
HUNDRED AND 45% REALLY PREMIUMS
ARE GROWING MUCH FASTER THAN
GDP UNDERLYING ECONOMIC GROWTH
ALL RIGHT THE FOUR STATES THAT
WE LOOKED AT ALL HAD
SUSTAINABLE. ECONOMIC
BENCHMARKS AS THEIR GOAL FOR
SPENDING. IF WE FOR THIS
EXAMPLE WE SET ALL RIGHT WHAT
IF. HEALTHCARE PREMIUMS HAD
GROWN AT THE SAME RATE INSTEAD
OF A 145% THE GROUP AT 33% OF
THE RIGHT HAND SIDE OF THE
GRAPH YOU CAN SEE. THAT THAT
MEETING 33% BUT IF THE SAVINGS
A PREMIUM HAD BEEN PASSED ON TO
WORKERS WHICH IS REASONABLE TO
ASSUME INC IN TIGHTENING LABOR
MARKETS- THEN THEN HOUSEHOLD
INCOMES WOULD HAVE GONE UP
SUBSTANTIALLY MORE AND SOLVING
ONE OF OUR MORE BROAD PROBLEMS
WHICH IS STAGNATING INCOME
GROWTH AND INCOME INEQUALITY
THE EFFECTS OF THESE KINDS OF
SAVINGS EVEN BE GREAT I LOOK.
THEM RIGHT. NOT ALWAYS FROM A
STATES THAT A MIXED APPROACH
WORKS BEST ONE THAT COMBINES
TARGETS DATA AND ENFORCEMENT
AND THAT'S COMPREHENSIVE THAT
IT COVERS ALL PIECES OF THE
HEALTHCARE COSTS PUZZLE AND NOT
JUST ONE PIECE. THE
CALIFORNIA'S LUCKY IN THAT WE
CAN LEARN FROM THE EXPERIENCE
OF OTHERS WE'RE VERY FORTUNATE
TODAY HAVE TO LEADERS FROM
OTHER PIONEERING STATES TO HERE
TO SHARE FIRSTHAND THEIR
KNOWLEDGE AND EXPERIENCE AND
GIVE US GUIDANCE AS WE MOVE
FORWARD. IN SOMETHING TO THE
REVIEWS OF THE STATE'S IS WORTH
NOTING SOME WENT OUT WHAT WE
OBSERVE SOME COMMON
SUCCESSFACTORS. ALL RIGHT THE
ROLE IN SETTING OF EXPLICIT
BENCHMARKS IF YOU CAN MEASURE
IT YOU CAN'T MANAGE IT. ALL
RIGHT THE AUTHORITY SOURCE AND
ANALYZE DETAILED DATA- AND IN
FACT MASSACHUSETTS LEADERS HAVE
A CALLER WORKS. MR TILSON
AMASSED POLICY COMMISSION SHE'S
CONSTANTLY BREAKING TO ME ABOUT
HOW COMPREHENSIVE AND GREAT
THEIR DATA ARE. YOU CAN LOOK AT
EVERYTHING. THANK YOU BYE A
COMPLETE PICTURE OF GOING.
WHICH YOU MIGHT IS GOING TO BE
NO. IF WE'RE GOING TO MOVE
FORWARD. THE NEED FOR
INDEPENDENT AUTHORITY COMBINED
WITH STAKEHOLDER COLLABORATION
AND COOPERATION IS ALSO A THEME
THAT WE SAW ACROSS ALL STATES
BUT AT THE SAME TIME
UNDERSTANDING THE ROLE OF
ENFORCEMENT. AND ENFORCEMENT
MECHANISMS IN MEETING THESE
TARGETS AND THAT WE REALLY NEED
A RANGE OF MECHANISMS BECAUSE
AS A PRIOR SPEAKER TALKED ABOUT
THE PROFESSOR CAIN. THIS IS A
COMPLICATED SYSTEM. DIFFERENT
PIECES THEY'RE MOVING. YOU MAY
TO DEVELOP POLICIES TO TARGET
DIFFERENT THINGS AND SO WE NEED
A HYBRID KIND OF APPROACH- TO
ADDRESS THESE THINGS. I'LL BE
TALKING TO YOU LATER ABOUT TWO
OTHER STATES BUT- THAT'S WHAT
MY COMMENTS THAT FOR THE-
PRODUCTION THANK YOU. THANK YOU
DAVID. GREAT GOOD MORNING- IT'S
GREAT TO BE HERE THIS MORNING
THANK YOU MISTER CHAIRMAN FOR
INVITING ME OUT HERE TIME FOR
YOU TO ALL THE MEMBERS OF THIS
TEAM COMMITTEE AND TO ALL OF
YOUR STAFF ACTUALLY BEGAN MY WE
ARE ALL WORKING IN THE STATE
LEGISLATURE IN MASSACHUSETTS AS
A CHANNEL LESS- FOR THE SENATE
WAYS AND MEANS COMMITTEE- SO I
THINK THAT THAT HELPS AND ARM
MIKE. BELIEVE THAT STATE. ME
REAL LABORATORY. COMES TO
INNOVATION A SPECIALLY IN
HEALTH POLICY. AND SO JUST WANT
TO SAY AT THE OUT WE ARE
EXCITED TO BE A RESOURCE TO
YOU- AS YOU HAVE BEEN A
RESOURCE TO US. STATES CAN
LEARN FROM EACH OTHER'S
SUCCESSES AND FAILURES SO TODAY
I WANT PROVIDE A LITTLE BIT OF
BACKGROUND ON. OUR. THURMOND
BUT ALSO JUST WANT TO SAY THE
OUTSET AND SAY AGAIN AT THE- IF
WE CAN BE REACHED TO YOU ARE
BEYOND TODAY'S HEARING PLEASE
DO NOT HESITATE TO REACH OUT-
OUT YOUR SEATS. ARE SO THAT'S
AND- SUCCESS AMONG STATES. AND
I WELL I WOULD ALSO SAY THAT
THERE'S NOT ONE RIGHT WAY TO DO
THIS- I DO THINK THAT THERE ARE
CERTAIN ELEMENTS OF WHAT WE-
DOING IN MASSACHUSETTS. CAN BE
A DOUBLE. ANY TYPES OF STATES
THE SIZE DAY THERE MARKET FROM
A STATE AS SMALL AS DELLA TO
MEDIUM SIZED STATES IN OREGON
IN MASSACHUSETTS TO A STATE OF
LARGEST CALIFORNIA SO I WANT TO
TALK A LITTLE ABOUT SOME OF THE
PRETTY FULL I KIND OF KNOW HOW
MANY. CAN LEAD THAT SUCCESS. A
LITTLE BIT OF BACKGROUND HERE
ABOUT WHY WE DECIDED TO TAKE ON
HEALTHCARE COSTS- SO
MASSACHUSETTS WAS A FOUR
RUNNER- FOR HEALTH CARE JUST
REFORM WE PASSED UNIVERSAL
ACCESS REFORM IN TWO THOUSAND
AND SIX. WHICH BECAME A MODEL
FOR THE AFFORDABLE CARE ACT-
AND HAD A LARGE DEAL SUCCESS
AND THAT AFTER GETTING. MOST BE
THE NIGHT EIGHT POINT FIVE IN
SHORT THANK YOU TO HAVE THE
LOWEST RATE OF UNINSURED STATE
IN THE COUNTRY. HOWEVER A
SUBSEQUENT SUCCESS OF THAT
ACCESS. THE CHALLENGE OF
SUSTAINING KNOW FOURTEEN. CAME
EVEN MORE. AS AN ANSWER. ANY
MORE OF A CHALLENGE OF NEEDED
TO FACE. AND SO WHAT THIS GRAPH
HERE SHOWS IS PERSON HELP
ACOSTA. IN MASS. IN TWO NINE
WERE THE HIGHEST ANY IN THE
STATES. YEAH AS HAS BEEN
MENTIONED AND WARY MENTION I
THINK AT THE BEGINNING THE
UNITED STATES HAS OBVIOUSLY THE
HIGHEST PER PACK PER PERSON
HEALTHCARE COSTS OF ALL
DEVELOPED COUNTRIES SO IN TWO
THOUSAND NINE MASSACHUSETTS WAS
LITERALLY PROBABLY THE MOST
EXPENSIVE PLACE ON THE PLANET-
TO RECEIVE HEALTHCARE. AND WAS
GROWING AT AN UNSUSTAINABLE
RATE AND A RATE THAT WAS NOT
GOING TO BE AFFORDABLE NOT JUST
STATE GOVERNMENT. BUT FOR THE
EMPLOYER BUSINESS IS
MASSACHUSETTS ESPECIALLY OUR
SMALL BUSINESSES THAT ARE OF
OUR ECONOMY FOR FAMILIES AN
INDIVIDUAL. FOR ANYONE WHO'S
SEEN ANY WAGE GROWTH IN REVENUE
GROUP JUST COMPLETELY SWAMPED.
RISING HEALTHCARE COSTS. AND SO
WE SET. WE NEED TO THIS
HEALTHCARE PROP AND PASS
ANOTHER BIG OF LEAD TO TRY TO
REALLY CREATE A MORE
SUSTAINABLE AND AFFORDABLE PATH
FOR THE FUTURE SO THAT WE CAN
KEEP THIS PROMISE TO OUR
RESIDENTS WE SAID WE WANT TO
GET HAVE UNIVERSAL COVERAGE BUT
IF YOU CAN'T AFFORD IT. THAT'S
NOT COVERAGE AT ALL THAT'S NOT
TRUE ACCESS SO IN TWO THOUSAND
AND TWELVE WE PASSED A
COMPREHENSIVE PIECE OF
LEGISLATION. WHICH HAS ADDED
CENTER AND ITS ORGANIZING
PRINCIPLE THIS IDEA OF THE
HEALTH CARE COST GROWTH
BENCHMARK. AND THIS IS A TARGET
BY WHICH WE ARE SETTING IN LAW-
TO TRY TO HAVE TOTAL HEALTHCARE
SPENDING GROW ADDED ANNUAL AND
MORE SUSTAINABLE RATE. AND AS
GLENN MENTIONED WE DO T
THAT- TO WHAT WE PROJECT IN
TERMS OF. THE OVERALL GROWTH IN
OUR STATE'S ECONOMY IN THE LONG
TERM AND THE IDEA THEIR WORDS
AGAIN KIND OF THIS CROWDING OUT
IDEA. THAT IF HEALTH CARE CAN
AND SHOULD GROW. OUT BECAUSE OF
THEIR INNOVATION BECAUSE OF
INFLATION BECAUSE OF-
TECHNOLOGICAL IMPROVEMENTS. BUT
SHOULD TO GROW TWICE AS FAST AS
EVERYTHING ELSE AND WHAT DOES
THAT MEAN FOR ABILITY TO MAKE
AN ESTIMATES. HI AGAIN AS AN
EMPLOYER FAMILY OR GOVERNMENT
IN OTHER ELEMENTS WHEN THAT IS
GROWING SO MUCH FASTER. THE
LAST THING I WOULD DO ON THIS.
IS A- STATEMENT THAT WE HAVE
HERE. WHICH IS AROUND A YOU
KNOW I TRANSPARENT IN
INNOVATIVE HEALTHCARE SYSTEM
THAT IS ACCOUNTABLE FOR. HELLO.
SAVING MONEY AND IMPROVING THE
HEALTH OF OUR COMMUNITIES AND
IMPROVING ACCESS AND REDUCING
DISPARITIES INEQUITIES THAT WE
KNOW ARE INHERENT IN OUR
HEALTHCARE SYSTEM ACROSS THE
UNITED STATES. WE CAN SAVE
MONEY AND TOTALLY COMPROMISE
OUR QUALITY AND COMPROMISE OUR
ACCESS WE WILL HAVE FAILED AND
THAT WILL BE IN CONSISTENT WITH
OUR VALUES AS A STATE. SO HOW
CAN WE FIND THOSE STRATEGIES TO
HAVE. TO YES OVER TIME BUT
ACTUALLY THEN BE ABLE TO
CONTINUE TO MAKE INVESTMENTS IN
AREAS WHERE WE NEED TO AREAS
THAT HAVE BEEN HISTOICALLY
UNDER INVEST IN LIKE PRIMARY
CARE AND THEY HAVE A HEALTH
CARE AND SUBSTANCE USE DISORDER
CARE. SO LITTLE BIT MORE ABOUT
THIS IDEA OF THIS BENCHMARK-
SO. THIS IS A IT IS A TARGET IT
IS NOT A CáC WE CAN EXCEEDED
IT IN ANY GIVEN YEAR AND ALSO
YOU THAT ACTUALLY HAVE- BUT IT
IS SET IN LAW AND IT IS
SOMETHING THAT AGAIN WAS TIED
INITIAL. DO ECONOMIC GROWTH
RATE OF A THREE POINT 6% ANNUAL
TARGET. AND THIS IS A
SIGNIFICANT AN AMBITIOUS GOAL-
EVEN AS LARRY SAID THAT HEALTH
CARE COST GROWTH HAVE MODERATED
IN RECENT YEARS. FOR
MASSACHUSETTS. YOU KNOW WE WERE
CLOSE TO DOUBLE DIGIT YEAR OVER
YEAR SPENDING GROWTH. AND
MASSACHUSETTS HEALTHCARE IS OUR
NUMBER ONE EMPLOYER IT'S A
SIXTY BILLION DOLLAR A YEAR
INDUSTRY- AND SO PERCENTAGE
POINTS MATTER- AND ULTIMATELY
WHITES HEALTH CARE COST
CONTAINMENT IS THAT CHALLENGES
ONE PERSON'S. ACOSTA IS ANOTHER
ORGANIZATIONS REVENUE THAT THEY
COUNT ON FOR DELIVERING THEIR
MISSION. AND SO WE WANTED TO BE
ABLE TO BE THOUGHTFUL ABOUT
THIS TO HAVE AND IN. BUT IT SHE
WILL ARCHITECT TRACKING MONITOR
OVER TIME. AND THE LAW ACTUALLY
ALLOWED FOR AFTER A COUPLE OF
YEARS THAT WE WOULD ACTUALLY BE
ABLE TO MOVE TO A MORE
AGGRESSIVE TARGET OF THREE
POINT 1% TO SAY. HOW DO WE
CONTINUE TO. PUSH THE ENVELOPE
IN WELL TO GET A SAVINGS OUT OF.
NOW THIS IS BECAUSE- THE WAY WE
WORK THINKING ABOUT TOTAL
HEALTHCARE EXPENDITURES THIS IS
ALL IN. IT IS THIS WHAT WE
SPEND ON THE STATE'S MEDICAID
PROGRAM. IT'S EMPLOYER
SPONSORED HEALTH INSURANCE IT'S
OUR MEDICARE PROGRAM IT IS THE
KNACK COSTS THE ADMINISTRATIVE
COSTS OF OUR PRIVATE HEALTH
INSURANCE. AND IT'S WHAT PEOPLE
PAY FOR THEIR COPAYS AND
DEDUCTIBLES AND THEIR COST
SHARING OUT OF POCKET. OUT ALL
OF THAT UP WE TRACK ITS GROWTH
MERE OVER HERE. AND THAT IS
THAT IS WHAT WE'RE MEASURING SO
IT'S A REALLY IT'S A BIG ALL IN
NUMBER. AND IMPORTANCE OF THAT
IS A COMMON PROBLEM IN
HEALTHCARE POLICY WHICH WE
OFTEN SOMETIMES CALLED THE
BALLOON PROBLEM OR THE WHACK A
MOLE PROBLEM THAT IT JUST PUSHY
COUNTER JUST. BROKE ONE OF CARE
THAT IS REALLY GOOD SOMETHING
HAVE. PLACE BEING CURD IT'S NOT.
BACK OUT. AND WE REALLY. HAVE
BEEN ALL OF YOU. ALL IN AS I
SAID BUT WE CAN DO HAVE AN
ACCOUNTABILITY MECHANISM FOR
INDIVIDUAL HEALTH SYSTEMS AN
INDIVIDUAL HEALTH PLANS
INSURANCE COMPANIES TO SAY THAT
THEY ARE ALSO ACCOUNTABLE TO
TRY TO KEEP HEALTHCARE SPENDING
GROWTH TO A MORE SUSTAINABLE
RIGHT AND SO EVERY YEAR WE- ARE
IDENTIFIED A LIST OF THOSE
HEALTHCARE BIG HEALTHCARE
SYSTEMS AND HOW INSURANCE
COMPANIES WHOSE COSTS GROWTH
HAVE EXCEEDED THE BENCHMARK.
AND WE CAN I HAVE THE AUTHORITY
AT OUR COMMISSION TO A REQUIRE
THEM TO TAKE STEPS TO ADDRESS
THEIR HEALTHCARE SPENDING
GROWTH IN A PUBLIC AND
TRANSPARENT AND REPORTED WAY A
WHAT WE CALL PERFORMANCE
IMPROVEMENT PLAN COULD
OTHERWISE WE CALL THE
CORRECTIVE ACTION PLAN BUT
REALLY IT THIS IS A- BASICALLY
SAYING WE'VE I DON'T THERE'S AN
HERE. AND CITY OF. PROVIDE WHEN
DID YOU. YOUR HELP STRUCK THE
MINE. TRACK AND WE'RE GONNA
MINOR WE'RE GOING TO HOLD YOU
PUBLIC TO ACCOUNT FOR THAT. I
WOULD NOTE HERE THIS IS KIND OF
ARC AVAIL TOOL AND WE HAVE NOT
HAD TO THIS TOOL WE HAVE HAD IT
IN FACT AND WE HAVE GOT THESE
LESS WE HAVE GONE THROUGH A
WE'VE HAD BACK FORTH WITH
HEALTH PLAN AND HEALTH. BUT WE
HAVE NOT ACTUALLY TO TAKE THE
ADDITIONAL STAFF AND AB ONE
THING I WOULD SAY IS THERE IS A
SUDDEN FACT A KNOWING WE ARE
WHAT. THAT ARE TRACKING AND
THERE CAN BE IN MECHANISM THAT
WE HAVE FOUND CAN TO IN
INFLUENCE BUT WITHOUT TO
NECESSARILY THAT IT SOME STUFF.
THAT OF IN ASK. CAN CHANGE
BEHAVIOR SO AGAIN WE TRY OF
THIS NOT NOT AS A AS BUT AS A
TO SAY WE'RE ALL IN THIS
TOGETHER HOWEVER ALL WERE
TOWARDS THESE GOALS. I'M NOT.
THIS IS AN- WHOLE PROCESS. WALK
ALL THE. THIS IS MARK. EVERY
YEAR WHERE WE CAN CALL- THE
LEADERSHIP OF OUR BIGGEST
HEALTH SYSTEMS AND HEALTH PLANS
TO COME AND TESTIFY NOT ON LIKE
THIS- UNDER OATH- IN A PUBLIC
SETTING ABOUT WHAT THEIR
ORGANIZATIONS ARE DOING TO TRY
TO HELP MEET THE HEALTH CARE
COST GROWTH BENCHMARK AND WHERE
DO THEY EITHER CHALLENGES
AMERICA THEY USE HELP POTENTIAL.
AND SO CAN BE. COMMUNITY COM.
ABOUT HOW ALL OF US ARE WORKING
TOGETHER. TO TRY TO ACHIEVE
THIS GOAL WE THEN HAVE THE WE
ISSUE OUR OWN ANNUAL REPORT
THAT DOES DEEPER DIVE INTO SOME
OF THOSE AREAS OF SIGNIFICANT
YOU KNOW DRIVERS OF HEALTH CARE
SPENDING. AND MAKE POLICY
RECOMMENDATIONS TO OUR
LEGISLATURE TO OUR
ADMINISTRATION AND TO THE
MARKET A BIG PART OF THIS- IS
AS AN INDEPENDENT AGENTS WHICH
I'LL TALK ABOUT IN A SECOND- WE
WANT TO BE ABLE TO PROVIDE DATA
AND INFORMATION TO ALL OF THE
MOST IMPORTANT STAKEHOLDERS
INCLUDING THE BUDGET. TO MAKE.
WHAT THE DATA ALSO. AND HOW CAN
WE I REALLY HAVE DATA INFORMS
POLICY MAKING NOT ANECDOTE
INFORMED POLICY MAKING AND
THAT'S A BIG PART OF HAT WE
TRY TO ACCOMPLISH. AND THAT CAN
CHANGE OVER TIME. AND SO ONCE
YOU BUILD THAT INFRASTRUCTURE
BEING ABLE TO LOOK AT DATA
UNDERSTANDING. AS HEALTHCARE
SYSTEM IS RAPIDLY CHANGING. THE
PROBLEMS THAT WE THINK WE KNOW
NOW COULD BE VERY DIFFERENT
FROM FOR FIVE YEARS FROM NOW.
AND HAVING THIS ABILITY TO
NIMBLE AND TO BE FLEXIBLE AND
TO GO WHERE THE TREND TAKE US.
ALLOWS US TO THEN BE ABLE TO
ADAPT OUR POLICY
RECOMMENDATIONS YEAR OVER YEAR
ALONG WITH A DEADLY CHANGING
HEALTHCARE MARK. NOT IN IN IN
IN FIGHTING WITH THAT. SO THE
HEALTH POLICY COMMISSION IS UP
I KNEW STATE AGENCY THAT WAS
ESTABLISHED AS PART OF THIS
OUGHT TO REALLY. MONITOR AND TO
BE THE HUB FOR ALL OF THE
ACTIVITIES TO TRY TO HELP US
ACHIEVE THE BENCHMARK- IT WAS A
NEW STATE AGENCY AT THE TIME AN
INDEPENDENT STATE AGENCY. I WAS
THE FIRST EMPLOYEE THIS A STATE
AGENCY THIS WAS TRULY A START
UP- WITH A VERY AMBITIOUS GOAL-
BUT I WASN'T IN THE SOUL- I
THAT I HAVE A BOARD THAT I
WILL. DO THAT IS MADE UP OF
APPOINTMENTS BY THE GOVERNOR
THE ATTORNEY GENERAL ON OUR
STATE AUDITOR ALL. INDIVIDUALLY
CONSTITUTIONALLY ELECTED
OFFICERS AND TWO SETS. AND EACH
ONE OF THOSE. CAN A POINTS- A
CERTAIN NUMBER OF MEMBERS HERE
AND THEIR EXPERTISE IS LAID OUT
IN LOSS WE HAVE SOMEONE WHO. IS
A PRIMARY CARE PHYSICIAN IF
SOMEONE WHO IS AN EXPERT ON
BEHAVIORAL HEALTH CARE EXPERT
ON HEALTH COM ECONOMICS- A
WORKFORCE EXPERT. AND I DON'T
REALLY REFLECT YOU KNOW AYE
DIVERSE RANGE OF DIFFERENT
PERSPECTIVES AND EXPERTISE. BUT
NOT ONE OF THOSE CONSTITUTIONAL
OFFICERS HAS A MAJORITY OF THE
BOARD. AND THE BOARD WAS
INITIALLY HAD STAGGERED TERMS
AND THE REASON BEHIND THAT WAS
TO INSURE. POLITICAL
INDEPENDENCE AT IS I'M-
PARTISAN STATE AGENCY- AND WE
VIEW OUR GOALS AS REALLY BEING
FOR THE PUBLIC AND SO I'VE-
PUTTING SOME OF THESE KIND OF
STRUCTURES IN PLACE- WE WORK
VERY CLOSELY WITH OUR
LEGISLATURE AND EXECUTIVE- BUT
WE ARE I DO NOT REPORT UP TO
THEM- AND IN FACT OUR BOARD HAS
SOME LEVEL OF INDEPENDENCE.
FROM THAT TO BE ABLE TO MAKE
HARD DECISIONS SOMETIMES- AS IS
INEVITABLE- WHEN DEALING WITH
HEALTH CARE COST CONTAINMENT.
I'M ONE LAST THING I WOULD VERY.
ON MY BOARD IS THAT THERE IS-
STRONG FINANCIAL CONFLICT OF
INTEREST PROTECTIONS SO OUR
BOARD MEMBERS CANNOT BE PEOPLE
WHO ARE EMPLOYED BY OUR BIGGEST
HEALTHCARE SYSTEMS OR VIGOROUS.
HEALTH INSURANCE PLANS AGAIN
UNDERSTANDING THAT WE WANT
PEOPLE WHO ARE BRINGING THAT
LEVEL OF EXPERTISE. BUT NOT
NECESSARILY THERE REPRESENTING
A PIECE OF THE INDUSTRY THAT WE
ARE IN FACT TRUMP. CHANGE OVER
TIME IN INFLUENCE BEHAVIOR
CHANGE. THAT BEING SAD- I'VE I
RECOGNIZE WAS REALLY IMPORTANT
THAT WE HAVE. A VERY BROAD A
GROUP OF P. INFLUENCE AND HAVE
INPUT INTO THE- PROCESS SO THE
FIRST THING I DID WAS EXACTLY
EXACTLY. AN ADVISORY COUNCIL.
AND SO I THIRTY PERSON ADVISER
COUNCIL. WELL IT'S NOT THAT THE
HOT ASSOCIATION PLANS BUT NURSE
AND SO WORKERS AND A LONG TERM
CARE AND SENIOR CARE AND CHILL
PEDIATRIC HEALTH AND HEALTH
EQUITY AND OUR BUSINESS
COMMUNITY OUR SMALL BUSINESS
COMMUNITY OUR LIFE SCIENCES
COMMUNITY ARE BIOTECH COMMUNITY
THE ALL REPRESENTED OUT AS PART
OF THIS ADVISORY COUNCIL AND I
CAN TELL YOU EVEN SEVEN YEARS
INTO THIS I HAVE AN ADVISORY
COMMITTEE MEETING TOMORROW-
EVERYONE STILL COME TO THESE
MEETINGS TO BE ABLE TO
INFLUENCE AND BE A PART OF ARE
YOU MAKING PROCESS AT THE WORK
AGENCY. ARE NEED TO DO THIS GO
YOU DO. AND I REALLY THOUGHT IT
WAS THE BILL STATE OLDER UNITY
THAT'S BOB AND WE MEET. AND
DISCUSS. WHERE ARE STRATEGIC TO
BE AWARE SHOULD GO I WON'T WALK
ALL OF THIS CAN BE IN YOUR DAD
BUT THIS JUST SOME OF OUR
BIGGEST I STAKEHOLDER
CONSTITUENTS IT SEES. WHO ARE
STILL VERY SUPPORTIVE OF THIS
AFTER- AND I WOULD NOTE
ESPECIALLY OUR CONSUMER
ADVOCATES AND OUR BUSINESS
COMMUNITY IS SO STRONGLY
SUPPORTIVE OF THIS BECAUSE OF
THE CHALLENGES OF
AFFORDABILITY. ACTIVATE ITS
EVERY SINGLE DAY- YOU KNOW OUR
HEALTH CARE FOR ALL GIVEN THE
ONGOING CHALLENGES OF HEALTH
CARE AFFORDABILITY FOR STATES
RESIDENTS WE HAVE IT'S
CRITICALLY IMPORTANT. TO
CONTINUE THESE POLICIES. I
THINK WHAT'S MOST INTERESTING
HERE IS PROBABLY THE LAST YEAR
WHICH ARE OUR HOSPITAL. AND OUR
MASS MEDICAL SOCIETY WHO BOTH
SAY THEY STRONGLY SUPPORT THE
OF THE IN THE MSSION OF THE
HELP POLICY COMMISSION AND
RECOGNIZE THAT THEY TO HAVE TO
BE A PART OF THE SOLUTION. IF
WE'RE REALLY GONNA HAVE
AFFORDABLE ACCESS. TO HEALTH
CARE. SO DOES THE HELP
COMMISSION ACTUALLY DO ITS WORK
I WE'RE NOT A DIRECT REGULATORS
WE DON'T SET PRICES WE DON'T
SET PRICE CAPS SO HOW DO WE
ACTUALLY USE. THE TOOLS AT OUR
DISPOSAL TO TRY TO INFLUENCE.
BEHAVIOR CHANGE- WITHIN THE
MARKET. AND THESE ARE REALLY
KIND OF THE FOR TOOLS THAT I
LIKE TO THINK ABOUT OF HOW WE
ACTUALLY GO ABOUT. I'VE SEEN
THAT CHANGE THAT WE WANT TO
HAVE HAPPEN WE HAVE RESEARCH
REPORTING- TALK WE TALK A LOT
ABOUT THE POWER OF DATA A
PUTTING DATE OUT OF THE WORLD
WE HAVE FOUND THAT. JUST
PUTTING TO GET OUT IN THE WORLD
CAN GET PROVIDERS AND HEALTH
PLANS TO STAND UP AND PAY
ATTENTION TO SAY- I THOUGHT I
WAS DOING BETTER ON THIS. THEN
THEN I ACTUALLY AND ONCE ISEE
MYSELF COMPARED TO SOME MY
COMPETITORS- THAT'S A REAL WAKE
UP CALL I YOU KNOW I THERE'S
MORE THAT I COULD BE DOING IN
TERMS OF MAYBE REDUCING
AVOIDABLE EMERGENCY DEPARTMENT
USE. OR REDUCING UNNECESSARY
TESTING AN IMAGING. OUR WORK
CONVENER WE'RE GOVERNMENT BUT
WE DON'T HAVE ALL THE ANSWERS
TO HELP ME BRING THE PEOPLE
TOGETHER THAT ARE. A PART OF
THIS COMMUNITY THAT SEE
PATIENTS EVERY DAY THAT WORK IN
THIS INDUSTRY TO SAY HOW DO WE-
COME TOGETHER AND- IDENTIFY
THOSE PROBLEMS AND FIND
SOLUTIONS. WORK PARTNER WE'VE
ACTUALLY MAKE INVESTMENTS WE
MADE OVER A HUNDRED MILLION
DOLLARS OF INVESTMENTS IN
GRANTS. I TO COMMUNITY
HOSPITALS AND OTHER PROVIDERS
IN MASSACHUSETTS. THE TASK NEW
pCARE THAT ACHIEVE THOSE GOALS
THAT I TALKED ABOUT BEFORE.
REALLY TRYING TO IMPROVE CARE
IN MANY CASES FAR MOST COMPLEX
AND VULNERABLE PATIENTS. WERE
DEALING WITH COMPLEX MEDICAL
BEHAVIORAL AND SOCIAL NEEDS BUT
IF WE CAN IMPROVE THE CARE OF
THOSE POPULATIONS WE CAN SAVE
SO MUCH MONEY AND- DO YOU
REALLY POSITIVE THINGS AN
IMPROVING PEOPLE'S LIVES. AND
THEN FINALLY. THE WORLD
WATCHED. NAM AND HERE WE ACT IN
TERMS OF REALLY THINKING ABOUT-
BEAN THE BEAN ON THE SIDE OF.
THE FAMILY INDIVIDUALS AND
BUSINESSES AND TAX IS THAT OUR
TEAM FOR THIS VERY EXPENSIVE
HEALTHCARE SYSTEM. AND I TO
FIND HAVER THAT WE THINK IS
INCONSISTENT WITH OUR GOALS OF
TRYING TO HIT THE BENCH. AND
ALSO SOME. A PLAY WHERE ARE TO
REALLY DO THE RIGHT THING AND
ACHIEVING SUCCESS. I THINK ONE
THING I'D WANNA HIGHLIGHT HERE
IS THE BENCHMARK ITSELF. IS IT
DOESN'T SAVE THE MONEY BUT
BECOMES ALL LANDS AND A TOOL BY
WHICH THEN YOU CAN A RAIL ALL
OF THESE OTHER POLICIES AROUND
DO YOU WANT TO DO MORE
INTEGRATED CARE YOU WANT TO
THINK ABOUT HOW DO YOU DO PRICE
TRANSPARENCY YOU WANT TO THINK
ABOUT HOW DO YOU MAKE YOUR
MARKET FUNCTION BETTER. BY
HAVING THIS COMMON GOAL KIND OF
AT THE CENTER THAT YOU CAN
ADAPT ALL OF THOSE OTHER IDEAS
AND POLICIES TO YOUR MARKET TO
YOUR STATE. AND THINK ABOUT IT
BUT KIND OF HOW THAT ONE
CENTRAL PLACE WHERE EVERYONE IS
WORKING TOGETHER SAY OKAY WELL
WHAT WOULD IT TAKE FOR US TO
MEET THIS GOAL WHERE WOULD WE
HAVE TO MAKE IMPROVEMENTS AND
THAT MAY GET IN CALIFORNIA THAT
MESSAGE TO IT'S- COME. THIS FOR
PRINCIPLE BY WHICH YOU THEN YOU
CAN START TO MAKE ALL OF THOSE
QUESTIONS. OUR I KNOW I'M I'M
GOING A LITTLE BIT OVER TO. TRY
TO BE QUICK CARRIED. BOTH TO
HOW WE DONE SO LET ME SHOW YOU
SOME RESULTS- SO WE HAD SIX
YEARS OF RESULTS AGAINST THE
HEALTH CARE COST GROWTH
BENCHMARK- THE DOTTED LINE
THERE IN THE MIDDLE IS THE
BENCHMARK. YOU CAN SEE FOR THE
SIX YEARS WE'VE BEEN BELOW
INCLUDING THE MOST RECENT YEAR
WHERE WE DID HAVE THAT MORE
AGGRESSIVE. I THREE POINT 1%
TARGET. YOU CAN SEE THAT
THERE'S YEARS THAT WE ACTUALLY
WENT ABOUT. AS I SAID THIS IS
NOT A CáC THERE CAN BE YEARS
WHETHER WE GO ABOUT- AND I WILL
NOTE. IN ONE OF IN THE YEARS
THAT WE WENT ABOVE. I ONE OF
THOSE YEARS- OUR STATE
EXCHANGE- HAD SOME TOUGH OF.
TECHNICAL DIFFICULTIES. AND SO
WE DECIDED THAT AS A STATE WE
WANT TO MAKE SURE THAT EVEYONE
CONTINUED ACCESS TO HEALTH
INSURANCE WE PUT PEOPLE ON. A
TEMPORARY MEDICAID PROGRAM FOR
A YEAR. THAT INCREASE OUR
SPENDING THAT YEAR. BUT WE SAID
YOU KNOW WHAT ACCESS TO HEALTH
INSURANCE IS. MORE IMPORTANT SO
LET'S MAKE THAT CHANGE THAT
MAKE THAT COMPROMISE. AND THEN
ANOTHER YEAR WHICH I THINK IS-
AN AREA. I'M GOING VOTE FOR US.
IS INJURED. OF DATE OF. I THAT
FOR THAT. INTERLOCK THAT ONE
DRUG. HAVE BEEN BELOW THIS.
BENCHMARK AND I DROPS OF ALL
WHICH IS A ONE TIME TO OR FOUR
HABITAT. C. AND I THINK ABOUT
OF THE- I WOULD LIKE TO MAKE
THEIR A LOT. READ KEEP MAY JUST.
ABOUT THE RE WILL NOT OF THE
LESS PRICE OF THAT. WHEN IT WAS
FIRST INTERVIEW IN A HUNDRED
THOUSAND. I THINK WE'LL DO YOU
UNDERSTAND THAT THIS WAS LIKE
YOU WERE- THAT SAVES LIVES AND
WILL SAVE US- EXTEND LIVES FOR
MANY PEOPLE. A TRUE INNOVATION
SO I THINK HERE IS THAT- YOU
CAN BE ABOVE THE BENCHMARK BUT
YOU MAY BE MAKING INVESTMENTS
THAT. UP IN THE- ROOM WHERE YOU
CAN BE BOTH OF THE BENCHMARK-
AND YOU HAVE TO UNDERSTAND THE
CONTEXT IN DOT. ALL RIGHT. HOW
THERE ARE. OUT OF. THAT KIND OF
THREE TRACK TO THE STATES
WEARING THOUGH THE BILL DATA WE-
KIND OF COMPARING STATES WHICH
OTHERS FROM. UP TO TWO THOUSAND
FOURTEEN WHICH IS QUITE OLD-
BUT- FROM THAT LAST TRYING TO
DAY THAT WE GOT FROM THE
FEDERAL GOVERNMENT. CHOOSE A
TWO FOURTH LOWEST. TOTAL NEGRO
THE STATE THE COUNTRY
CALIFORNIA HAVE ATTEMPT. AND
WHAT THIS IS MEANT IS THAT-
THIS IS LOOKING AT A PROPORTION
OF OUR HEALTHCARE SPENDING
SPENDING HAS OF COURSE OF TOTAL.
AKAN AND THE- ORANGE LINE
HERE'S MASSIVE. AND THE BLUE IS
YOUR STATES. YOU CAN SEE THAT
WE ARE SPENDING MUCH MORE OF
OUR ECONOMY OUR ECONOMIC GROWTH
R. G. R. GDP ON HEALTHCARE IN
THE UNITED STATES FOR A VERY
LONG TIME. BUT THAT RATE IS NOW
STABILIZE IN THE LAST COUPLE OF
YEARS AND WE'VE ACTUALLY-
DOUBLE OF THE UNITED STATES
WE'VE SEEN THAT WE'VE ACTUALLY
CHANGE THE TRAJECTORY HERE- AND
THIS IS- ABOUT PERHAPS MOST
EASIEST WAY TO LOOK AT THIS.
NOW THIS IS JUST EMPLOYER
SPONSORED CARE THIS IS JUST A
COMMERCIAL MARKET. A YEAR OVER
YEAR GROWTH- MASSACHUSETTS IN
ORANGE. THE UNITED STATES AND
BELOW. AND YOU CAN SEE THAT
EVERY YEAR CENTS TWO THOUSAND
TWELVE THAT WARNS LINE HAS BEEN
BELOW THE BLUE LINE.
MASSACHUSETTS AMHERST. EUROPE
YEAR. IN THE UNITED AB. HAS
GENERATED. OF DOLLARS ABOUT
WHAT OTHER HAVE BEEN IF WE
GROWN AT THE U. S. RATE. THAT
MEANS THOUSANDS OF DOLLARS FOR
INDIVIDUALS THAT OTHERWISE
WOULD HAVE BEEN IN INCREASE
PREMIUMS. I AM MEANS WAGE
GROWTH THAT ACTUALLY WENT TO
PEOPLE INTO PEOPLE'S POCKETS
ARE RATHER THAN GOING INTO
HEALTHCARE- IT'S HARD TO SAY
EXACTLY WHAT- BUT FOR THIS
EFFORT WHAT THAT TREND LINE
WOULD HAVE BEEN. MAYBE WOULD
HAVE BEEN IN EXCESS OF THE
UNITED STATES AND CONTINUED
TREND. UP NONETHELESS THESE ARE
GOOD DIRECTIONAL DATA THAT SAYS
SOMETHING CHANGED IN OUR
ENVIRONMENT IN IN OUR MARKET
AROUND TWO THOUSAND TWELVE IN
TWO THOUSAND THIRTEEN. THAT IS
AFFECTING OUR RESIDENTS. AND
WHERE IS THAT OCCURRED- AGAIN
KIND OF DIVING BENEATH HERE
IT'S REALLY. POSSIBLE REDUCE IN
OUR GROWTH NOT BE AS HIGH AS AS
THE- STATES. THE NOT TO SAY
THAT ARE HOT. APART ARE THEY
CONTINUE TO HAVE A VERY
POSITIVE MARK IS AND OF. COURSE
CONTINUES TO GROUSE DOES NOT
NOT. BACK. OUT ON ANY BACK INTO
THE COMMUNITY. I KNOW THAT I'VE
I'VE I'VE BUT LABOR MY TIME
HERE BUT I DO WANT TO JUST HIT
A COUPLE MORE QUICK POINTS- ONE
IS THAT WE ALSO HAVE A ROLE IN
EVALUATING I HEALTHCARE MARKET
CHANGES- SO VERY SIMILAR TO
WHAT JAMIE WAS SAYING- WE KNOW
THAT THE HEALTHCARE MARKET
CHANGES IMPACT SPENDING
QUALITY. AND WE HAVE A PROCESS
WHERE UP BEFORE- THERE CAN BE
CHANGES IN. BUYERS ARE
PROPOSING EITHER NEW
RELATIONSHIPS I KNEW MERGERS
NEW ACQUISITIONS NEW JOINT
VENTURES NEW OVER CONTRACTING
RELATIONSHIPS THEY BEFORE THEY
CAN EXECUTE ON THOSE MERGERS
ARE THOSE NEW PLANS. THEY HAVE
TO GIVE NOTICE TO THE HEALTH
POLICY COMMISSION. IT'S A
PUBLIC NOTICE WE PUT IT ON OUR
WEBSITE AND THEY HAVE TO DETAIL
TO US WHAT THEY THINK THE
SPENDING IMPACT THE QUALITY
PACKED AND THE ACCESS IMPACT IS
GOING TO BE FROM THIS PROPOSED
TRANSACTION. AND HAVE TO STAY
PUBLICLY WHY THEY THINK THIS
MEANS. IS IN. SYSTEM WITH
ARTICLES OF HITTING THE
BENCHMARK AND HOW THE TRAINS
WATCHES. OUR EFFORTS TO HIT
THIS BENCHMARK AND THOSE ARE
PUBLICLY POSTED. BUT WHAT WE
THEN DO AND HAVE THE ABILITY TO
DO IS ONCE WE RECEIVE THAT
NOTICE I WE ENGAGE IN A REALLY
RAPID KIND OF PRE MERGER OF
REVIEW. WHERE ACTED WITHIN
THIRTY DAYS OF GETTING IS
NOTICE- WE TALK TO THOSE
PROVIDERS AND THEN WE LOOK AT
THEIR CONFIDENTIAL INFORMATION
WE LOOK AT THEIR CONTRACTS WE
LOOK AT THEIR MEMORANDUM OF
UNDERSTANDING WE LOOK AT THAT
DATA. AND WE SAY DO THESE
THINGS ALL MATCH UP. IT DOES
WHAT THEY'RE SAYING PUBLICLY
ABOUT THEIR WHAT THE GOODS IN
THE BENEFITS THAT ARE COMING
FROM THIS TRANSACTION THEY
ACTUALLY MATCH. THEIR OWN
INTERNAL DOCUMENTS OUR OWN
INTERNAL PLANS OUR OWN INTERNAL
CONTRACTS MEMORANDA OF
UNDERSTANDING. AND THROUGH THIS
REVIEW PROCESS- WHAT WERE
INTENDED TO DO IS REALLY BOTH
PROVIDE PUBLIC SHOULD PUBLIC
TRANSPARENCY THAT WHEN THESE
THINGS ARE HAPPENING- BUT ALSO
TO TRY TO JUST REALLY MINIMIZE.
THE QUOTE QUOTE QUOTE NEGATIVE
IMPACTS JAMIE TALK ABOUT. AND
ENHANCE THE POSITIVE IMPACT
THAT CAN COME FROM SOME OF
THESE TRANSACTIONS. AND SO- WE
HAVE HAD OVER A HUNDRED OF
THESE I KNOW THIS IS TO US I
CAN SEE HERE THEY'RE NOT ALL
HOT SUMMERS. MANY OF THESE ARE
PHYSICIAN OPPOSITION. YOU ARE
JOINT VENTURE DIFFER TYPES OF
THINGS THAT IS JAMIE WAS ABOUT
OFF. UST FALL THROUGH THE
CRACKS BUT STILL CAN HAVE AN
IMPACT. NOW ALL OF THESE ABOUT
A HUNDRED TRANSACTIONS THAT WE
REVIEWED. WE DO HAVE THE
ABILITY TO GO AND BASICALLY DO
A DEEPER DIVE ON TRANSACTIONS
THAT WE THINK ARE GOING TO HAVE
A BIG SIGNIFICANT IMPACT. I AM
NOT MUCH LONGER THAT CAN BE
UPWARDS OF SIXTY EIGHT. YOU THE
END. IS A MORE CYCLE. WE'VE
ONLY GONE TO THAT FURTHER
EXTENDED REVIEW ABOUT THE TIMES
SO IT IS A HIGH BAR- BUT IN
THAT EXTENDED REVIEW AGAIN THE
MERGER CANNOT CLOSE INTEL
FINISH OUR REVIEW AN ISSUE OUR
PUBLIC REPORT. AND WE HAVE
FOUND THAT. GEN ASKING THESE.
HAVING A PUBLIC DIALOGUE AROUND
THE POTENTIAL IMPACT HAS CHANGE
MARKET BEHAVIOR BECAUSE ONE OF
PUTS PEOPLE ON THE RECORD TO
SAY THIS IS WHAT YOU SAID GOING
TO HAPPEN AND THEN WE CAN GO
BACK YOU KNOW. TWO THREE YEARS.
AND SAY WELL DO WE HAVE. DO
WHAT YOU SAID WAS GOING HAPPEN
ACTUALLY HAPPEN AND PUT HAVE
THAT ON. YOU KNOW UNDER THE
KEYS IN PANEL ARE PERJURY THIS
IS WHAT THEY SAID THEIR PLANS
WORK. WE HAD PEOPLE MAKE
VOLUNTARY COMMITMENTS WE RAISE
ISSUES WHERE WE SAY HEY WE'RE
REALLY CONCERNED ABOUT THIS NEW
MERGER BECAUSE YOU'RE GONNA BE
ABLE TO IMPORT A HOSPITAL FEES
ON TO THIS PHYSICIAN PRACTICE.
THAT'S JUST GONNA RESPECT BUT
IT'S A REALLY CHANGE ANYTHING
ABOUT THE DELIVERY OF CARE AND
THEY SAY YOU KNOW WHAT. WE'RE
NOT DO THAT WE COULD JUST NOT
THAT WILL COME. YOU CAN US TO
THAT. NOT EVEN A- CONSENT TO
CREATE JUST VOLUNTARY
COMMITMENTS FOR ORGAN WANTING
TO LIVE SEE THAT WERE. THESE
QUESTIONS INTO IN THE RIGHT
THING. WE FEED OUR REPORTS THE
ATTORNEY GENERAL'S OFFICE SO
THAT. WHEN THOSE KEY RISE TO
THAT ANTI TRUST VIOLATIONS THAT
WE WERE EATING SO MUCH MORE
INFORMATION BEYOND JUST ANTI
TRUST BUT ALSO. NEW TAXES COME
FROM THESE. AND IN A SMALL
NUMBER OF. YOU KNOW DO NOT HAVE
THE IF TO. IT ALL REPORTS HOW
LED PROVIDE ORGANIZATIONS
ABANDONING PLANS TO PURSUE A
MERGER BECAUSE OUR REPORTS
REYES SUCH SIGNIFICANT
CONCERNS. ABOUT WHAT THE
IMPACTS OF THAT COULD BE. SO WE
ALSO HAVE A NEW ROLE IN
EVALUATING THE VALUE OF DRUGS I
WILL MAYBE SKIP OVER THIS PART
IN THE INTEREST OF TIME I CAN
TALK. MORE ABOUT ACTUALLY WERE
OKAY ON TIME- PLEASE DON'T SKIP
OVER THIS ONE. SO I HAVE THANK
YOU- I WILL SAY- AND YOU KNOW
ONE OF THE- PHARMACEUTICAL
SPENDING HAS BEEN A MAJOR
DRIVER OVER THE LAST COUPLE OF
YEARS- AND AS YOU SAID IT'S NOT
JUST AT THE RETAIL- CLINIC- WE
SEE A IT INCREASE. IN IN THE
HOSPITALS AND PLACE IS KIND OF
THE MEDICAL PHARMACY SPEND
THINGS LIKE ONCOLOGY DRUGS. AND
INCREASING AND SO THAT THE
DOCTORS HERE THAT WE'RETALKING
ABOUT. SMALL ANYMORE I AM IN
OUR CAR BOND MARKET IT CAN BE
UPWARDS OF BASICALLY ONE IN
FOUR DOLLARS OF HEALTHCARE
DOLLARS IS GOING A PHARMACY.
THIS IS AN IMPORTANT PART OF
THIS ENTIRE PIE THAT WE NEED TO
ALSO BE ABLE TO LOOK AT AND
MAKE SURE THAT WERE HOLDING
ACCOUNTABLE AND IS PART OF THIS
THIS OVERALL COLLECTIVE ACTION
WE HAVE BEEN- KIND OF.
BEGINNING TO WORK IN THIS AREA
AND SO ONE OF THAT ARE KIND OF
INITIAL STEPS THAT ARE GOVERNOR
PROPOSED ARE LEGISLATURE.
ADOPTED LAST YEAR. WAS A
PROCESS BY WHICH- WE NOW POLICY
COMMISSION WORK WITH OUR STATE
MEDICAID PROGRAM. ORDER TO TRY
TO GET BETTER VALUE FOR THE FAR
MEDICAID PROGRAM. I'M SO THE
WAY THAT THIS WORKS REALLY
QUICKLY IS THAT I'VE MEDICAID
WHICH IS CALLED MASS HEALTH AND
NOT USE ITS- NEGOTIATED
MANUFACTURE. ON TRYING TO GET A
SUPPLEMENTAL READING. AUG MANY
HAVE TO PROVIDE UNDER FEDERAL
RULES KIND OF A STANDARD REBATE
BUT STATES CAN NEGOTIATE
GREATER REBATES. AND SO
AUTHORIZES OUR MEDICAID PROGRAM
TO ENTER INTO THOSE TYPES
NEGOTIATIONS. IF THOSE
NEGOTIATIONS FAIL- AND THE DRUG
IS OF A CERTAIN HIGH COST OR
CERTAIN IMPACT OF THE BUDGET.
THEN OUR OUR MASS OF PROGRAM
CAN THEN IDENTIFY WHAT IT
THINKS THE RIGHT VALUE OF THAT
DRUG CAN BE CAN HOLD A PUBLIC
HEARING. ON THAT DRUGS AND
CONTINUE TO GO WITH THE
MANUFACTURER ROUND POTENTIAL
SUPPLEMENTAL BATES. IF ALL OF
THOSE NEGOTIATIONS FAIL- THEN
BASICALLY THE MEDICAID PROGRAM
REFERS THAT ISSUE THAT DRUG
THAT MANUFACTURE TO THE HEALTH
POLICY COMMISSION WEAR THEM WE
CONDUCT OUR OWN INDEPENDENT
OBJECTIVE REVIEW OF THE VALUE
AND PRICING OF THAT DRUG- AND
SO WE RECEIVED NOTICE NOT SO
DISSIMILAR FROM THE PROCESS
THAT I WAS JUST TALKING ABOUT
WHEN I TALK ABOUT. YOU KNOW
MERGERS AND PROVIDER CHANGES WE
RECEIVE A NOTICE AND THEN WE
CAN GET SIGNIFICANT WE CAN GET
OUR CONFIDENTIAL INFORMATION
FROM THE MANUFACTURER AROUND
THEIR PRICING THEIR BATES-
THEIR PRICES IN ARE ONLY.
THEY'RE RE AND DEVELOPMENT. ALL
OF WHICH THEN I FEEDS INTO OUR
OWN OBJECTIVE REVIEW TO TRY TO
UNDERSTAND IS THE PRICE OF THIS
DRUG ON REASONABLE OR EXCESSIVE
IN RELATION TO WHAT WE THINK
THE TRUE VALUE OF THE DRUG IS.
SO I'LL BE BASICALLY THAT AND
SAY WE THINK THAT THIS DRUG IS
POTENTIALLY ON REASONABLY ARE
ACCEPT CHRIST- THAT TRIGGERS
ANOTHER PUBLIC HEARING MORE
OPPORTUNITY FOR INFORMATION
SHARING BACK AND FORTH. AND
THEN FINALLY THE PROCESS AND
WITH US BEING ABLE TO MAKE A
FINAL DETERMINATION THAT A DRUG
IS EXCESSIVELY ARE REASONABLY
PRICED. I'M THIS IS OUR AREA
FOR THE HOUSEHOLD THE
COMMISSION. BUT WE THINK IT IS
VERY CONSISTENT. WITH OUR OTHER
MARK. FACTORS WERE REALLY.
BRING MORE ACCOUNTABILITY AND
TRANSPARENCY TO DO THIS THE END
IS. AND FIND YOUR- THE
RELATIONSHIP BETWEEN PRICING
AND VALUE. WE WANT TO THE RIGHT
YOU KNOW. AB THAT THE PRICE IS
WHAT THE MANUFACTURER HAS
PROPOSED- IN RELATION TO THAT
OUT. BY MADE YOU AT THAT PRICE
IS DOUBLE THE APPLE VALLEY THAT
PROVIDED DROUGHT WE KNOW THAT
AND UNDER THAT BE TRAINED.
ABOUT THAT. IN ORDER TO TOUR
THAT. THAT WERE. SOME ARE. WHY
SHOULD STATE FOLKS ON
HEALTHCARE COSTS FOR THE BILL I
THINK I WILL JUST AND REPEATING
MANY OF THINGS THAT HAVE
ALREADY BEEN SAID HERE TODAY-
FIVE AND THIS IS A TREND THAT
WAS I THINK THE VERY SIMILAR
SLIDE THAT WHERE YOU SHOWED
EARLIER TODAY THIS IS
MASSACHUSETTS DATA I HAVE TO
IMAGINE IF YOU READ HELP ME DAY
YOU WOULD FIND A VERY SIMILAR
STORY. EMPLOYEES PREMIUMS ARE
GOING UP EMPLOYER CONTRIBUTIONS
TO THOSE PREMIUMS ARE GOING UP.
CO PAYMENTS AND DEDUCTIBLES ARE
GOING OUT AT RAPID RAPID RATES
AND WAGE GROWTH AND INFLATION
ARE NOT AND SO WHAT THIS MEANS
IS JUST LAST AND LAST DOLLARS
IN THE HANDS OF OUR FAMILIES
AND INDIVIDUALS TO BE ABLE FOR
HELP. AND EVEN IN A VERY HIGH
INCOME STATE LIKE MASSACHUSETTS
AND EVEN WITH OUR RECENT
PROGRESS- WE HAVE WANTED FOR
MASSACHUSETTS RESIDENTS TO
REPORT THAT THEY DEFERRED
NECESSARYHEALTH CARE BECAUSE
THEY COULDN'T AFFORD THE COST.
WE HAVE ONE IN FIVE
MASSACHUSETTS RESIDENTS WHO
SAID THEY CAN GET UP TO FILL
BECAUSE THEY CAN AFFORD THE
COST. I'M CASES WHENCE TELLS OR
RATION THEIR PILLS OR SHARE
THEIR PILLS WITH ANOTHER FAMILY
MEMBER. CONTRIBUTING TO
WORSENING HEALTH. THIS IS THIS
IS SOMETHING THAT- ULTIMATELY
IMPACTS EVERYONE IN THE STATE
AND IT ALSO IMPACTS PEOPLE IN
IT IN NOT NECESSARILY EQUAL
WEIGHTS WE SEE THAT THIS IS
MOST IMPACTING OUR LOWER AND
MIDDLE INCOME FAMILIES- THERE'S
ONE BEARING THE BRUNT OF THIS
AND SO- YOU. THE RECENT
PROGRESS WE'VE MADE I WE LOOKED
AT THE TOTAL AMOUNT OF WAGE
INCREASES BETWEEN TWENTY
SIXTEEN AND TWENTY EIGHTEEN AND
WHERE DID ALL THAT MONEY WHERE
DID THAT WAGE INCREASE CO. MORE
OF THAT WAGE INCREASE WENT INTO
HEALTHCARE AND WENT INTO
PEOPLE'S POCKETS. AND YOU KNOW
I COULD SAY MAYBE THE STORY
WOULD BE MUCH WORSE BUT FOR OUR
EFFORTS I DO BELIEVE THAT. THIS
STORY WOULD BE WORST BY FAR
EFFORTS IN RECENT YEARS TO TRY
TO CONTROL HEALTHCARE COST
GROWTH. BUT THAT'S NOT TO SAY
THAT AND I'M NOT HERE TO SAY
MISSION ACCOMPLISHED I'M
BECAUSE THIS IS THIS IS AN
URGENT AND GENERATIONAL
CHALLENGE IF WE CAN SWIM DOWN
TO A REASONABLE DEGREE OVER
TIME. THE WORST PART OF THIS
DOLLAR THAT MEANS MORE IN THE
BLUE PART OF THIS DOLLAR AND
THAT MEANS A STRONGER AND
HEALTHIER- SOCIETY BEFORE. AND
THERE IS TO DO THIS AND TO DO
IT ONCE AND TO DO IT STILL
PROVIDES INNOVATION THAT STILL
PROVIDES ACCESS. AND THAT'S
REALLY THE FOUNDATION OF WHAT
WE'RE TRYING TO ACHIEVE AND
WHAT I HOPE THAT- CALIFORNIA-
YOU KNOW ALSO IS INTERESTED IN
PURSUING AND WE WILL BE THERE
AS A PARTNER IN A RESOURCE
EVERY STEP ALONG THE WAY. THANK
YOU THANK YOU VERY MUCH I THINK
RATHER THAN QUESTIONS LET'S
WAIT UNTIL. PHONE REPAIR FROM
BOTH PALACE I WOULD LIKE TO
KNOW SOMETHING YOU SAID- DAVID
AND I THINK WHICH IS IMPORTANT
IF I HEARD IT CORRECTLY AND
DOCTOR KING MIGHT BE ABLE TO-
CORRECT ME IF I'M WRONG BUT YOU
SAID ONE IN FOUR PEOPLE IN
MASSACHUSETTS. DELAY TREATMENT
BECAUSE OF COST BUT I HEARD HER
NUMBER CLOSER ONE TO ONE AND
TWO. OR. OKAY AND I THINK THAT
THE NASH I'M SORRY I THINK THE
NATIONAL NUMBER BUT I THINK
IT'S. I'M SORRY SO WHERE NEXT
BUT IT I THINK IF ONE TWO NOW.
SO YOU'VE YOU'VE CUT SO IF
YOU'RE WANTING FOR ANMESSAGE.
AND TO NATIONAL IS STRUGGLING-
YEAH THAT'S A THAT'S AN
ADMIRABLE NUMBER IN SOMETHING-
THAT THAT'S A LOT MORE THAN I
OPENING SO. MUCH APPRECIATED
THANK YOU. JEREMY THANK YOU DR-
WOULDN'T BY MEMBERS OF THE
COMMITTEE- FOR THE RECORD IN
GERMANY AND HIM THE DIRECTOR OF
THE HEALTH POLICY IN ANALYTICS
DIVISION FOR THE OREGON HEALTH
AUTHORITY- REALLY AN HONOR TO
BE HERE EVEN THOUGH- THE
BORDERS BETWEEN THE BOARD OF
TURNER STATES ONLY A COUPLE
HOURS FROM HERE- IT'S FAR- YOU
SHOULD HAVE BEEN MUCH MORE
OFTEN I THINK THAT WE'RE
SHARING THESE IDEAS ACROSS THE
STATE SENATE. EXCITED AND
HOPEFUL ROBERT FOR US CONTINUE
TO TRACK PROGRESS TOGETHER AND
LEARN FROM EACH OTHER OUR
GOVERNOR- LIKE DAVID SAID
ISRAEL TRUE BELIEVER STATES
BEING A PETRI DISHES OF
INNOVATION AND DAVID MANY HUGE.
I PARTNER AND A REALLY BEEN
GRACIOUS HIS TIME AS WE'VE BEEN
TRYING TO. EXPLORE THIS IS A
STATE AND WANT TO PAY THAT
FORWARD AND SO WE'RE HERE. TO
HELP AS WE WATCHES FOR AND WE
TOO ARE LAUNCHING A CROSSROADS
TARGET PROGRAM WE DON'T HAVE
THAT- KIND OF. RETROSPECTIVE
PERSPECTIVE OF- AND HAS IT
WORKED YET THAT AND THE DAVID
PROVIDES WERE SORT OF MID
STREAM OF LAUNCHING IT AND SO.
I WANT TO GIVE YOU A BIT OF
BACKGROUND ON OUT I WE DECIDED
TO GO THIS DIRECTION- KIND OF
WHERE WE'RE AT IN TERMS OF THE
IMPLEMENTATION PROCESS AND
WOULD LOVE TO HEAR. YOUR
FEEDBACK AND QUESTIONS AS
YOU'RE CONSIDERING THIS SO
JUST. JUST QUICKLY WITH THE
OREGON HEALTH AUTHORITY WILL-
IS A UMBRELLA- HEALTH CARE
AGENCIES IN TWO THOUSAND NINE.
THE LEGISLATURE REORGANIZED THE
STATE'S HEALTH VARIOUS HEALTH
CARE PROGRAMS INTO ONE AGENCY.
YEAH WE'VE BEEN REALLY- IN
OREGON- FOR SEVERAL DECADES
TRAINED- RUN DOWN OF A COURSE
OF GETTING PEOPLE GETTING.
READY ACCESS TO HEALTHCARE
COVERAGE AND TRYING TO MAKE
THAT AFFORDABLE AND HIGH
QUALITY. I'M AND HAVE HAVE
TRIED AS A STATE TO LEVERAGE
EVERY- POLICY TOOL ARE
PURCHASING TOOL THAT WE CAN TO
TRY TO- REACH THAT. THAT GOAL-
IN IN IN- NINE THE LEGISLATURE
TOOK A BIG STEP TO SAY LET'S
ACTUALLY REORGANIZE ALL OVER
HEALTHCARE PROGRAMS AND ONE
AGENCY. WITH THAT TRIPLING THE
AND- OTHER. BEING LET'S LET'S.
ONE VISION FOR A WE'RE GOING TO
HEALTHCARE IS A STAY AND THEN
USE THE STATE'S VARIOUS. GRAMS
AND- AND LEVER TO TRY THAT.
ACCOMPLISH THAT. SINCE MEDICAID
PUBLIC EMPLOYEES. OUR STATE
CATCH. THE DEEPER ALL WILSON.
I'M TO SEE RUN HEALTH POLICY
AND TEAM WITH THAT WE'RE
PERCEIVED. IN MEMBER HEALTH.
BOARD WHICH MAKES US A LITTLE
BIT UNIQUE. EIGHTY HA IS THE
LAW. HELL CARE PURCHASER IN THE
STATE OF OREGON- WE DIRECTLY
COVER ONE AND THREE OREGONIANS-
THE TWO BLUE SLICES HERE ARE. A
WHERE WE PROVIDE COVERAGE
DIRECTLY- SO MEDIC IT'S THE
BIGGEST PROGRAM WITH- 26% OF
THE STATE. GETTING CARE THROUGH
YOUR HEALTH PLAN OR MAY PRO.
PERCENT THE STATE ABOUT THREE
HUNDRED THOUSAND INDIVIDUALS
GET HEALTH CARE COVERAGE
THROUGH A PUBLIC EMPLOYEE
PROGRAMS THAT WE HAVE THAT
SERVE BOTH STATE EMPLOYEES WELL
AS SOME EDUCATORS AND SOME
LOCAL- SOME LOCAL GOVERNMENTS-
AND SO THOSE ARE THE AREAS
WHERE WE HAVE THE MOST LEVERAGE
ON THE MOST TOOLS BUT ABOUT A
LOT OF WHAT MIGHT MY TEAM DOES.
REALLY TRY TO SET THE OVERALL
HEALTH VISION WHERE WHICH TO
GET IN THE TWO WE HAVE THE
STATE IN TERMS OF- THE STATE
PROGRAMS- AS A AS A VEHICLE IF
YOU WELL TO TRY TO INFLUENCE
THE ENTIRE MARKET AND SO AS AS
CASA IS WE'LL TALK. IS FOR THE
ANNUAL WELL THE MORE. IS THE
SPREAD ARE GROWN OUTSIDE OF
STATE PROGRAM I'M REALLY FIGURE
OUT WHAT ARE THE TOOLS WE HAVE
AS A STATE THROUGH AND FOR THAT
SO BLURRY WHAT THE DIRECT
CONTROL WELL REALLY TRYING TO
GET FURTHER FOR THEIR OVER INTO
THE GREEN. WHAT'S THE PROBLEM
LIKE MANY STATES WE'VE BEEN.
TRYING TO FIGURE OUT TO GET
PEOPLE HEALTHCARE COVERAGE FOR
A LONG TIME- AND THEN FIGURE
OUT HOW TO MAKE THAT
AFFORDABLE- AND THANKS IN LARGE
PART TO THE AFFORDABLE CARE
ACT- WE ARE ABLE TO DECREASE
THE UNINSURED RATE IN OREGON
FROM ABOUT 15% TO SIX PERCENT-
AND THAT'S REMAIN PRETTY STABLE
94% OF ALL OREGONIANS HAVE
HEALTH CARE COVERAGE. ON THE
LEGISLATURE'S BUILT ON THE
AFFORDABLE CARE I. ADDED SOME
ADDITIONAL PROGRAMS- TO EXPAND
COVERED FURTHER- BUT LITTLE
OVERALL. LEVEL TO STAY PRETTY
PEOPLE ABOUT EIGHTY FOUR
PERCENT. OUR CHALLENGE RIGHT
NOW IS THE COP PRESSURE AND SO
WE'RE REALLY WORRIED THAT IF WE
DON'T GET COSTS UNDER CONTROL.
ORGANISED TO. BACKWARD
ORGANISED. THE STARTED BY
COVERAGE. YOU MUCH LIKE THE-
TALKED ABOUT. YOU KNOW WE'RE
STILL. SEATS TO SEE DATA AS
WELL AS SORT OF ANECDOTES OF
FOLKS SAYING. WORKS OR
EXPENSIVE FOR ME TO. PRE AND
THEN JUST OUT OF POCKET TO GO
TO THE DOCTOR SO THAT'S A- TO
ME A PRETTY. THE WAR SIGN OF WE
DON'T GET HEALTHCARE COSTS
UNDER CONTROL IN PREMIUMS UNDER
CONTROL. THEN WE'RE GONNA START
TO GO BACKWARDS HERE THIS IS
THE SAME CHART DAVID TO SHOW
YOU A SECOND AGO IN TERMS OF-
PER CAPITA SPENDING GROWTH- I
NATIONALLY COMPARING ALL
STATES- AND LOOKS LIKE A-
VALUES ARE SHOWING UP BUT-
ORGAN WAS THE FOURTH HIGHEST-
PER CAPITA. GROWTH RATE FROM
NINE TO FOURTEEN. THAT TEAL-
LINES CALIFORNIA- SO YOU'VE
BEEN DOING BETTER THAN US BUT
WERE WE'VE BOTH BEEN GROWING.
FASTER THAN THE NATIONAL
AVERAGE. WE ALSO HAVE AN ALL
PAYER CLAIMS DATABASE- AND THE
STATE I KNOW THAT'S- SOMETHING
THAT YOU ALL ARE WORKING ON-
AND THAT'S REALLY BEEN. ABLE
FOR US TO BE ABLE TO START TO
TAKE THIS TYPE OF DATA WHICH WE
GET NATIONALLY BUT IT'S PRETTY
OUTDATED. AND GET A REAL. MAN
FOR. MY WIFE. NO FROM THAT THAT.
AND MORE RECENTLY. WE'VE
ACTUALLY BEEN GROWING AT A RATE
OF CLOSER DOT SIX. CHANNEL
REALLY JOHN ON FOR. AND ON END
OF. AND A- IN THE STATE AND
THIS IS ORGAN DAY LIKE DAVID
SAID I WOULD SUSPECT THAT IF
YOU RAN SOMETHING SIMILAR YOU
PROBABLY SEE SIMILAR TRENDS IN
CALIFORNIA- THIS IS ALL
PUBLICLY AVAILABLE DATA AND-
HAPPY TO SHARE HOW WE DID THIS-
IF IT'S HELPFUL BUT- THE TAKE
AWAY HERE THIS COMPARES-
INCOME- GROWTH FROM TWO
THOUSAND TO TWENTY SEVENTEEN
COMPARED TO. PREMIUM GROWTH AND
THIS IS FOR PEOPLE WHO GET
COVERAGE THROUGH THEIR EMPLOYER
SO THIS IS JUST. PRIVATE
MARKETS- PREMIUMS WERE THREE
TIMES FASTER THAN WAGES-
WORKERS CONTRIBUTIONS GROUP
FOUR TIMES FASTER THAN WAGES
AND DEDUCTIBLES GREW TO FASTER
SO. WHAT THIS REALLY A QUITE
STEW IS A DOUBLE WHAMMY FOR
FAMILIES IN THE STATE. I'M AS
PREMIUMS ARE. GROWING AGAIN.
THERE'S FEWER DOLLARS FOR
EMPLOYERS TO PUT TOWARDS WAGES
AND IT. AND THESE ARE. OUR
YOU'RE SURE AT OF THEIR OWN
POCKET. THOSE COSTS KIND OF WAR
THE- AND IN A MORE YEARS FROM
TWENTY TEN TO TWENTY SIXTEEN.
INCOME GREW FIFTEEN PERCENT SO
I AM NOT SURE WHY IT. HASN'T
SHOWN A THE- HOUSEHOLD INCOME
GROWTH. PERCENT IN ORDER.
DEDUCTIBLES FOR SEVENTY SEVEN
PERCENT. AND THE AVERAGE FAMILY
PREMIUM EQUAL 29% OF AVERAGE
HOUSEHOLD INCOME SO. FROM
AMOUNT UP. SORT OF COMPENSATION
BENEFITS- TRAPPED IN HEALTH
CARE THAT AREN'T GOING TO
WAGES. GOING COULD. AND WHAT I
HEAR FROM. FROM STATE. RUNNING
WITH A WE LOSS PEOPLE BEFORE
HOUSING ALLOWS FOR RETIRED THE
LAW FOR A THINGS OF THINGS THAT
ARE ALSO UNFORTUNATELY THE PICK
ISN'T ALL THAT ROSE LOOKING FOR
OR FORWARD HEALTH IS X. TO GO
FROM ABOUT SEVENTEEN AND A HALF
PERCENT OF GROSS DOMESTIC
PRODUCT NATIONALLY TODAY TO
ABOUT NINETEEN AND A HALF BY
TWENTY TWENTY SEVEN AND THAT'S-
BASED ON THE AMOUNT IS
PROJECTIONS THAT ON AVERAGE
HEALTHCARE COSTS WILL GROW FOUR
POINT SEVEN PERCENT. PER CENT
PER YEAR THAT MAY NOT SOUND
ENORMOUS IT'S ALL IT'S A LOT
BUT IT IT'S THE KEY HERE IS
THAT IT'S GROWING IT'S FASTER
THAN ALL THE OTHER ECONOMIC
INDICATORS IT'S THROUGH AND
WAGES FASTER THAN THE ECONOMY
AND SO THAT THAT'S THE PROBLEM
IS KEEP THE DELTA BETWEEN TO
JUST GETTING BIGGER HERE. THE
CMS BREAKS ONE SORT OF WHAT
THOSE COSTS DRIVERS ARE IF YOU
ABOUT WHAT TOTAL SPENDING IN
THE STATE YOU CAN KIND OF BREAK
IT INTO TWO THINGS THAT'S THE
PRICE OF SERVICES THAT YOU PAY
AND IT'S THAT. THE UTILIZATION
THE NUMBER OF SERVICES THAT GET
PROVIDED YOU COMBINE THOSE TWO
YOU HAVE TOTAL SPENDING. YOU
CAN ALSO PICK APART- SORT OF
THE DEMOGRAPHICS SO HOW MUCH-
IS THE RESULT OF AN AGING
POPULATION AND THAT'S WHAT THIS
PIE CHART THAT SO- I THINK A
LOT OF FOLKS- YOU KNOW OFTEN
SAY WELL WE'VE GOT AGING
POPULATION AND SO THAT'S WHAT'S
DRIVING HEALTHCARE COSTS THAT'S
ACTUALLY ONLY SEVENTEEN
PERCENT. THE BASE COST DRIVER
IS PRICE INCREASES YOUR OVER
YOUR FIRST FOR SERVICES- ORGAN
IN CALIFORNIA HAVE HAD SOME
RECENT TRENDS IN THE SPACE THIS
SHOWS- THE DIFFERENCE. BETWEEN
PRICE AND YOUR POSITION FOR- IT
INPATIENT OUTPATIENT SERVICES
TOP LINES ARE INCREASE. PRICES
AND. IS MISSION WE'RE JUST HERE
N. N. O. THE TAKE AWAY HERE
THAT WE ACTUALLY BOTH STATES
HAVE BEEN DOING A GOOD JOB OF
THE YOUR- ASSUMING THAT WAS
GOOD DECREASES IN UTILIZATION
BUT FOR THAT PRICE HAVE BEEN
MORE THAN UP FOR THAT AND SO
THAT'S A- A BIG. A BIG
CHALLENGE THAT WE BOTH HAVE.
EDITION ONLY PRICES VERY VERY
DRAMATICALLY- THIS ALSO COMES
FROM OUR ALL PAYER CLAIMS
DATABASE WE'VE BEEN DOING IT
MORE MORE WITH THAT DATABASE-
AND THIS COST GROWTH TARGET
PROGRAM WILL REALLY TAKE THAT
TO THE NEXT LEVEL BUT- ONE OF
THE THINGS WE'VE BEEN DOING IS
PUTTING OUT AN ANNUAL REPORT
ON. VARIATION AND TYPICAL
PRICES- BY A HOSPITAL FACILITY
IN THE STATE AND SO JUST TO
GIVE YOU AN EXAMPLE OF. WHAT
THAT VARIATIONLOOKS LIKE- A
NORMAL DELIVERY AGAIN THIS IS
JUST COME FROM MARKET NOT
MEDICAID OR MEDICARE ONCE IN A
MEDICARE BUT NOT MEDICAID- THE-
THE RANGE OF. ALL DELIVERY
RANGES FROM THOUSAND DOLLARS TO
TWENTY THOUSAND DOLLARS THESE
ARE ACTUAL. PAID IN TWENTY
SIXTEEN SO. IN ORDER AGAIN PAGE.
I DO OF FOUR TIMES THE AMOUNT
BASED OFF OF WHAT HOSPITAL
FACILITY THEY HAPPEN TO WALK
THROUGH. AND THIS IS A REAL
THIS IS A REAL CHALLENGE WHEN
DEDUCTIBLES ARE NOW GROWING TO
THREE FOUR FIVE SIX SEVEN
THOUSAND DOLLARS. SO WHAT'S THE
SOLUTION AT LEAST THE SOLUTION
IN OREGON THAT WERE WHAT THE
WORD MARCHING TOWARDS- LET'S
THE SIMILAR TO MET TO
MASSACHUSETTS IT'S TO SET THE
STATE WIDE. CARE COST GROWTH
TARGET MUCH LIKE GLENN SAID AT
THE HIS OPENING REMARKS- I
THINK OF THIS IS SORT OF
STUDYING AND BUDGET TARGET FOR
TOTAL HEALTHCARE SPENDING- IN
THE STATE. WE DON'T WE DON'T
TYPICALLY AND STATES HAVE NOT
LOOKED AT WHAT THE TOTAL
HEALTHCARE SPENDING AS WE OFTEN
LOOK AT WHAT IT IS FOR MEDICAID
OR WHAT IS REPUBLICAN.
EMPLOYEES BUT WE LOOK AT THOSE
ALL ESTA SILOS AND THIS IS
REALLY. I THINK ABOUT SETTING A
BUDGET TARGET- AND THEN
STARTING HOLD OURSELVES
ACCOUNTABLE TO SAY HOW DO WE
LIVE WITHIN THAT BUDGET TARGET-
I AM MUCH LIKE MY- HI. I'M
HOUSEHOLD- MUCH LIKE MY- TEAM
WITH AN ORGAN HEALTH AUTHORITY
I HAVE A BUDGET I GOT A MANAGE
TO- SO I WOULDN'T KNOW HOW TO
DO THAT IF I FOR STUDENTS AT A
BUDGET AND THEN STARTED A
MEASURE MY SPENDING TO FIGURE
OUT WHETHER I MEDIAN OR NOT.
AND WE HAVEN'T BEEN DOING THAT
HEALTHCARE SYSTEM SORT OF LET
LET- FRANKLY ACTUARIES OFTEN TO
THOSE WITH THE HEALTHCARE COSTS
GOING TO GROW. WHAT WE ALL. BY
OF MY TIME ABOUT PRICE BEING A
BIG DRIVER AND JAMIE NOW. STOCK
OF THAT IS YOU'LL NOTE THAT WE
ARE TAKE WE ARE GOING TO ACOSTA
CARE APPROACH AND WE'VE STE.
THE WAY WE LANDED ON HIS
PROGRAM WAS WE HAD A TASK FORCE
AND- TWENTY SEVENTEEN THAT WAS
CHARGED WITH LOOKING AT. SHE WE
CREATE A MARYLAND STYLE
HOSPITAL RATE SETTING. UP
PROGRAM MARYLAND- SETS HOSPITAL
RATES FOR ALL MARKETS. NOT
STATEWIDE- WE LOOKED AT THAT
AND ULTIMATELY DECIDED THAT
WASN'T THE RIGHT COURSE FOR
ORGAN FOR A COUPLE REASONS. ONE
MARYLAND HAS A WAIVER THAT
NOBODY ELSE THINKS THERE SHOULD
BE ABLE TO GET. BUT MORE
IMPORTANTLY- EVEN THOUGH-
PRICES ARE CHALLENGE EVEN THE
HOSPITAL HOSPITAL PRICES IN.
RECENT YEARS HAVE REALLY BEEN A
CHALLENGE. THERE WAS A BIG
CONCERN THAT IF WE FOCUS ONLY
ONE PART OF THE SYSTEM. WE
MIGHT. OF THE DAY. WE'RE GONNA.
FROM NOW TRYING TO CHASE SOME
OTHER PROBLEM. WELL MEANWHILE
COSTS CONTINUES TO GROW AT
THREE OR FOUR FIVE OR SIX
PERCENT- SO THE GROUP GROUP
DECIDED TO- LOOKED AT WHAT WHAT
WHAT MASSACHUSETTS A DONE AND
DECIDED TO CREATE THIS-
SPENDING TARGET THAT APPLY- TO
TOTAL PER CAPITA SPENDING-
INCREASES YEAR OVER YEAR AND
WILL APPLY. ALL PAIRS AND ALL
PROVIDERS IN ALL MARKETS IN THE
STATE. GET THE WRONG IDEA HERE
IS THAT WE CAN BUILD MORE ON
THIS ONCE YOU HAVE THE DATA
ONCE YOU UNDERSTAND WHAT THAT
THE COST DRIVERS. THAT THEIR
POLICY THINGS THAT MAYBE
EVENTUALLY COMPLEMENT THIS. BUT
IF WE DON'T START TO UNDERSTAND
WHAT TOTAL SPENDING IS. AND
START TO HAVE A COMMON
UNDERSTANDING OF WHERE THE COST
DRIVERS. THEN WE'RE JUST SORT
OF. AT THE- SINCE I HERE AT THE
CREE UP. REALLY COMMON. OR
UNDER ANY PROBLEM ARE. SORT OF
IMBALANCE AND THE MORE IS JAMIE
MENTIONED EARLIER THERE'S BEEN
HUGE CONSOLIDATION. NORMAL
MARKET NEGOTIATIONS MARKET
DYNAMICS ARE HOLDING COSTS DOWN
THEY ARE HOLDING PRICES IN
CHECK. AND THE SYSTEM FRANKLY
IS FOCUSED ON REVENUE- IT'S
SHOOING FOR. INCREASES IN
REVENUE OR TRYING TO ITS
REVENUE TARGET AND NOT TO SAY
THAT THERE ARE. LEGITIMATE CASA
UNDERNEATH THAT. BUT WHAT WE'RE
FINALLY TRYING TO DO WITH THIS
TARGET IS TO CHANGE THE DOSES.
IN THE HEALTHCARE SYSTEM. LET'S
TOWARDS. ENTERS COLLECT WHAT.
MEETING A BUDGET THAT WE CAN
AFFORD AS A STATE AND WORK BACK
FROM THERE AND FIGURE OUT HOW
DO WE HOW DO WE DO THAT AND HOW
DO WE IMPROVE. VALUE IN IT AS
PART OF THAT OVERALL EQUATION.
JUST TO GIVE YOU AN IDEA OF.
KIND OF THE SQUEEZING THE
BALLOON CHALLENGE THAT WE THAT
WE HAVE AND WHY WE THINK THIS
TOTAL SPEND APPROACHES. IS
RIGHT FOR AGAIN- THIS SHOWS
CHANGES IN UTILIZATION A PRICE
FOR EMERGENCY ROOM VISITS
NATIONALLY SO. TO STILL LOOK TO
THE CHART ON THE LEFT- BLEW IS
A UTILIZATION GREEN A SPRITE IS
THERE IS A LOT OF EMPHASIS.
EIGHT EIGHT YEARS OR SO ON
GETTING. EMERGE ROOM IT'S THE
MOST. PLACE WHERE PEOPLE GO
WHEN OFTEN THE SYSTEM BREAKS
DOWN AND IN GET. SERVICE AND A
BETTER BETTER PLACE WITHIN THE-
SO WE GOT LUCKY ONE OF
EMERGENCY ROOM IT THEN WE'RE
WE'RE GONNA NATIONALLY AND THEN
WE'LL HAVE. PRICE RUMORED ROOMS.
COULD THE SYSTEM. AND GENTLY IN
OUR ERR MODEL THE KNOW IT. ALSO
ISN'T LOOK AT TRYING TO OUT HOW
TO HOW TO KEEP THIS OVER SPEND
WITH AND- A- ASK A SORT COST.
COST TARGET. SO WE'LL FOCUS ON
CAN'T WORRY PUSH UP. WERE RE
PUSH. A HOW DO WE- THE REVENUE
TARA THEY WERE SHE FOR AND FOR.
THIS SCREEN SHOT ON THE IS FROM
LOCAL PORTLAND AREA HOSPITAL I
TOOK IT FROM- WEBSITE. THE AD
THAT RAN ON THE ON THE SIDE-
ADVERTISING FOR THEIR SHORT
EMERGENCY ROOM VISITS AND
TRYING TO GET MORE PEOPLE IN
THERE SO THE SYSTEMS ARE SPOTS
THAT'S GETTING PEOPLE OUT OF
EMERGENCY ROOM WAS. WE SHOULD
GET MORE PEOPLE IN THE
EMERGENCY ROOM. IT'S THE WAY I
SCRIPT GET YOU KNOW WE REALLY
THINK THE CREATES A- GOAL. AND
TRYING TO GET PAIRS AND
PROVIDERS TOGETHER AND IT IS IT
IS ABOUT. ACCOUNTABILITY AND
TRANSPARENCY BUT THIS IS ALSO
ABOUT- COLLABORATION BOTH
WITHIN THE HEALTH SYSTEM FIGURE
OUT HOW THEY- HOW THEY WORK
TOGETHER TO ACHIEVE A GOAL. AND
IT'S ALSO AROUND- ON THE ON THE
POLICY SIDE HOW DO WE REALLY
TRY TO BRING FOLKS TOGETHER ON
A COMMON GOAL AND FIGURE OUT
WHAT THOSE POLICY LOVERS ARE-
THE OLD. FAMILY REDUCED COSTS.
SEEN THIS TO ASSIST IN TARGET
AND PICKING AN ECONOMIC
INDICATOR. THE HEALTH CARE.
LINE WITH. I'M THE GENERAL CAN.
WE'RE TRYING TO DO HERE IS TO
IS TO. CLOSE THAT DELTA NO. HOW
THE HELL. FASTENERS THE ECONOMY.
I'M WILLING TO TRY. IS JUST ON
A- HERE WE HAVE A LOT OF DATA
HAVE A DECEMBER HEALTH CARE BUT
WE STILL. TO BRING IT TOGETHER
TO TOLD. STORY OF WHAT'S GOING
ON THE HEALTH CARE SYSTEM. OUR
MEDICAID ACTUARIES ARE
OPERATING AROUND WHAT'S GOING
ON MEDICAID ARE. INSURANCE
ACTUARIES ARE LOOKING WITH
HAVING THE COMMERCIAL
INSURANCE. THEY ARE TALKING TO
ONE ANOTHER. SO I REALLY SEE
THIS AS A AS A WAY THAT WE
BRING INFORMATION TOGETHER. I'M
IN A MORE HOLISTIC FASHION AND
BILL INFORM THE PUBLIC AND
POLICY MAKERS. I'M AND
STAKEHOLDERS- WHAT WERE SEEN AT
THE CHALLENGES OF THE DAY- AND
THEN AS WE MENTIONED THIS. WEEK
WE HOPE THAT METAL ACOSTA. PRO
WE DROP OR THIS THEM AND FOCUS
FOCUS CHANGING THE WAY THE PAY
FOR HEALTH MOVING FROM FEES
SERVICE TO TOWARDS MORE TO
ACOSTA CARE CON THAT IMPROVE
QUALITY AS WELL AND WE'RE GONNA
BE LEFT FORCE TO DO THIS SO AT
THE TIME IN A MASSACHUSETTS
RHODE ISLAND AND- DELAWARE JUMP
THE GUN AND THE HOUSE THAT THEY
WERE LAUNCHING PROGRAMS- AND
THEN CONNECTICUT JUST ANNOUNCED
TO THE LAST COUPLE WEEKS AND
THEN- THERE'S A BUILT ON
WASHINGTON'S WILL. ENSURE FOLKS
ARE. THIS CON IS NOT ENTIRELY
NEW TO. DATE WE'VE ACTUALLY
BEEN STUDYING A PER CAPITA
TARGET FOR HEALTHCARE
EXPENDITURES FOR STATE PROGRAMS
FOR THE BETTER HALF OF THE LAST
DECADE- WE STARTED IN TWENTY
TWELVE- BY SETTING A THREE
POINT 4% TARGET WITH A-
PROGRAM- THE LEGISLATURE THEN
EXPANDED THAT TO- PUBLIC
PROGRAMS- SO. MUCH LIKE- DAVE
THE EXPERIENCE IN MASSACHUSETTS
SOME YEARS WE'VE MET THE TARGET
SOME YEARS WE HAVEN'T BUT
OVERALL WE HAVE REDUCE THE RATE
OF GROWTH IN THOSE PROGRAMS.
WE'VE GOTTEN FOLKS A LINE
AROUND THAT COMMON GOAL WE'VE
REALLY STARTED UNDERSTAND
DRIVERS- IN THAT- AND INVOKES
REALLY FELT LIKE NOW THAT. THAT
WE STAND ON THAT AND THE STATE
HAS TIED IT FELL. BUT AT THIS
TIME COST. GRAMS BEEN
SKYROCKETING SO THAT I HERE IS
TO IS A LITTLE BIT FOR ON OF
SET ONE TARGET NOW THAT APPLY
STATEWIDE AND HAD HOLD
EVERYBODY ACCOUNTABLE TO THE
SAME TARGETS NOT FAIR THAT I'M
STATE PROGRAMS ARE TRYING TO
REDUCE COSTS- WALL ALL OF OUR
HELD A TARGET IF WE WERE. WE
ARE SICK. AND WE ARE ABLE TO
GROW LET'S JUST SAY AT THREE
POINT 4% OUR STATE TARGET-
STATEWIDE IF WE REALLY ALL THE
TARGET ALL THE- ALL THE MARKETS
TO HIT THAT TARGET. THE
DIFFERENCE BETWEEN THREE POINT
4% AND THE FOUR POINT 7% THE
CMS IS FIRST PROJECTING. IS
TWENTY NINE BILLION DOLLARS FOR
THE COST SELECT NEXT EIGHT
YEARS. I REALIZE THIS IS LIKE A
ROUNDING ERROR IN THE
CALIFORNIA BUDGET- THIS IS A
SUBSTANTIAL AMOUNT AND IN I
THINK OF THIS IS LIKE A- A
MORTGAGE OR STUDENT LOAN-
INTEREST RATE. YOU KNOW
BRINGING THAT DOWN A HALF A
PERCENT OR SENATE- MAY NOT SEEM
LIKE A LOT ANY GIVEN MONTH BUT
OVER THE COURSE OF. AND THIRTY
YEARS IT'S- NORMAL. SO WITH THE
LEAD. IN PASS. LEGISLATION THIS
LAST. TO CREATE THIS FOR. AND
WE'RE CALLING SUSTAIN HEALTH
CARE COSTS GROWTH TARA PROBE
IT'S A MOUTHFUL BUT- WE THE
LEAST CUT ONE SYLLABLE OUT BY
MOVING FROM BENCHMARK TO
TARGET- THE LEGISLATION CREATES
THE GENERAL FRAMEWORK FOR THE
PROGRAM. TO BE RUN WITH AND-
THE ORGAN HEALTH OF. WITH
OVERSIGHT FOR MORAL POLICY
BOARD- AT AT IT IN THE BASIC
FRAMEWORK IS EXACTLY WHAT- WHAT
MASSACHUSETTS DOES A SET UP
TARGET MEASURE AGAINST IT- HAVE
A ANNUAL COST HEARING. OF AN
ANNUAL COST TRENDS REPORT- BUT
THERE'S A LOT OF KEY DECISIONS
UNDERNEATH THAT. THE
LEGISLATURE. AND IT STAKEHOLDER
INPUT ON. CREATED AND
IMPLEMENTATION COMMITTEE.
EIGHTY THANK. STOOD UP RIGHT
NOW THAT'S ME A NUMBER OF THE
MORE DETAIL OP. THIS ARE. HOW
THE PROGRAM ACTUALLY FUNCTION-
I KNOW OF NO OFFENSE TO OUR-
OUR FRIENDS ON THE EAST COAST
BUT IT WAS REALLY IMPORTANT IN
OREGON THAT WE- BOTH LEARN FROM
WHAT THEY'VE DONE BUT ALSO FOR
RECOGNIZE THAT. YOU KNOW
THERE'S DIFFERENT MARKET THAT
MAKES A DIFFERENCE STATE. WANT
TO BUILD THING THAT MAKES THE
MOST SENSE FOR WORK AND I THINK
THAT TO DAVID'S POINT THIS IS
SOMETHING THAT THE DOCTOR BULL
AND IN THAT SENSE IT DOES NEED
TO BE A ONCE. FITS ALL.
REQUIRED TO SPEND AN
IMPLEMENTATION. TO THE
LEGISLATURE IN SEPTEMBER OF
THIS YEAR AND THEN THE PROGRAM
WILL BEGIN INTO. AND TWENTY
TWENTY ONE. SO THEY'RE THEY'RE
THIS COMMITTEE IS TASKED WITH
THIRTEEN DISCREET DIFFERENT
THINGS THEY HAVE TO DO- I WILL
GO THROUGH. ALL OF THOSE BUT-
TO GIVE YOU A KIND OF A FLAVOR-
THEY HAVE TO SET THE INITIAL
TARGET AND FIGURE OUT WHAT THE
METHODOLOGY IS AND- HOW OFTEN
IT GETS UPDATED- THEY'VE GOT TO
FIGURE OUT WHAT DATA WE
ORDERED. AS A STATE WHERE
DIGITAL DATA WE MIGHT NEED AND-
AND- AND IT'S NOT JUST ABOUT
DATA BUT IT'S WHAT THE- WHAT'S
THE ANALYSIS THAT WE'RE GONNA
DO WHAT WHAT ARE. THE THINGS
THAT. MEASURE AND WE'RE- OUT ON
IT AND WE FOR. YOUR OUT. WHAT
DO. WE HAVE. WILL BE A DAY. BUT
THE IN. POLICE STRATEGIES ARE
OUR WHOLE IS TRAIN. AND CRAIG A
COMMON. IS A BUT ALSO. THAT
THERE USED TO BE SOME OF
SOMEONE FORCE IN ACCOUNT.
MECHANISM OUT THERE IF- IF WE
GET TO THE POINT WHERE FOLKS
AREN'T ME IN THE TARGET- AND
THE- LEGISLATURE IN OREGON- AND
THE TASK FORCE THE RICK
PERSONALLY RECOMMENDED THIS-
TOOK. LOOK MASSACHUSETTS HAS
AROUND A PERFORMANCE
IMPROVEMENT PLAN BUT WANTED TO
SEE IF THERE WAS MORE TOOLS WE
CAN BUILD ON IT. IN ADDITION TO
THAT. AND THEY GOT IN A FIGHT A
LONG TERM GOVERNANCE OF THE
PLAN. AND THEN- AND THEN
THEY'VE ALSO GOT FIGURE OUT HOW
WE'RE GONNA MEASURE QUALITY
AND- AND ACT AND EQUITIES.
EQUITY AS WELL. IDEA HERE'S WE
DON'T. THIS IS USUALLY ARE
TRAINING COSTS. WITHIN THEIR
WAITED AND- IN. COME QUALITY. I
CERTAINLY DO NOT WANT TO SEE
BACK. OR CREATE MORE IN A- IN
THE STATE WE HAVE A FORTY WE
THE LARGEST TO LAUNCH THE WHOLE
PRO WITH THE X. OF THE ENFORCED
AT PEACE THE BILL CALLS FOR.
THE STAFF THIS COMMITTEE TO
SUBMIT A LETTER A BILL IN
TWENTY TWENTY ONE- AND LARGELY
THAT WAS- BECAUSE THE GROUP
REALLY WANTED US TO FIGURE OUT
KIND OF WHAT'S OF A LARGER
ARRAY OF PRETEND WILL
ENFORCEMENT MECHANISMS THAT-
THE LEGISLATURE SHOULD. WE JUST
RUN THROUGH A COUPLE. TENS OF
WE'VE MADE TODAY I GUESS STILL
IN THE PROCESS OF BUILDING THIS
THING AND STUFF A LOT OF WORK
AHEAD OF US THIS YEAR- TWO
WEEKS AGO THE COMMITTEE MET AND
DID. THAT THE TARGET FOR THE
NEXT TEN YEARS. WINSTON PICK
THREE POINT 4% WHICH IS THE
TARGET WE HAVE FOR STATE
PROGRAMS- AFTER SEVERAL YEARS
OF DISCUSSION AND EVERYBODY'S
SAYING WELL WE'RE NOT GONNA
STUDENTS JUST THREE POINT FOUR
PERCENT. THAT'S EXACTLY WHERE
THEY LANDED- AND THEY ACTUALLY
LOOKED AT A WHOLE ARRAY OF
ECONOMIC INDICATORS WAGES AND-
INFLATION AND SCORE STATE
PRODUCT. AND ALL THOSE WERE
SORT OF IN THAT TOO. AFTER FOUR
RANGE TO THREE POINT FOUR. SEEM
LIKE A GOOD STARTING POINT- BUT
ALSO- SAID THAT IN FIVE YEARS
FOR. THE RESERVE A DEFAULT
REDUCTION 23% WITH THE IDEA
THAT- A GROUP SIMILAR. TO THIS
WILL COME TOGETHER. AND YOUR
FIVE AND FIGURE OUT THAT STILL
MAKES SENSE SO. I'M STARTING
THREE POINT 4% A TRUCK BUT
INSTEAD. INSTEAD DOWN OVER
TIME. THE TARGET WILL APPLY AT
FOUR LEVELS. THANKS BASIS SO.
SORT SPENDING THE STATE BY THE
BY TOTAL. TO MEET THE TAR OR
NOT. WILL MEASURE IT AT THE
MAJOR- MARKET LEVEL MEDICAID
MEDICARE COMMERCIAL. WILL
MEASURED AT THE ENSURE LEVEL SO
HOLD HEALTH PLANS THAT SERVE
EACH OF THOSE MARKETS. AND THEN
ALL MEASURE AT THE PROVIDER
LEVEL- THE PROVIDER LEVELS CAN
BE THE MOST COMPLICATED AND
THERE'S A VARIETY OF WAYS TO DO
THAT ME IN IT GETS A LITTLE.
COMPLICATED BECAUSE YOU HAVE TO
FIGURE OUT QUE WHICH PATIENTS
ATTACHED TO WHICH PER. ADS THAT
APPLY AT ALL FOUR LEVELS. OF
THE MARK THE SPENDING THAT'S
INCLUDED WHICH MARKETS-
MEDICAID MEDICARE COMMERCIAL.
BOTH FULLY AND- SHARED. NOT
THOSE THREE GODDESS ABOUT NINE.
TWO PROBABLY A FULL SPENDING A
WHOLE BUNCH OF THINGS OUT. OF
THAT PEOPLES- OVER THE COUNTER
SPEND- VA- TRY KERR- INDIAN
HEALTH SERVICES YOU KNOW
SEPARATE PROGRAMS THAT COUNTIES
AROUND LOCAL CORRECTIONS- SO WE
LOOKED AT A BUNCH OF THOSE
ULTIMATELY OR SIR SHOOTING FOR
IF WE CAN GET TO THE NINETY.
95% RANGE THAT'S PROBABLY
PRETTY GOOD- AND A LOT OF THE
STUFF BE ON THAT'S PROBABLY NOT
THE JEWS PROBABLY IS A WITH THE
SQUEEZE IN TERMS OF THE EFFORT
TO TRY TO. COLLECT THE DATA-
WE'RE GONNA INCLUDE THESE THREE
MORE ITS ROLE SO GETTING THE-
STATE- STATE CORRECTIONS. AS
WELL AS OUR STATE PSYCHIATRIC
FACILITY- AND- AND Vì ã
SPENDING BUT- SOME OTHERS LIKE
TRAVEL. MICHAEL WHAT IS CAUGHT
WHAT COUNTS TO ALL THEIR X.
THIS PROGRAM IS REALLY ABOUT
TRYING TO GET THIS. GET AT THE
SPENDING THAT'S HAPPENING ON
THE GROUND THE ULTIMATELY
IMPACTS PREMIUM SO WE- WE TRACK
PREMIUMS AND WE EVEN HAVE RATE
REVIEW PROCESSES FOR PREMIUMS
IN THE COMMERCIAL MARKET. THE
CHALLENGES PREMIUMS ONLY
REFLECT WHAT'S HAPPENING IN
TERMS OF SPENDING ON THE GROUND
SO THIS IS REALLY AROUND. THE
SPENDING GOING OUT TO PROVIDERS
AND INTO THE HEALTHCARE SYSTEM
IN A GIVEN YEAR- SO THEY'RE
SORT OF THREE MAIN BUCKETS
THERE'S- ALL OF THE CLAIMS ALL
ALL CLAIMS BASED PAYMENTS TO
PROVIDERS. ALL NON CLAIMS BASED
PAYMENTS PROVIDER SO IF THERE'S
A QUALITY BONUS OR SOMETHING
LIKE THAT WITH THE PROVIDER-
AND THEN WHAT'S CALLED NET
CAUGHT. COST OF PATIENT THERE'S
NOT COST OF. HEALTH INSURANCE
WHICH IS A WALKIE TERM FOR
BASICALLY AND- WHAT'S LEFT OVER
WITH THE INSURER AT THE END OF
THE YEAR AFTER THEY PAID ALL
THE CLAIMS WHAT WHETHER I MEAN
CAUGHT. MARGIN I KNOW BUT IT IS.
THE GROUP AT ALL GREETED FARM
REBAY FOR. SO IS THIS TALK
ABOUT HER PHARMACY ARE ARE
LOWER ISSUE THAT WE DON'T HAVE
A FULL LINE OF SIGHT IN TERMS
OF WHAT THAT ACTUAL NET COST IS
BECAUSE- A CLEAN GETS PAID
WITHIN A REBATE COMES BACK AND
SO THE IDEAS WILL CLICK WILL
START COLLECTING SOME AGGREGATE
PHARMACY RELATED INFORMATION SO
THAT WE CAN UNDERSTAND WHAT THE
TRUTH. THIS PHARMACY IS. I'M
OVERALL. THE COMMITTEE WILL
WRAP UP IN SUPPORT AND SIMPSON
THE REPORT TO THE LEGISLATURE'S
WELL AS- PROPOSE A BILL FOR
TWENTY TWENTY ONE- AND THEN WE
ARE PLANNING TO START- WITH
SORT OF A DRY RUN OUR FIRST
OST TRENDS HEARING THIS FALL.
IT WON'T BE TILL TWENTY TWENTY
TWO AND WE KNOW HOW WE DID IN
TWENTY TWENTY ONE. AND WE DON'T
WANT TO WAIT THAT LONG WE WANT
TO GET START TO GET IN THE
RHYTHM OF MEASURING COSTING
COST TRENDS AND START TO- GET
THAT RHYTHM OF HOW DO WE HAVE
THOSE COMMUNITY CONVERSATIONS
WE PLAN THAT. HAVE ARE FOR ONE.
SO THAT HAPPY TO ANSWER ANY
QUESTIONS. GREAT THANK YOU VERY
BOTH YOU- THE GLENN IS GOING TO
COME BACK AND- GIVE. A BUT KIND
OF A THE OVERVIEW OF THE TO
STAY AND THEN WILL THEM ALL OF
IT UP FOR. THANK YOU. YEAH IT
WAS ONE. OKAY THANK YOU FOR.
HELLO AGAIN SO I'M GONNA FILL
IN. SO YOU PUT THROUGH A COUPLE
OF OTHER STATE. MARYLAND IN
RHODE ISLAND SO A REVIEW
BRIEFLY THESE TWO OTHER STATES
WITH- COMMISSIONS MARYLAND IS
CLEARLY THE GRANDFATHER OF ALL
STATE COMMISSIONS DATING BACK
TO NINETEEN SEVENTY TWO- AND
STILL GOING STRONG THE WITH
MANY CHANGES AND THAT'S ONE OF
THE THINGS THAT WE SAW IN OUR
WORD IS THAT ALL OF THESE
COMMISSIONS HAVE VICE OVER
TIME. I THINK UNLESS IT IS NOT
IF WE DO IT HERE WE'RE NOT
GOING TO FIGURE OUT IN ADVANCE
WHAT THE BEST MODEL AND ALL THE
DETAILS ARE KIND OF THING THAT
AS WE LEARN LEARN AS WE GO
FORWARD- THE RHODE ISLAND IS
MORE RECENT BUT IT WAS
ESTABLISHED IN TWO THOUSAND
FOUR AND ALSO HAS EVOLVED WITH
CHANGES OVER TIME. AS SEVEN
COME. BOTH HAVE COME IS
APPOINTED BY THE GOVERNOR- IF
YOU HAVE DETAILED QUESTIONS
ABOUT MARYLAND WE ACTUALLY HAVE
A FORMER COMMISSIONER HERE WITH
US TODAY. BOB VERY AND HE COULD
PROVIDE A LOT MORE DETAIL THAN
I CAN I'M SURE. BOTH HAVE
EXTENSIVE DATA REPORTING
REQUIREMENTS WITH SUPPLEMENTAL
SUPPORT FOR A SENT THIS
ESSENTIAL FUNCTION. AND AGAIN
THE THEME OF DATA. JUST KEEP
BECOMES CLEARER AND CLEARER-
FROM EVERYTHING I HEAR AND READ
ABOUT THESE- FUNCTIONS.
MARYLAND HAS IT ALL PAY OUR
GLOBAL BUDGET SYSTEM FOR
HOSPITALS NOW SO THEY SAID A
GLOBAL BUDGET. BUT IT FOCUSES
ONLY ON HOSPITALS- IT HAS A
DIFFERENT SET OF POLISH POLICY
FOR RURAL HOSPITALS RECOGNIZING
THEIR DIFFERENT SITUATION OTHER
FACTORS THAT AFFECT THEM. THE A
THERE'S SEVERAL LIMITATIONS ARE
CHALLENGES TO- TO- THE GLOBAL
BUDGET FOLKSINGER HOSPITALS
WELL HOSPITALS ARE THE BIGGEST
PIECE ABOUT ONE THIRD IT'S ONLY
ONE PIECE OF THE PUZZLE RIGHT
AND ALSO SETTING HOSPITAL
BUDGETS IS A COMPLEX AND ALSO.
EXERCISE OFF WOULD CUT
REQUIRING LOTS OF VERY DETAILED
DATA ONE SO WHILE THE POLICY
ALSO FROM HOSPITALS PROVIDES A
MORE STABLE REVENUE SOURCE IT
ALSO IS SUBJECT TO THE
COMPLEXITY OF HOW DO YOU DEAL
WITH FACTORS YOUNG TROLL THE
HOSPITAL DOING ADJUSTMENTS.
THINGS LIKE THAT. MERYL HOWEVER
HAS THE BROADER SCOPE AS WAS
MENTIONED EARLIER IN TERMS OF
THE FACT THAT COVERS MEDICARE
AS WELL AS MEDICAID THIS IS DUE
TO ITS UNIQUE WAIVER FROM C.
EVENTS THAT MOST PEOPLE BELIEVE
OTHER STATES WOULD NOT BE WITH
ABLE TO. ACHIEVE RHODE ISLAND
MODEL IS A HEALTH INSURANCE
PREMIUM MODEL PLUS
AFFORDABILITY STANDARDS SO.
INITIALLY THIS MODEL FOCUSES ON
REVIEW AND APPROVAL OF PREMIUMS
BUT VERY QUICKLY AS YOU STUDY
YOU REALIZE IT GOES BENEATH.
PREMIUMS TO LOOK AT THE
UNDERLYING FACTORS THERE
DRIVING PREMIUM GROWTH WHICH IS
I THINK ESSENTIAL IF YOU IF YOU
IF YOU JUST LOOK AT PREMIUMS
LET'S. TRY TO PUT A CAP ON A
VOLCANO YOU'RE NOT REALLY
LOOKING AT THE FALLING LOVE
UNDER THE THAT'S GOING TO PUSH
THAT CAP. UP THE COME. THROUGH
RULE OF FOR. AND THEY
ESTABLISHED A STATE WIDE
SPENDING CAP AND- THEY INCLUDE
THESE AFFORDABILITY BETTER KIND
OF GENERAL LANGUAGE AS I
UNDERSTAND IT IN THEIR
LEGISLATION. WELL AS THIS GIVES
THE ABILITY THE COME TO MAKE
BROAD CHANGE THAT FLOW FROM
THESE AFFORDABLE FOR
AFFORDABILITY LANGUAGE. THAT
ALLOWS THEM TO REACH DOWN INTO
CONTRACTS BETWEEN HEALTH PLANS
AND HOSPITALS FOR EXAMPLE. AND
OTHER CHANGES THAT GET AT THE
UNDERLYING COST TRENDS THAT
ACTUALLY DRIVE PREMIUMS A
CLOSING COMMENTS I JUST HAVE A
COUPLE OF A SET OF COMMENTS
HERE. ONE IS IN STUDY THESE
OTHER STATES THE NUMBER OF
LESSONS OUR CURRENT SYSTEM.
NEARLY LACKS TRANSPARENCY AND
AS IS LOST COMPETITIVENESS
WHICH IS LEADING TO HIGHER
PRICES HIGHER SPENDING. SLOWING
COST GROWTH WILL BE VERY
DIFFICULT. I WITH WITHOUT THE
DATA I THINK IMPOSSIBLE. I KNOW
IN MY OWN RESEARCH WHEN I
PUBLISHED A PAPER THAT SOMEONE
DOESN'T LIKE THE FIRST THING
THEY SAY IS. YOU DON'T HAVE THE
RIGHT DATA. IT'S NOT THE RIGHT
TIME PERIOD OR IT'S JUST
CALIFORNIA OR WHATEVER BUT WE
DON'T WANT THE DEBATE TO BE
ABOUT THE DATA. WE NEED GOOD
THAT WE NEED TO AGREE ON WHAT
WE'RE DOING OUR MEASURING IT.
WE WANT TO DEBATE. ABOUT POLICY
WHAT TRADE OFFS FOR MEASURING
THESE TRADE OFFS CORRECTLY
ACCURATELY WITH AGREEDUPON
MEASURES. THAT WE CAN OF
MEANINGFUL WORTHWHILE DEBATE.
ON THE OTHER HAND. WE CAN WAIT
FOR EVERYTHING I THE- TO. MOVE
FORWARD AS AS STORE GATHERING.
START MAKE IT AVAILABLE AND
START THIS THIS THIS PATH OF
MAKING TRANSPARENCY GREATER FOR
OUR SYSTEM. AND THEN FINALLY WE
NEED TO DEVELOP. THE BENCH AND
BENT BENCH AND TRACK THEM
AGAINST MULTIPLE BENCHMARKS
RIGHT SO THE IDEA AFFORDABILITY
WE LOOK AT FOR EXAMPLE THANKS
MORE SORT OF TOTAL HEALTHCARE
SPENDING WELL THEY COULD BE
DIFFERENT TRENDS FOR DIFFERENT
SUBPOPULATIONS MEDICARE
MEDICAID- SELF INSURED
EMPLOYERS COMMERCIALLY SHORT
ALL OF THEM MAYBE STICK TO
SEPARATE DIFFERENT TRENDS A
DIFFERENT PRESSURE. THEN WE
POCKET SPENDING SO WITH MORE
COMPREHENSIVE MEASURES OF BOTH
COST AND AFFORDABILITY YOU'VE
REALLY GOT TO MAKE CHRIS- AND
THEN FOR ALSO WE NEED I THINK A
STRUCTURE THAT PROVIDES BOTH
INDEPENDENCE TO MAKE THESE ARE
DECISIONS AND A GREAT DATA TO
SUPPORT THEM BECAUSE THEY'RE
NOT GOING TO BE EASILY ACCEPTED
BY EVERYONE. THANK THAT'S
COMMENTS THANK YOU. THANK YOU
THANK YOU ALL VERY MUCH IF YOU
PLEASE STAY WE'RE GONNA HAVE SO
GAVE COME SPEAK TO HE'S GOT A
LITTLE BIT CRUNCH BUT- SO
MAKING COMFORTABLE STAY THERE
THERE'S THREE OTHER CHAIR SIDE.
CONFIDENT WILL. FOR ONE THAT
WOULD WORSE FOR BUT TO. THANK
YOU SO MUCH AFTER A FOR COMING
IN. AND THANK YOU FOR HAVING ME
THANK YOU CHAIRMAN WOULD
MEMBERS OF THE FOR LAW ME TO
HERE TO. AND FOR SUCH IN A
ISSUE THAT IS AS WE KNOW
INCREASINGLY AN ISSUE FOR
CALIFORNIANS AS OF REPORT TO IN
THE YOUR COMMITTEES BACKGROUND
PAPER IDENTIFIED THE KNOWLEDGE
THAT JUST A COUPLE WEEKS AGO
SEAT CF. HOW CALIFORNIA
HEALTHCARE FOUNDATION- DID AN
ANNUAL REPORT THE DEMONSTRATES-
THAT MORE THAN EIGHT OUT OF TEN
CALIFORNIANS CONSIDER HEALTH
CARE AFFORDABILITY EITHER AN
EXTREMELY ARE VERY IMPORTANT
ISSUE TO THEM AND SO THE LINES
WITH THIS TIMELY CONVERSATION
HERE AND- THE GOVERNOR AND THE
LEGISLATURE IS LEGISLATORS-
VISION TO REALLY CREATE A MORE
AFFORDABLE CALIFORNIA AND THE
HEALTH CARE. PART WELL WE KNOW
THAT COLOR HAS ENJOY A GRAY
ECONOMIC BOOM- WE STILL KNOW
THAT PLENTY OF CALIFORNIANS NOT
JUST THE MOST VULNERABLE AND
MOST IT COME BUT PLENTY OF
CALIFORNIANS IN THE MIDDLE. IN
THE SQUEEZE AROUND
AFFORDABILITY. AND AT THE COST
AND AFFORDABILITY OF HEALTH
CARE IS AN IMPORTANT PIECE OF
THAT. AND AS DRIVEN DRIVEN-
THIS ADMINISTRATION AND MY
AGENCY- REALLY LED BY- DR ALICE
TEN WHO'S HERE TODAY WITH US
AND HER GREAT WORK ON THINKING-
AND WORKING WITH A NUMBER OF
STAKEHOLDERS ABOUT HOW
CALIFORNIA CAN ACTUALLY. MOVE
THE NEEDLE HERE AND- WE ALSO
KNOW THAT THE- YOU KNOW MORE
THAN 51% OF CALIFORNIANS ARE
MAKING DECISIONS. ABOUT HEALTH
CARE BASED ON THE IMPACT WITH
COSTS. AND DAD I KNOW THAT
PATIENTS THAT I HAVE THE
PRIVILEGE TO TAKE CARE OF AS A
PHYSICIAN- DAYS CITY PARKING
LOTS OF- DRUGSTORES WONDERING
IF THEY SHOULD GET OUT AND
ACTUALLY GO PICK UP THEIR
INSULIN. OR THEY'RE OUT AND
HALLER. BECAUSE THE COPAY OR
THE COST OF CARE IS DISK INTO
HOT. I THINK CAL SHOULD BE S.
LIKE IT IS IN MANY OTHER AREAS
OF OUR ECONOMY WHERE THAT ISN'T
THE CHOICE THAT OUR NEIGHBORS
ARE FACING. AND THAT WE CAN AS
A STATE TO BETTER THROUGH THE
LEADERSHIP HERE IN SACRAMENTO
AND LOCALLY AT IDENTIFYING TO
WEAR THOSE LOVERS ARE TO
CONTROL THOSE COSTS AND MAKE
HEALTH CARE MORE AFFORDABLE.
LAST YEAR IN PARTNERSHIP
BETWEEN THE LEGISLATURE AND THE
GOVERNOR WE DID A NUMBER OF
IMPORTANT THINGS TO STABILIZE
OUR HEALTH CARE MARKETS IN
COVERED CALIFORNIA- WE ADDED
THE FIRST IN THE NATION
SUBSIDIES TO MIDDLE INCOME
CALIFORNIANS- ALLOWING PEOPLE
WHO FOR MANY YEARS IT MIGHT
HAVE BEEN OUT OF REACH FOR JUST
UNTHINKABLE. TO GET COVERAGE
pINDIVIDUALLY OR FOR THEIR
FAMILIES AND AS A RESULT IN THE
MOST RECENT NUMBERS WITH
COVERED CALIFORNIA WE'VE SEEN
OVER FOUR HUNDRED THOUSAND
PEOPLE- OUTSIDE FOR COVERAGE
THAT'S AN INCREASE OF 41% UP
FROM LAST YEAR'S NUMBERS THAT
HAD MANY OF THE MOVES
CALIFORNIA HAS MADE ARE WORKING
THAT THESE BOLD STEPS ARE ARE
IMPORTANT. BUT STILL THERE'S
MORE THAT WE CAN DO. AND THAT
LEADS TO- THIS MULTI PRONGED
APPROACH THAT THE
ADMINISTRATION IS RECOMMENDING
MANY OF THESE PARTS ARE
HIGHLIGHTED AND IN THE BUDGET-
PROPOSED BUDGET ARE READY
LOOKING AT A SUITE OF
ACTIVITIES AROUND PHAM PHARMACY
COSTS AND REALLY- HELPING BRING
TO THE ESCALATION OF DRUG
COSTS- DOWN IN CALIFORNIA WITH
IDA PASS THOSE ON TO CONSUMERS
WHO ARE TODAY AND TONIGHT GOING
TO BE MAKING THAT DECISION AS
TO WHETHER THEY WANT TO GO PICK
UP THAT EXPENSE MEDICATION.
THAT THEY KNOW ME CHANGED THEIR
LIFE AND CERTAINLY THEIR
HEALTH- TODAY I WANT TO FOCUS
ON ONE OTHER PART OF THE
PORTABILITY. THE OFFICE OF HELP
FORD ABILITY THE ADMINISTRATION
GOALS FOR DOING SURE OF FOR.
AND THAT IT AND OUR ABILITY TO
TRACK AND ADDRESS UNDERLYING
DRIVERS OF COSTS IN HEALTHCARE.
AND THAT WE MAINTAIN- IN OUR
LOOK AT THOSE COSTS A REAL
LASER FOCUS ON EQUITY ACCESS
AND QUALITY. ARE THE PRINCIPLES
OF DESIGN OF THE PROPOSED
OFFICE INCLUDE FOUR KEY THINGS
SALAS THEM NOW. FIRST SETTING
CLEAR OVERALL IN SPECIFIC
GROWTH TARGETS. APPLYING THOSE
TARGETS TO ALL SECTORS OF THE
HEALTH CARE SYSTEM PLANS
HOSPITALS PROVIDER GROUPS
EXCEPT FOR. CREATING
ACCOUNTABILITY THROUGH
ENFORCEMENT RANGING FROM
TECHNICAL ASSISTANCE TO
CORRECTIVE ACTION PLANS TO
FINANCIAL PENALTIES. AND
ENSURING AND VERY IMPORTANTLY
ENSURING THAT THOSE- THOSE
SAVINGS GO AND BENEFIT REAL
CONSUMERS AND THEIR HOMES TODAY.
SO ESTABLISHING THIS OFFICE OF
HEALTH CARE AFFORDABILITY IS
ONE OF A NUMBER OF STEPS THAT
WE'RE TAKING- PROPOSING TO TAKE
TO REALLY HELP CALIFORNIA GET A
HANDLE ON HEALTHCARE COSTS PART
OF THIS BROADER EFFORT TO MAKE
CALIFORNIA MORE AFFORDABLE FOR
MORE POIGNANT. AND WE LOOK
FORWARD TO THE CONVERSATIONS
THAT IT WE WILL HAVE YOUR TODAY
AND IN THE WEEKS TO COME AS WE
TRY TO DO THE BEST WE CAN THE
SUPPORT IS CALIFORNIA'S TO HAVE
BEEN AFFORDABLE AND GREAT LIFE
IS GREAT STATE. I'M I'LL AND
WITH THAT AND HAPPY TO THE REST
OF THE GROUP AND ANSWER SOME
QUESTIONS THANK YOU VERY MUCH
OF SECRETARY OF QUESTION IS.
FIRST OFF THANK YOU FOR THE FOR
YOUR- IN THE- PERSPECTIVE OF
THE OF THE- I THINK IT'S THAT
WE HEAR THAT AND THAT THEY AND
THAT WE KNOW. WE GET AN
OPPORTUNITY TO ENGAGE ON THAT-
BEFORE YOU GOT HERE MISTER
SECRETARY WE HAD- DISCUSSIONS
ABOUT- THE MASSACHUSETTS-
PLANET OR THE BATHROOM WAS
WORKING WITH WORKING IN OREGON
AND THAT KIND OF AN OVERVIEW OF
MARYLAND AND DELAWARE SO. SO
I'M AT A POINT RIGHT TO ASK
QUESTIONS YOU'RE WELCOME TO
STAY AND LISTEN. OR ASK YOUR
OWN IF YOU WISH- THE OKAY. SO
I'M GONNA START A AND USUALLY
THE ARE GONNA BE FOCUS MORE ON
ON ON ON YOU DAY THEN AND SO
YOUR YOUR TOP IS- IS THAT THAT
NUMBER IT IS ADJUSTABLE OVER
TIME IS IT IS IT'S NOT IT'S NOT
THAT FAR NUMBER IN LAW THIS
WORLD CHANGE OBVIOUSLY- SO IS
THAT IS THAT ADJUSTABLE. SO
THERE'S TWO WAYS IT IS
ADJUSTABLE ONE IS THAT IT IS
TIED TO THIS PROJECTION OF LONG
TERM ECONOMIC GROWTH AND THAT
IS SOMETHING THAT IS ACTUALLY A
FRACTION IN ANY BASIS IN THE
AND THE BRANCH. THANK GOD THAT
HAS THAT CHANGED THAT CHANGED
MUST OF YEARS THAT COULD BE
SOME THAT CHANGE. IN THE LAW I
DOUBT PER DOES PROVIDE THE
COMMISSION- SOME FLEXIBILITY TO
KIND OF ADJUST THAT BENCHMARK-
IN IN THE CURRENT YEAR WE CAN
WORK OUR POWERS LIMITED- WE CAN
CHANGE OF BETWEEN THREE POINT
1% AND THREE POINT SIX PERCENT.
WERE KIND OF CABINS- BY.
STARTING IN TWO THOUSAND AND
TWENTY TWO. THAT'S NOT THAT
LONG INTO THE FUTURE AT THAT
POINT THE LAW THEN ALLOW THE
COMMISSION AND THE BOARD TO SET
THE BENCHMARK AT ANY. AT ANY
RATE. AND SO THAT DOES REQUIRE
A PUBLIC PROCESS AND INPUT AND
ACTUALLY REPORT BACK TO THE
LEGISLATURE. I THINK PART OF
THESE WERE A COMPROMISE WERE
MADE ALONG THE WAY TO KIND OF
OKAY. HOW DO OVER TIME PEOPLE.
TRUSTING THE DATA TRUSTING WHAT
THIS IS STAN. HOW THE AGE PC
MAKES DECISIONS BEFORE KIND OF.
COMPLETELY OPENING UP OUR
ABILITY TO MAKE THOSE TYPES OF
ADJUSTMENTS HI SO KIND OF
ESCALATING- FLEXIBILITY. SO YOU
WHEN YOU COLLECT THE YOU YOU
CAN YOU COLLECT YOU GO TO YOUR
PROCESS TO THE YEAR IS THAT-
RESULTS OF THAT PUBLIC FOR
EXAMPLE SO THAT PEOPLE CAN
ACTUALLY SEE OR YOU IS OUT ALL
KEPT BEHIND THE SCENES SO THAT.
OTHER PLAYERS CAN SEE- THEY DID
BETTER THAN ME OR OR WHATEVER
IS IT OR IS IT IS A- KIND OF
HELD TIGHTLY WITHIN THE
ORGANIZATION. SO THE ONE PIECE
THAT IS CONFIDENTIAL IS THIS
IDENTIFICATION OF INDIVIDUAL
PROVIDERS IN INDIVIDUAL HEALTH
PLANS THAT HAVE IT. I COST
GROWTH- ABOVE THE BENCHMARK SO
THAT IS THAT IS HELD
CONFIDENTIAL ME DO NOT DISCLOSE
THE NAMES OF THOSE
ORGANIZATIONS ON THE LAST. WEEK
A LACK TO REQUIRE A PERFORMANCE
IMPROVEMENT PLAN. AT THAT POINT
THEN THAT ENTITIES NAME
PUBLICLY THEIR POSTED ON OUR
WEBSITE AND THERE'S A LOT OF
PUBLIC PROCESS TO THAT- I THINK
THERE ARE WAYS TO. APPROACH AS
I SAY THAT. HAVING THAT PROCESS
BE. FINANCIAL ALLOW FOR I THINK
I UNDERSTANDING THAT IN ONE
YEAR WITH ONE MAYBE A SMALL
PROVIDER THAT THEIR PATIENT
POPULATION CHANGED AND IT'S NOT
REALLY THROUGH ANY FAULT OF
THEIR OWN THAT THEY ENDED UP ON
THAT LIST AND YOU YOU KNOW YOU
MAY NOT WANT TO SAY HEY YOU'RE
ON THE YOU KNOW THE QUOTE
UNQUOTE- NADIE WEST- WHICH IS
NOT INTENDED TO BE BUT
OBVIOUSLY THERE'S A PERCEPTION
THAT IF YOUR NAME PUBLICLY. YOU
KNOW YOU YOU'VE DONE SOMETHING
YOU'RE NOT COMMITTED TO THE
VALUES AND THAT MAY NOT ALWAYS
BE THE CASE AND SO IT DOES
ALLOW FOR A LITTLE BIT OF KIND
OF A SEEKS A SAFE THOSE
COMMERCE TO OCCUR BUT AGAIN IF
THE BOARD DETERMINES THAT THERE
IS AN ISSUE THERE I A PROBLEM
AND THIS ENTITY IS NOT DOING
ITS PART OR COULD BE DOING MORE
TO CONSTRAIN HELP ACOSTA THEN
THERE'S THAT'S PUBLIC AND
THERE'S FURTHER ACTION TAKEN.
TO MENTION. YOU PARTNER WITH
PEOPLE. CAN USE OF GRAN TO HOW.
IMPROVE QUALITY WE'RE SOME
MONEY COME FROM FOR GRANTS. SO
WE ACTUALLY RECEIVED AS PART OF
OUR NATIONAL LEGISLATION- AN
INFLUX OF OVER A HUNDRED
MILLION DOLLARS- BASICALLY
FROM- AN ASSESSMENT A ONE TIME
ASSESSMENT ON OUR HEALTH PLANS.
ARE ARE HEALTH COMPANIES- SO
THERE IS A ONE TIME. INVESTMENT
THAT WAS PUT INTO A TRUST FUND
THAT THAT WE COULD USE. TO
DISTRIBUTE- AND GET THE MONEY
YOU KNOW. DISTRIBUTE MONEY TO
MAKE INVESTMENTS AND HOW DO YOU
ACTUALLY CHANGE THE DELIVERY OF
CARE- AND HOW WE WORK WITH
PROVIDERS TO DO THAT-
INCREDIBLE SUCCESS THROUGH THAT
THOSE PROGRAMS A- AND FOR
PROVIDERS WHO ARE NOT. YES THIS
IS. THE BIGGEST SUCCESSFUL.
PROVIDERS IS A- PRETTY HOT. IN
FAR FOR PARTS OF OUR SMALL.
THEY DON'T HAVE AN- TO. YOU
KNOW HUGE IN DOWN. OR RESERVES
AND SO IS THE WAY IT'S HOW CAN%
WE- SERVE TO MAKE SOME INITIAL
IN. IN ROLL AWAY. SO THAT'S
FROM WE INTEREST RATES OR
GAMING IN MASS. RECENTLY AND
THE CASINOS HAD TO MAKE A ONE
TIME- A LICENSE FEE SOME OF
THAT MONEY WAS DIVERTED TECH SO
IT WAS A ONE TIME KIND OF. YOU
KNOW KIND OF A- INVESTMENT. IN
THE FUTURE. SO HAVE YOU.
OBVIOUSLY YOU KNOW THINKING
THINKING YOU KNOW HEALTHCARE IS
A VERY- LABOR INTENSIVE-
INDUSTRY OBVIOUSLY I MEANING
YOU IT'S PRETTY HARD TO DO
HEALTH CARE WITHOUT HEALTH CARE
PROVIDERS SO DID IN IN THE
QUEST FOR PEOPLE TO REACH THEIR
BENCHMARKS DID YOU SEE ANY HAVE
YOU SEEN ANY KNEE JERK
REACTIONS THAT WILL JUST START
YOU KNOW WITH CERTAIN SOME
STAFF GO TO REDUCE OUR COSTS
AND GET INTO THE UNDER THE
UNDER THE BENCHMARKS IF YOU DID
YOU SEE ANY OF THAT. SO I
BECAUSE YOU DID MENTION YEAH-
OR SO SOMEWHERE MAYBE SOMEBODY
MENTIONED THAT THAT WAGES
HAVEN'T REALLY BEEN THAT WAY
JUST CONTINUE TO GROW SO I'M
CURIOUS DID YOU DID WAS A KNEE
JERK REACTION IN SOME IN SOME
SECTORS TO JETTISON EMPLOYEES
IT UNDER THE AGE MARK. NOW I
THINK THERE ARE. CIRCA WHERE
INDIVIDUAL PROVIDERS OF HAD TO
TAKE. YOU KNOW- MAKE SOME SOME
ADJUSTMENTS TO THEIR
ADMINISTRATIVE COSTS- BUT WHEN
YOU LOOK STATEWIDE AND YOU LOOK
ACROSS THE ENTIRE SECTOR OUR
HEALTHCARE WORKFORCE IS GROUND-
OVER THIS PERIOD OF TIME- AND
CONTINUES TO BE A BACKBONE OF
THIS SO WE DO NOT SEE ANY
SYSTEMATIC RELATIONSHIP BETWEEN
THE TWO AND THAT IS NOT
SOMETHING THAT THE PROVIDERS.
NECESSARILY TELLING US. NOW
UNDERSTANDING THAT LABOR IS A
PRESSURE AND CERTAINLY
SOMETHING THAT AS IN. A TINY
MARKET THERE THERE CERTAINLY
ARE RAISING TO US. BUT WE'VE
ALSO SEEN OUR WORKFORCE CHANGE-
THAT'S A REALLY IMPORTANT PART
OF THIS TO- WARNER
PRACTITIONERS MORE LICENSE
CLINICAL SOCIAL WORKER. WITH
WORKERS CLINICAL AND NON CLICK
STAFF ALL WORKING TOGETHER IN
MULTI DISCIPLINARY TEAMS TO TRY
TO BUY CARE SO THAT THE
WORKFORCE IS CHANGING AT THE
SAME TIME. THAT'S NOT TO SAY
THAT WE DON'T HAVE A BIG
CHALLENGES ESPECIALLY IN THE
BEHAVIORAL HEALTH CARE
WORKFORCE- AND THAT'S SOMETHING
AND IN PRIMARY CARE- AND I DO
WANT TO MENTION JUST ONE
INNOVATION THAT ARE GOVERNOR'S
PROPOSING. AS WE TAKE THIS
EXPERIMENT MOVING FORWARD.
HOWEVER HE IS PROPOSING THAT
FOR THE NEXT PHASE OF THIS THIS
AFTER. THAT WE STILL KEEP OUR
THREE POINT 1% ANNUAL TARGET.
BUT THE FACT THAT WE ACTUALLY
SET SUB TARGETS FOR GROWING
SPENDING IN AREAS LIKE PRIMARY
CARE AND BEHAVIOR HEALTH CARE.
AREAS THAT HAVE BEEN UNDER
INVESTED IN HISTORIC. LEGAL YOU
HAVE. HOUSE STRONG. ACCESS
YOU'RE GONNA HAVE A AND
STRONGER SO. WE TALKED A LITTLE
BIT EARLY ABOUT THAT ADDED TO
THAT OF ALL THE OCCURRING IN
THIS IS ONE OF NEW I. THAT IS
OUT THERE IS TO SAY IT'S A YES
KEEP THE TOTAL TARGET. BUT
LET'S TRY TO MAKE SOME
INVESTMENTS IN AREAS THAT WE
THINK ARE GOING TO PROVIDE THE
GREATEST AMOUNT OF VALUE IN THE
LONG TERM- SO THOSE ARE THAT'S
ONE EXAMPLE OF A NEW INNOVATION
AND A NEW EVOLUTION. CAL COULD
THINK ABOUT THIS IS YES HAVING.
A BIG TARGET- YOU KNOW A BIG
STATEWIDE TARGET BUT HAVING AS
GLENN SAID THOSE SUB PAR GET
SICK YOU'RE TRACKING WHERE THE
DOLLARS GOING WHERE. WHERE ARE
THOSE INVESTMENTS HAPPY AND
THERE ARE THEY GOING IN THE
PLACES WE MOST WANT THEM TO. WE
THOUGHT A LOT OF FLEXIBILITY TO
BEGINNING WAS IMPORTANT. BUT
OVER TIME I THINK THE SCIENCE
AND EVIDENCE A SHOWN. I AREAS
LIKE THEIR HEALTHCARE AND
PRIMARY CARE UNLESS. UNLESS
SOMETHING ABOUT THE SYSTEM
CHANGES THERE JUST NEVER GONNA
GET THAT KIND OF MONEY THAT
DESERVE. WELL AND I THINK WE-
WORLD. THAT OTHERS OTHERS. CAN
AND SYSTEMS THAT HAVE I'M A
UNIFIED PUBLICLY FINANCED
HEALTHCARE SYSTEM. HAVE MORE
PRIMARY CARE PROVIDERS MORE
MENTAL HEALTH MORE THE SOCIAL
SAFETY NETS. WHICH IS LEADING
TO HIGHER AND BETTER HEALTH
OUTCOMES FOR LESS MONEY. AND SO
I AM I'M ENCOURAGED THAT THAT
YOU'RE THAT THAT YOU'RE AS THE
USE A STATE OF BEGINNING TO
FOCUS ON THAT ONE WORK. I. ON
THAT I UNDERSTAND MR THANK YOU
SO MUCH FOR BEING HERE MUCH
APPRECIATED YOUR YOU TALK TO
PRE. REVIEWS SO WHEN YOU YOU
ARE YOU KIND OF OVER. YOU'RE
YOU'RE LOOKING AT THE THINGS
THAT- JAMIE WAS TALKING ABOUT
YES- WITH THE MERGERS AND THOSE
THOSE RECOMMENDATIONS- CAN GO
ALL THE WAY. TO THE ATTORNEY
GENERAL THAT'S CORRECT. OKAY
ANY MENTION DRUG REVIEW SO-
WHICH I. ASKED TO CONTINUE ON
THAT BECAUSE I WAS COMING IN
PORTLAND ME. HOWDY HOW OF THESE
HAVE THESE WORKED OUT- WHERE DO
THEY WERE THESE END UP GOING
YOU KNOW- WE THINK OF I THINK
OF YOU KNOW I JUST YOU YOU
MENTIONED YOU MENTIONED THE
SPIKE IN COST THIS OF ALL THE-
I THINK OF THE HIGH COST IT
SEEMS TO BE RATHER SUSTAIN AND
CONTINUE TO GROW RUN INSULIN
YEAH- SO WHEN YOU'VE DONE THESE
INFORMATION GO AND WHAT'S THE
OUTCOME THAT MIGHT. SO I'M- WE
HAVE NOT HAD ONE OF THESE OF
THESE THAT WE LITERALLY JUST
GOT THIS AUTHORIZATION. OUT
LAST AND THE END OF LAST YEAR
WE'VE JUST PUT FORWARD OUR
REGULATIONS AND SO ON THIS IS
STILL NEW FOR US SO I WILL BE
HAPPY TO REPORT BACK. TO YOU
ABOUT HOW THIS GOES I AND I
WOULD LIKE TO JUST SAY TO KIND
OF MAYBE HAVE IT AND ADD TO
THAT- WE DO. THINK THAT- IT'S
REALLY IMPORTANT TO HAVE ALL
THE DIFFERENT PIECES OF THE
PIPE UNDERNEATH THIS TENT I'M-
AFTER AND THAT WAS NOT
SOMETHING THAT. IN THE IN THE
LEGISLATION- THE PHARMACEUTICAL
INDUSTRY WAS WAS EXTENSIVELY
INCLUDED IN THIS WAY PROVIDE. A
PLAN. IN AND I JUST NEED THE
FACTORS I REALLY MEAN KIND OF
THE END. SO CHAIN FROM THE MAN.
TO THE PD. TO WHOLESALE. WE
REALLY SUFFER FROM A LACK OF
TRANSPARENCY ACROSS THAT
ENTIRE- CONTINUE ON- AND I AND
HAVE REAL CONCERNS ABOUT ARMY-
ARE ARE WE TRULY GETTING VALUE
OUT OF EVERY PIECE OF THAT. AND
SO- AGAIN- AS WE THINK IT KIND
OF NEXT EVOLUTION OR- IF I WAS
TO GIVE YOU SOME ADVICE ON
SOMETHING THAT WASN'T
NECESSARILY ON OUR RADAR TWO
THOUSAND ALTHOUGH IT'S VERY
MUCH ON OUR RADAR TODAY. THIS
IS A WE MAKE SURE THAT ALL OF
THESE DIFFERENT IMPORTANT
SEGMENTS OF THE BY ARE BEING
HELD TO. THE SAME STANDARD TIME
PARENTS CANNOT BE. AND HOW TO
GET AND WROTE IN THE STATE IRAQ.
YEAH ONE PIECE IS GOING IN COME.
FROM DIRECT. WE'RE NOT BE
SUCCESSFUL. BUT WE DON'T BOUNCE
WAY BECAUSE ONE. NATION ME THAT
BY BEING. AND I'M SIXTY. EIGHT
MEN OUT ARE WASTED. ABOUT THAT
YOU CAN ACHIEVE MORE GOALS.
THANK YOU FIX MUCH. SO JEREMY.
DO YOU SEE IF YOU SEEN SOME OF
THE. OUR NATION'S. IN YOUR THAT
HAVE LED TO. THE MAIN YOUR YOUR
CAR OF. OR YOU KNOW YOU GROWTH
RATE WAS CERTAIN HI THAN CAL.
SO WHAT IT WHAT WILL WHAT WAS
FUELING WAS FEW THAT AND AGAIN
AND WHAT WHAT DO YOU AT WITH
YOUR WITH THE NEW. AUTHORITY
THAT YOU YOU KNOW. IF FRANKLY I
THINK LOOK AT THAT TWO THOUSAND
TO TWENTY. DID THIS DESTROY IS
WITHOUT A COST GROWTH TARGET
PROGRAM WE'RE COLLECTING MORE
DETAILED DATA WE DON'T KNOW
EXACTLY WHAT WAS FEELING THAT-
AND SO ARE OUR HOPE IS THAT
GOING FORWARD WE WILL
UNDERSTAND YEAR AFTER YEAR-
WHAT IS WHAT IS. REALLY PART OF
THAT RIGHT NOW SIX AND A HALF
PERCENT OF. THREE POINT 4% OR
LESS GOING FORWARD WHAT IT
REALLY IS UNDERNEATH THAT THE
HOOD THERE- AT. WE HAVE A WE DO
HAVE A FAIRLY HIGH- THE
CONSOLIDATED MARKET- YOU KNOW I
THINK. IT'S BEEN LEFT IT'S LESS
SO THAT IT'S OCCURRED IN THE
LAST FEW YEARS AND MORE SO
HAPPENED BEFORE- BEFORE THAT-
WE- WE DEFINITELY SEEN SOME
CONSOLIDATE AND WE STILL HAVE-
YOU KNOW. IT IT'S A LITTLE IT'S
A LITTLE HARD TO COMPARE ITSELF
NATIONALLY BECAUSE LIKE
EVERYTHING'S CONSOLIDATED. SO
WHAT LEVEL OF EXTREME
CONSOLIDATION ARE YOU- SO WE'RE
NOT AS EXTREMELY CONSOLIDATED
IN THE PORTLAND AREA AS MAYBE
SOME OTHER PLACES BUT WORSE
THAN SOME OTHERS. BUT OUTSIDE
THE PORTLAND AREA LARGELY IT'S
ONE. HOSPITAL COMMUNITIES AND
IN A LOT OF THOSE COMMUNITIES
THEY HAVE ACQUIRED- THE LOCAL
PROVIDER GROUP- AND SO THEY DO
OPERATE IN LARGE PART. AND IT
IS NOT UNIVERSAL THAN A LARGE
PARTS OF THIS. IS A HEALTH. HAS
AS MEDICAL GROUP IN THE AND THE
X. SEVERAL HOSP IT.
INDEPENDENCE RIGHT AREAS SO I.
HAVEN'T SEEN AS MUCH OF A
SELECTION AND WE'LL SEE YOU.
I'M IT. STARTED CONSOLIDATED
ESPECIALLY OUTSIDE. SO YOU
DON'T SEE THIS IN OF CARE IN
RURAL FOR LARGE WE ASK DO WE
ASK DO PRICE ANNIE THIS IS
WHERE WITHOUT PROBABLY THE OF
AT OCCURRED IF I'M WRONG PRICES
ARE LOW LOWER IN THE PORTLAND
AREA WHERE WE DO HAVE
COMPETITION- AND THEY GET
HIGHER AND HIGHER AS YOU GET
FARTHER AND FARTHER AWAY FROM
THE PORTLAND AREA TO RURAL
COMMUNITIES SO THAT THE COSTS
ARE DEFINITELY HIGHER AND THE
RURAL COMMUNITIES YOU KNOW AND
SOME OF THAT IS. YOU KNOW
SERVICE DELIVERY IS MORE
EXPENSIVE IN SOME PARTS OF THIS
COMMUNITY SO WE HAVEN'T REALLY
LOOKED UNDER THE HOOD TO SAY
WHY EXACTLY BUT WE DO RECOGNIZE
EVERYBODY SORT OF STARTING FROM
A DIFFERENT POINT- BUT GOING
FORWARD EVERY THE IDEAS OF WHAT
HE'S GONNA BE HELD AT THE SAME
TARGET AND THAT WE THEN
UNDERSTAND MORE AND MORE OVER
TIME WHAT DRIVERS UNDER THE
HOOD SO WE CAN EVALUATE MORE
POLICY OPTIONS POTENTIALLY FOR
WHAT WE DO COLLECTIVELY TO GET
THAT THOSE COSTS- AND I WILL
JUST SAY I THINK. THAT IS AN
AREA WE HAVE TO IS THE UNITY OF
THE HAS GOT SO WE'RE GONNA I
HIGHLY ANTICIPATED WILL MAKING
SURE WE ARE READING ABOUT ANY
SORT OF AN INTENT TO QUINCY
LAND ROLE COMMUNITY- ME WE'VE
GOT VERY HERE PARTS OF THE
STATE- FOLKS. YOU'VE GOT PARTS
OF CALIFORNIA SIMILAR THE RHINO
VERY FROM AND SO THE MARKET DAM
ARE JUST VERY DIFFERENT THAN IN
THE POOR AREA SO ONE OF THE ONE
OF THE REASONS WE LIKE THIS
GROWTH TARGET A PRO IS IT IS
RECOGNIZE EACH COMMUNITIES
COMING TO THE TABLES WITH A
SORT OF DIFFERENT SET OF
DYNAMICS HAVE YOU KNOW THAT
MAKE IT TO THEIR AFFILIATED
WITH SOME HAVE SIGNIFICANT
PROVIDER SHORTAGES AND ALL OF
THEM HAVE PROVIDER CHALLENGES
BUT THEY'RE NOT THE ANSWER THE
SAME IN EVERY COMMUNITY SO
RECOGNIZE AND EVERYBODY'S
DIFFERENT SET OF CONTACTS AND
CIRCUMSTANCES. WILL NOT GET IN
THE WAY OF THE WORLD COMMITTED
TO A GOAL RIGHT WE'VE GOT A
REDUCED THE RATE OF GROWTH AND
READ THE THERE DIFFERENT
CHALLENGE COMMUNITY AND IT'S
ALSO. GET THEIR ARE YOU CAN GET
THERE BY PRICES YOU GET THEIR I.
VALLEY AND TRY. THINGS YOU FOR
THE US. I WOULD JUST THAT I
THINK ONE OF THE YOU KNOW ONE
THAT. THE BENCHMARK THE GO
MENTAL PRESENTS IS THAT THERE
IS ENOUGH MONEY PLAYING FIELD
TO BE WITH THAT DIFFERENT
PROVIDERS ARE PAID DIFFERENTLY
FOR PROVIDING THE EXACT SAME
TYPES OF SERVICES SIMILAR TYPES
OF PATIENTS. AND A LOT OF THAT
VARIATION IS DRIVEN BY THEIR
MARKET LEVERAGE. SO ONE OF THE
WAYS THAT WE'VE WE'VE SOUGHT TO
ADDRESS THIS THOUGH. IS THAT
WHEN WE'RE LOOKING WHEN WE'RE
AT THE KIND OF THE- ENFORCEMENT
STAGE WHEN WE'RE CONSIDERING AN
ENTITY. FOR OP PERFORMANCE
IMPROVEMENT PLAN WE REALLY LOOK
AT THAT THE HOLD. SIR CONTACTS
OF THAT ORGAN XIN. AND SO YOU
COULD SEE IT WE HAVE HAD
CIRCUMSTANCES WHERE YOU KNOW IF
THIS IS A HISTORICALLY LIKE
VERY LOW PRICED PROVIDER. THAT
TREATS YOU KNOW A LOT OF PUBLIC
PATIENTS IN IN A REALLY
VULNERABLE PART OF OUR STATE.
AND THEIR COST GROWTH WAS FOUR
PERCENT. WE MAY THINK VERY
DIFFERENTLY ABOUT THAT PROVIDER
THAN HISTORICALLY VERY HIGH
PRICE PROVIDER THAT- ONLY
TREATS COMMERCIAL PATIENTS AND
WAS YOU KNOW. YOU KNOW. DOING
EXCESSIVE MANAGING ADJUSTING
I'M I'M I'M KIND OF. USE A
HYPOTHETICAL HERE BUT THE
CONTEXT HOURS HERE AND SO ARE
THOSE ARE FACTORED THAT CAN.
BEAR INTO THE JUST OF WHETHER A
PERFORMANCE IN PLAN. IS
WARRANTED OR NOT IT'S NOT A
CLEAR FORMULA THAT JUST SAYS AX
PLUS WHITE WE'LL SEE. YOU TAKE
INTO ACCOUNT WHAT ARE THESE
ORGANIZATIONS WHERE THEY
SITUATE WHAT POPULATIONS TODAY
SIR WHAT ARE THEY DOING AND-
HOW THEY MAY PASSED INVESTMENTS
AND ALL THIS CAN GO INTO KIND
OF THIS THIS KIND OF REVIEW.
AND AS I SAID- EVEN HAVING
THOSE CONVERSATIONS WITH
ENTITIES WITH PROVIDERS- CAN
CHANGE BEHAVIOR IN AND OF
ITSELF- BECAUSE THEY SAY THAT'S
A THAT'S AN INTERESTING I NEVER
REALLY THOUGHT ABOUT. LOOKING
AT MY OWN ORGANIZATION THAT WAY
I CAN SEE WHERE THAT MIGHT BE.
WHAT YOU KNOW TROUBLING- IN
TERMS OF THE GREATER GOAL OF
MEETING THE BENCHMARK AND SO. I
GET WHETHER YOU BUILD THAT AND
KIND OF THE OUTSIDER WHERE YOU
HAVE AN OF THE FOOT. IN REVIEW
IN THE ACCOUNTABILITY MEASURES
YOU WANT YOU WANT TO BRING IT
BACK THAT CONTEXTUAL
INFORMATION. BECAUSE WE DO
THINK IT'S IMPORTANT. SO
MASSACHUSETTS IS A IS A
INDEPENDENT AND ORGANISE UNDER
THE OREGON HEALTH AUTHORITY
MARYLAND AND DELAWARE ARE
COMING. GOVERNMENT AGENCIES
THEREUNDER SO. SO THREE THREE
TO ONE HERE- ON THAT SO I BUT I
YOU KNOW I I'M CURIOUS I'M
CURIOUS- BUT PERSONALLY I WILL
I WILL SAY I HAVE A BIAS I'M
AYE I WOULD PREFER TO SEE AN
INDEPENDENT ENTITY- I THINK IT
WOULD BE IT KEEPS THE POLITICS
OUT OF IT- ULTIMATELY
RECOMMENDATIONS WE HAVE AN LA-
WE HAVE A RIDE WHICH ARE NON
PARTISAN- BUT THAT'S YOU KNOW
THAT'S THAT'S THAT'S A THAT'S A
PERSONAL PERSONAL BIAS- IS OR
AGAIN. HARD FAST ON ON STATE
WITH THEIR OR IS IT JUST IT
JUST THE WAY OUR SYSTEM WORKS-
THE AT THE WAY THE LEGISLATION
IS RIGHT NOW ISN'T IT SAYS IT
WILL BE RUN BY- HA IN
COLLABORATION WITH- WITH THE C.
B. S. A SEPARATE AGENCY THAT
DOES OUR INSURANCE REGULATION-
AND WITH OVERSIGHT FROM THIS.
THIS BOARD WHICH IS A GOVERNOR
APPOINTED- BUT IS- CITIZEN
BOARD THAT'S THAT'S LAID OFF
WITH INDEPENDENT- AND SINCE
THEY ARE. EMPLOYEES OF THE
AGENCY- IT'S THAT'S A LOS THAT
LEGISLATION RIGHT NOW IN THE IN
THE GROUP DOES HAVE TO COME UP
WITH THE GOVERNMENT'S PLANS OF
THEIR SUMMERS MAYBE THEY COME
BACK WITH SOMETHING. DIFFERENT
THAN THAT BUT I THINK THERE'S
ALSO THE CHALLENGE OF WE'VE
CONSOLIDATE EVERYTHING UNDER
ONE AGENCY IF WE START
SPLITTING STUFF APART THEN
THERE'S PROBABLY F. ACOSTA THAT
AS WELL RIGHT SO WE'VE GOT ALL
OF A LOT OF THE DATA. ALREADY
IN HOUSE WITHIN THE AGENCY- I
ACTUALLY THIS IS A OPPORTUNITY
REALLY BUILT OF THAT AND DO
MORE WITH- AND SO I THINK THERE
WOULD BE A RISK OF A- SHOULD
SAY WITH. STATE INTO SEPARATE
AGENCY BUT ON THE FLIP SIDE I
CAN ALSO SEE THE VALUE AND- AND
REALLY HAPPENED SOMEBODY WHO'S
COMPLETELY INDEPENDENT FROM.
YOU KNOW HAVING OPERATE THE
PROGRAM WHICH HAS ITS OWN
SEPARATE SET OF CHALLENGES- SO
I YOU KNOW I THINK THERE'S PROS
AND CONS- EITHER WAY IT JUST
HAPPENS THAT IN OREGON WE FOR A
SORT OF CONSOLIDATE ALL THE
PROGRAMS AND SO. THE STARTING
POINT FOR THE CONVERSATION HAD.
JACKSON BLESSING WHAT'S
INCLUDED THERE. THE THOUGHTS ON
THAT ONE. YEAH ONE UP IS A YOU
HAVE A GOVERNMENT AID. BUT THE
YOU HAVE IN. COME RIGHT WHO ARE
MAYBE NOT SO. YOU KNOW KIND OF
LIKE A MIXED WHERE YOU KNOW YOU
YOU'RE YOU'RE YOU'RE COMING IS
ALL THESE INDEPENDENT EXPERTS-
BUT ARE NOT PART OF THE
INDUSTRY- SO THAT WAY YOU KIND
OF. HAVE BOTH. YEAH I THINK
THERE'S YOU KNOW TO BE CLEAR
WORK GOVERNMENT AGENCY- SO I
THINK THERE'S- DIFFERENT
FLAVORS OF THE SAME THING HERE-
YOU KNOW I WOULD SAY YOU KNOW
ONE OF THE KIND OF- STRAIGHT
FROM OUR FROM WHAT WE'VE DONE
IS. AS GLENN SAID OUR
COMMISSIONERS HAVE THIS
CONFLICT OF INTEREST SO ON THE
BOARD MEMBERS ARE REALLY THERE-
NOT TO DRIVE THEIR OWN PERSONAL
AGENDAS NOT TO DRIVE AN AGENDA
OF AN ORGANIZATION THAT'S
THAT'S FINE AND- REALLY THEY'RE
JUST. HOW CAN WE BE A PART OF
THIS BOARD AND IMPROVE CARE FOR
THE PUBLIC OF THE OF THE STATE
AND REALLY BRING THAT NOT LENDS
TO IT AND I'M A HAPPY. ON THERE
ARE NONE. HOWEVER YOU DID OF
HAVING OF A BOARD THIS. IS IT
ALL IS JUST ON WAY OF A
BUILDING TRANSPARENCY AND-
TRUST BECAUSE- PEOPLE WE ALL OF
OUR WERE MEANS ARE PUBLIC AND
PEOPLE CAN SEE OUR BOARD
MEMBERS. BOB WRESTLE WITH THESE
ISSUES AND DISAGREE SOMETIMES
AND I THINK THAT ACTUALLY.
ENGENDERS AN ABILITY TO SAY- I
CAN SEE THAT THIS BOARD IS
STRUGGLING WITH DIFFICULT
DECISIONS AND THAT THIS IS NOT
SOME TYPE OF LIKE. IT'S ALL
KIND OF PRE ARRANGED IN SOME
PRE ROOM AND THEN COME OUT LIKE
THIS IS A REAL TIME INACTION
KIND OF LIKE. YOU KNOW HOW TO
BE WRESTLE WITH THESE- TRADE
OFFS ON DIFFERENT THINGS AND-
IN THE SEVEN YEARS THAT WE'VE-
DINNER. AT THAT AGENCY- WE'VE
PROBABLY AVERAGE. I DO THE MATH
ON THIS THREE PUBLIC MEETINGS A
MONTH FOR SEVEN YEARS. AND WE
STILL GET- YOU KNOW OVER YOU
KNOW HUNDREDS OF PEOPLE THAT
COULD COME TO OUR MEETING ARE
WATCH ONLINE. SO THE AMOUNT OF
ENGAGEMENT THAT WE'VE BEEN ABLE
TO. AND THEN STILL THAT PUBLIC
I HER. CONTINUES TO COME OF A
HOT WE ALL IN THIS THIS THAT
WHEN WE DO MAKE DECISIONS. WE
DISAGREE WITH YOU KNOW THAT
CONCLUSION BUT THEY CAN'T AGREE
WITH A PROCESSES THE DATA OR
THE METHODOLOGY WE. THANK YOU
VERY MUCH I TO IF ANY OF MY-
MEMBERS SELECT HAVE THE
COMMENTS ARE. OKAY THANK YOU
VERY VERY VERY MUCH YOUR WE'VE
GOT TO COME MORE SPEAKERS IN
BUT I REALLY AND WE WILL TAKE
YOU UP ON YOUR OFFER OF A AS
RESOURCE I CAN GUARANTEE THAT.
THANK YOU. SO WE HAVE- CHERYL
DAM BERG ARE CHAIR AND
HEALTHCARE POLICY IN PRINCIPLE
SENIOR ADVISER FOR THE RAND
CORPORATION AND- CHRISTINE I'VE
NEVER I THINK YOU SHOULD COME
IS CHRISTINE COMING UP WITH THE
WITH YOU AS WELL GREAT THANK
YOU- THE DIRECTOR PAYMENT
COSTING COVERAGE PROGRAM FOR
ALSO WITH THE RAND CORPORATION
SO. THANK YOU VERY MUCH. I LOVE
IT WHEN TECHNOLOGY WERE SO
WONDERFUL. THANK YOU THANK YOU
DOCTOR WOULD ADDRESS THE
COMMITTEE FOR THE OPPORTUNITY
TO PRESENT HERE TODAY- YOU'VE
HEARD A LOT OF GREAT
PRESENTATIONS FROM VARIOUS
SPEAKERS TODAY ABOUT- THERE IS
COST PROBLEMS ARE HEALTHCARE
SYSTEM IS FACING THE VARIOUS
COST DRIVERS AND THEN THINKING
ABOUT SOME OF THE STRATEGIES TO
TRY TO ADDRESS THOSE AND
ACTUALLY- CHRISTINE EISNER
WHO'S MY COLLEAGUE GET RANDALL
BE TALKING- IN MORE DETAIL
ABOUT SOME OF THOSE STRATEGIES-
BUT I THINK THE ONE COMMON
THEME THAT YOU'VE HEARD
THROUGHOUT THE MORNING. IS THE
ABILITY TO MAKE PROGRESS ON THE
COST FRONT- IN THE STATE OF
CALIFORNIA IS PREDICATED ON
HAVING GOOD DATA TO INFORM
POLICY MAKING AND SO WHAT I'M
GOING TO DO IS GIVE- A BRIEF
OVERVIEW OF ALL PAYER CLAIMS
DATABASE SEES AND THEN TALK
SPECIFICALLY ABOUT THE HEALTH
CARE PAYMENT DATABASE THAT'S
BEING ESTABLISHED YEAR CAL. SEC
MISTER BRIEFLY IS BACK ON OF
WHAT IS AN OLD CLAIM STATE OF A
SO WHAT THE DATABASE THAT TO DO
AS TO PULL DATE FROM BOTH
PUBLIC AND PRIVATE SOURCES OF
INFORMATION SO WHETHER THAT'S-
MEDICARE OR MEDICAID- PRIVATE
INSURERS- AND IT INCLUDES DATA
OF A VARIETY OF SOURCES-
INCLUDING MEDICAL PHARMACY AND
DENTAL CLAIMS. AND IMPORTANTLY
BECAUSE TO STUDY THESE
PROBLEMS- IT'S CRITICAL TO BE
ABLE TO IDENTIFY SPECIFIC
PROVIDERS WHETHER THEY BE
HOSPITALS POSITIONS PHYSICIAN
GROUPS- SKATED NURSING
FACILITIES AND SO ON- ONE NEEDS
TO HAVE GOOD UNDERLYING- FILES
THAT CONTAIN PROVIDERS IN THE
ABILITY TO TRACK THOSE
PROVIDERS OVER TIME. AS WELL AS
THE PATIENTS TREATED BY THOSE
PROVDE. AND ALL THIS
INFORMATION AS REPORTED IN TWO
A CENTRAL REPOSITORY UP. TO RUN
A STATE. SO CURRENTLY THERE ARE
SEVENTEEN STATES HAVE ALL HERE
BECAUSE DATA IS AND OR IN THE
OF AND THEM AND- CAL. THE RE
WHY HAVE IN THE DIRECTION OF
FORMING AT ALL PAYER CLAIMS
DATABASE SEES IS THAT MANY OF
THE DAY YOU THAT- DIFFERENT
ENTITIES HAVE USED
HISTORICALLY. I HAVE RELIED ON
WHAT CALL- PRIVATE POOLING OF
DATA- SO THERE ARE THESE
PRIVATE FIRMS OUT THERE WHO
MAYBE HAVE AMASSED A PRIVATE
CLAIMS DATA- OR- PEOPLE HAVE
ACCESS MEDICARE DATA BUT-
FREQUENTLY WHEN ONE LOOKS AT
THOSE DATA YOU'RE LOOKING WITH
IN SILOS AND YOU DON'T HAVE THE
ABILITY TO LOOK ACROSS THE
OTHER ISSUE WITH- SOME OF THESE
VOLUNTARY REPORTING EFFORTS IS
THAT. TYPICALLY THEY ONLY
INCLUDE TO UPDATE ON A LIMITED
NUMBER OF SUBMITTERS AND THEY
OFTEN RESTRICT AT USE OF THE
DATA SO ALL HERE CLAIMS
DATABASE SEIZE REALLY TRY TO
MOVE BEYOND SOME OF THESE
UNDERLYING PROBLEMS BY HAVING
DATA FROM MOST OR ALL OF THE
STATE'S INSURERS AND THEY ALSO
HAVE THE BENEFIT OF MOVING
BEYOND SOME OF THE CURRENT
EFFORTS THAT EXIST I
CALIFORNIA SUCH AS WITH OSCAR
COLLECTING DATA ON HOSPITAL
DISCHARGES- BY. INCLUDING THE
CARE THAT'S PROVIDED ACROSS ALL
SITES OF CARE- RATHER THAN JUST
HOSPITALIZATIONS AND ANOTHER
BENEFIT IS THAT- THEY TYPICALLY
HAVE MUCH LARGER SAMPLE SIZES
SO- WHY THAT'S IMPORTANT IS
THAT WHEN YOU'RE DEVELOPING
ESTIMATES OF A PROVIDERS- LET'S
SAY QUALITY PERFORMANCE- YOU
NEED TO HAVE A CERTAIN NUMBER
OF OBSERVATIONS TO BE ABLE TO
GET A RELIABLE ESTIMATE- AND
SO. LARGER SAMPLES ENABLE THAT-
THEY ALSO HAVE BROADER
GEOGRAPHIC REPRESENTATION AND
THE OTHER THING THAT'S CRITICAL
AS WE TRY TO THINK ABOUT
MEASURING COST TRENDS AND
CHANGES OVER TIME IS THE
ABILITY TO HAVE LONGITUDINAL
INFORMATION- ON BOTH
INDIVIDUALS AND PROVIDERS-
BECAUSE WE KNOW THAT THE HEALTH
CARE MARKET PLACE IS VERY
DYNAMIC- PEOPLE SWITCH HEALTH
PLANS THEY SWITCH PROVIDERS.
AND THE ABILITY TO TRACK THEM
OVER TIME AND UNDERSTAND WHAT
HAPPENS TO THEM AS A FUNCTION
OF THOSE SWITCHES IS ALSO
CRITICALLY IMPORTANT. SO I
THINK ALL OF YOU KNOW THAT
CALIFORNIA'S MOVING DOWN THE
PATH- AS A FUNCTION OF AB
EIGHTEEN TEN- AB EIGHTEEN TEN
ESTABLISHED- THE HEALTH CARE
COSTS. TRANSPARENCY DATABASE
THAT IS SUPPOSED TO BE
OPERATIONAL BY JULY ONE OF
TWENTY TWENTY THREE AND THE
GOAL IS TO PROVIDE INFORMATION
TO INFORM POLICY DECISIONS
REGARDING- HEALTH CARE COSTS-
THE ABILITY TO. BETTER
UNDERSTAND AND REDUCE- HEALTH
CARE DISPARITIES AND ALSO TO
TRY TO IMPROVE THE QUALITY.
ROUGHLY ELEVEN MONTHS AUSTIN
HAS CONVENED A REVIEW COMMITTEE%
AND FULL DISCLOSURE I WAS THE
VICE CHAIR OF THAT COMMITTEE-
AND- THIS COMMITTEE WAS THAT I
HAD- REPRESENTATIVES FROM ALL
ACROSS THE DIFFERENT SECTORS-
OF CALIFORNIA. AND THEY
PROVIDED INPUT- AND I'M GONNA
SPEAK TO SOME OF THE
RECOMMENDATIONS LATER IN MY
PRESENTATION- RELATED TO THE
ESTABLISHMENT THE
IMPLEMENTATION OF THE
ADMINISTRATION OF THE DATABASE
AND AGAIN IF I COULD LEAVE YOU
WITH ONE AND- TAKE AWAY. THIS A
P. C. D. THAT'S BEING FORMED IN
CALIFORNIA IT IS A NECESSARY
TOOL TO SUPPORT THE PROPOSED-
CALIFORNIA OFFICE ON
AFFORDABILITY. SO THINKING
ABOUT HOW THIS DATABASE CAN BE
USED- RELATED TO COST
CONTAINMENT EFFORTS- CLEARLY-
IT'S I WILL ENABLE OUR- AT THE
WORK IN TERMS OF TRACKING
TRENDS AND SPENDING- WE CAN
LOOK AT VARIATION AND COST. OF
CARE AND- SOME OF THE FACTORS
INFLUENCING THE VARIATION
COSTS- WE CAN LOOK AT THE
EFFECTIVE PROVIDER
CONSOLIDATION- WE CAN ALSO LOOK
AT WAYS FULL HEALTH HEALTH CARE
SPENDING- AS WE TRIED TO- BAND
THAT- COST CURVE- THE OTHER.
IMPORTANT THING- CALIFORNIA HAS
ALWAYS BEEN A LEADER AND- THERE
IS HEALTH CARE REFORMS- AND
TRYING TO UNDERSTAND THE
EFFECTS OF THOSE HEALTH CARE
REFORMS PARTICULARLY IN THE
AREA OF PAYMENT POLICY- IS
ANOTHER CRITICAL- USE OF THE
DATA WE'VE ARE. ARE HEARD THE
MORNING ABOUT PRIMARY CARE
SPENDING AND TRYING TO
UNDERSTAND THAT THAT IS THE
SHARE OF TOTAL SPENDING GIVEN
THAT WE KNOW PRIMARY CARE IS
IMPORTANT- NOT ONLY FOR
PROVIDING- HIGH QUALITY CARE TO
PEOPLE BUT ALSO CONTROLLING
SPENDING. AND THEN LASTLY-
POTENTIALLY THE USE- OF THIS
INFORMATION FOR MAKING- COSTS
TRANSPARENT TO CONSUMERS. SO
THE H. B. D. BEYOND COST CAN
ALSO ANSWER OTHER KINDS OF
CRITICAL QUESTIONS THE POLICY
MAKERS HAVE- SO WE'VE ALREADY
TALKED TO PROVIDE ABOUT
PROVIDER CONSOLIDATION- WE WANT
TO BETTER UNDERSTAND HOW THE
UTILIZATION OF CARE CHANGES IN
RESPONSE TO PAYMENT CHANGES- WE
WANT TO UNDERSTAND UTILIZATION
OF SERVICES AND HOW THOSE
DIFFER ACROSS DIFFERENT PATIENT
POPULATIONS. AGAIN PLAYING TO
THE ISSUE OF DISPARITIES- WE
WANT TO UNDERSTAND WHAT THE
QUALITY OF CARE IS AND HOW THAT
FAIRIES FOR- DIFFERENT PATIENT
POPULATIONS AS WELL AS ACROSS
DIFFERENT TYPES OF PROVIDERS-
I'VE ALREADY MENTIONED- THE
ISSUE OF DISPARITIES
UNDERSTANDING THE SOCIAL RISK
FACTORS THAT ARE ASSOCIATED
WITH QUALITY PERFORMANCE. AND
WHETHER DISPARITIES ARE
SHRINKING ARE GROWING OVER TIME
AND RELATED TO COST QUESTION
AND THIS GETS TO SOME OF- THE
EARLIER SPEAKERS COMMENTS OUT.
HEALTH WE HAVE THE ABILITY HERE
TO LEVERAGE THESE DATA TO TRY
TO UNDERSTAND WHETHER SOME
PROVIDERS ARE MORE EFFICIENT
AND DELIVERING QUALITY THAN
OTHERS. SO BRIEF HOW SOME OF
THE STATES YOU ARE A P. C. D.
SO I'M I'M GOING TO BRING TOUCH
ON A- OF SO THAT HAVE BEEN DONE
SO IN VIRGINIA THERE WAS A
STUDY THAT DEMONSTRATED- THERE
WAS- FIVE HUNDRED AND EIGHTY
SIX MILLION DOLLARS WORTH OF
LOW VALUE CARE SERVICES THAT
DON'T PROVIDE BENEFIT TO
PATIENTS. DELIVERED IN
MINNESOTA THEY HAVE TRACKED
TRENDS AND PRESCRIPTION DRUG
SPENDING. BOB AND IN UTAH AND
COLORADO THEY LOOKED AT
INSURANCE TRANSITIONS AND WHAT
HAPPENS TO PATIENTS AS THEY
TRANCE. EXCUSE ME TRANSITION IN
A LOT OF MEDICAID- SO. THREE
IMPORTANT USE CASES- ANOTHER
USE CASE- THAT I WOULD BRING TO
YOUR ATTENTION BECAUSE OF THE
EMPHASIS ON MARKET
CONSOLIDATION. SO MY GROUP AT
RAND HAS BEEN LEVERAGING-
MEDICARE DATA- AND THE DATA
SHOWN ON THE SLIDE ARE ONLY THE
MEDICARE DATA BUT WE COULD
REPLICATE SOMETHING LIKE THIS
IF WE HAVE THE ALL PAYER DATA
BASE. I'M AND WHAT YOU SEE IS
THAT OVER TIME BETWEEN TWENTY
THIRTEEN AND TWENTY SIXTEEN-
THE NUMBER OF PHYSICIANS WHO
ARE PRACTICING LATE PRACTICING
INDEPENDENTLY HAS DECLINED- AND
WE ALSO SEE- THIS YEAR A
VERTICALLY INTEGRATED PHYSICIAN
GROUPS GOING UP OVER TIME. AND
TRYING TO UNDERSTAND WHAT THE
IMPLICATIONS ARE ON COSTS-
WOULD BE A KLAY IMPORTANT AT
QUESTION FOR THE STATE OF
CALIFORNIA TO ADDRESS- JUST
LOOKING AT THE MEDICARE DATA WE
FIND THAT. THIS CHANGE OVER
TIME HAS LED TO SIGNIFICANTLY
HIGHER SPENDING IN THE MEDICARE
PROGRAM. SO ONE OF THE THINGS
THAT'S UNIQUE IN CALIFORNIA
COMPARED TO OTHER STATES- IT IS
THE FACT THAT WE HAVE A LARGE
PROPORTION OF THE MARKET- THAT
IS NOT PAID THROUGH FEE FOR
SERVICE- TYPES OF PAYMENTS- AND
HISTORICALLY A. P. CD'S HAVE
FOCUSED ON PULLING IN THOSE FEE
FOR SERVICE CLAIMS- SO WE HAVE
A VARIETY OF ALTERNATIVE
PAYMENT MODELS IN PLAY-
CAPITATION BEING AT THE TOP OF
THE LIST- BUT ALSO SOME OF
THESEOTHER PAYMENTS LIKE-
QUALITY BASED- PAY FOR
PERFORMANCE PAYMENTS- SHARED
SAVINGS PAYMENTS THAT- ARE IN
THESE RESPECTS CONTRACTS- AS
WELL. AS FOR THINGS LIKE
PRIMARY CARE AND PATIENT
CENTERED MEDICAL HOMES. SO IT
IS GOING TO BE IMPORTANT THAT
AS IF HE'S THE DE AND CAL. IS
DEVELOPED AND FALL. THAT WE
WERE HARD TO CAPTURE BOTH THE
CLAIM SPACE PIECE OF THIS AND
THESE ALTERNATIVE PAYMENTS TO
ESTIMATE THE TOTALITY OF
PAYMENTS AND HEALTH CARE
SPENDING IN CALIFORNIA. AND
JUST AS A FOOTNOTE- OTHER
STATES HAVE BEEN WORKING TO
ADDRESS THIS ISSUE- COLORADO
BEING ONE- AS WELL AS SOME OF
THE WORK GOING ON HERE IN
CALIFORNIA THROUGH THE
INTEGRATED HEALTH CARE
ASSOCIATION. I'M SO SOME OF THE
OTHER IS THAT ARE IMPORTANT FOR
THE HEALTH CARE PAYMENT
DATABASE HERE IN CALIFORNIA IS
THE NEED TO INCLUDE MEDICAL
DATA- GIVEN THAT- ONE THIRD OF
CALIFORNIANS ARE COVERED UNDER
MEDICARE HOW- AND ONE OF THE
RECOMMENDATIONS COMING OUT OF
THE REVIEW COMMITTEE WAS THAT
THE H. P. PROGRAM SHOULD PURSUE
THE COLLECTION OF MEDI CAL DATA
DIRECTLY FROM. THE DEPARTMENT
OF HEALTH CARE SERVICES I'VE
MENTIONED THE NEED FOR- PATIENT
IDENTIFIERS AND PHYSICIAN
IDENTIFIERS- IT'S REALLY
CRITICAL TO BE ABLE TO TRACK
PATIENTS OVER TIME AS WELL AS
PROVIDERS OVER TIME- AND THESE
ARE FOUNDATIONAL ELEMENTS FOR
THE DATABASE TO BE USABLE BY A
VARIETY OF END USERS- AND THEN
LASTLY- I WOULD ENCOURAGE- AT.
THE ASSEMBLY TO MAKE SURE THAT-
ACCESS TO THE DATA IS BROADLY
AVAILABLE- I KNOW THIS LOOKS
FAIRLY SELF SERVING- AS I'M A
RESEARCHER. BUT WE HAVE THE
ABILITY- BOTH HERE IN THE STATE
OF CALIFORNIA AND NATIONALLY-
THERE IS A LOT OF- INTEREST BY
RESEARCHERS TO BE ABLE TO
LEVERAGE THESE DATA. AND I
THINK THE STATE WOULD BE THE
ULTIMATE BENEFACTOR HAVING A
BROAD ACCESS TO THESE DATA BY A
VARIETY OF END USERS SO JUST
BRIEFLY THE CAL HEALTH OF HIM
DATA. RIVER COMMITTEE ITS WORK
LAST WEEK- THE FINAL
RECOMMENDATIONS WERE POSTED
LAST NIGHT- THE COMMITTEE MADE
THIRTY SIX UNANIMOUS
RECOMMENDATION STOSCH CODE- AND
THEY RECOMMENDED A TIERED
APPROACH TO IMPLEMENTING THAT
WILL EXPAND THE DATABASE OVER
TIME GIVEN THE COMPLEXITY OF
CALIFORNIA- THIS DATABASE IS
GOING TO BE THE LARGEST.
DATABASE IN THE COUNTRY- AND WE
HAVE CERTAIN MARKET DYNAMICS
THAT ARE MORE COMPLEX THAN SOME
OF THE OTHER STATES OR AT LEAST
A LARGER PRESENCE OF THOSE
ISSUES- AND SO- FOLLOWING A
TIERED APPROACH I THINK WILL
HELP US. MOVE EXPEDITIOUSLY TO
GET SOMETHING UP AND RUNNING-
MORE QUICKLY BUT YOU KNOW
CONTINUE TO EXPLORE HOW TO
TACKLE SOME OF THOSE PROBLEMS
OVER THE LONG HAUL- THE OTHER
ISSUE THAT CAME UP WAS- THEY
MADE RECOMMENDATIONS ABOUT WHO
SHOULD BE MANDATORY DATA
BY. ALL COMMITTEE MEMBERS- ONE
OF THE THINGS- THAT WILL BE
MISSING IN THIS DATABASE
BECAUSE OF A RISA- IS THAT SELF
FUNDED PLANS WILL NOT BE
REQUIRED TO SUBMIT- THAT I
THINK STATES- AND OTHER ACTORS
IN THE COMMUNITY SHOULD TRY TO
WORK VERY HARD. TO GET THE
SOUTH SHIRT PLANS TO SUBMIT
THEIR DAY. THE AND I GUESS
LASTLY ASHRITA NOW. TO FIND
THIS WHICH IT EXPECTS TO
DELIVER JULY FOR. OF THIS YEAR.
SO WITH THAT I WILL STOP AND MY
COLLEAGUES CHRISSY. BEFORE WITH.
TO THE LITTLE SWITCH HERE IN A
SECOND. THANK YOU THEN WHAT
WE'LL ASK AT AT SPECTRUM BUT
THANK YOU. GREAT THANK YOU AND
THANK YOU EVERYONE FOR INVITING
ME HERE TODAY I APPRECIATE THE
OPPORTUNITY- I'M I'M CRISTINA
ABNER FROM RAND CORPORATION-
OVER THE PAST BETTER PART OF
THE PAST YEAR WE WORKED WITH
THE CALIFORNIA HEALTHCARE
FOUNDATION OR WE CONDUCTED
RESEARCH FOR THE CALIFORNIA
HEALTHCARE FOUNDATION.
UNDERSTAND PROMISING OPTIONS TO
REDUCE- HEALTHCARE COSTS IN
CALIFORNIA- SO NO SURPRISE TO
ANYONE HERE. HEALTHCARE COSTS
ARE TOP PRIORITY AMONG
CALIFORNIANS 45% OF THOSE
SURVEYED IT MENTIONED THIS IS
THE AMONG CALIFORNIA RESIDENTS
MENTIONED THIS IS THEIR TOP
PRIORITY. SECOND ONLY TO
EDUCATION ACROSS ALL OF
PRIORITIES IN THE STATE AND SO
WHAT WE DID WITH C. H. C. F.
IS- WE LOOKED- WE REVIEWED THE
LITERATURE TO UNDERSTAND
PROMISING OPTIONS FOR OTHER
FROM THAT OTHER STATES ARE
OTHER. THAT THAT HAVE BEEN
IMPLEMENTED IN OTHER STATES OR
OTHER SETTINGS. AND THEN WE
ASSESS THE EVIDENCE FOR THOSE
OPTIONS TO UNDERSTAND WHETHER
WOULD BE A VIABLE OPTION FOR
CALIFORNIA. SO THERE WERE A
TOTAL OF SEVENTEEN OPTIONS THAT
WE IDENTIFIED IN THIS IS BASED
ON LITERATURE REVIEW
ENVIRONMENTAL SCANNED
DISCUSSION WITH EXPERTS ACROSS
THE STATE. STATE TODAY I'M
GONNA FOCUS ON FOUR OF THOSE
OPTIONS JUST IN THE INTEREST OF
TIME- AND THESE FOR OPTIONS ARE
THINGS THAT HAVE BEEN DISCUSSED
CURRENTLY AT BOTH AT. YOU WITH
IN CALIFORNIA AND AT THE
NATIONAL LEVEL AS TURN IN TERMS
OF VERY AT THE PROMISING AND AN
IMPORTANT POLICY OPTIONS. THE
ONE IS TO REDUCE OUT OF NETWORK
FILLING OUT REGULATE HEALTH
INSURANCE PREMIUMS. IMPLEMENTED
PUBLIC OPTION ON COVER
CALIFORNIA. AND THEN EXPAND
SCOPE OF PRACTICE FOR NURSE
PRACTITIONERS. SO START WITH
OUT OF NETWORK BILLING- SO
CALIFORNIA ACTUALLY HAS AMONG
THE MOST PROTECTIVE. LAWS AND
REGULATIONS IN PLACE- TO.
PROTECT CONSUMERS AGAINST- OUT
OF POCKET BILLING RELATIVE TO
ANY STATE TO THE COMMONWEALTH
FUNDED A STUDY WHERE THEY FOUND
THAT- CALIFORNIA WAS IN THE TOP
SIX OF STATES- AND I'VE LISTED
SOME OF THESE PROTECTIONS HERE
WHICH OF COURSE YOU'RE VERY
FAMILIAR WITH. AB SEVENTY TWO
PROTECTS FULLY INSURED
ENROLLEES FROM TAPE FROM I'M
EXPERIENCING A SURPRISE BILL
WHEN AN OUT OF NETWORK
PHYSICIAN- WHO'S PERFORMING THE
WORK IT IN NETWORK HOSPITAL
SENSE IN THE BILL- AT TWO
THOUSAND AND NINE SUPREME
COURT. RULING PROTECTS IN
RELEASED- IN IN PLANS REGULATED
BY THE DEPARTMENT OF MANAGED
CARE FROM- IS FACING AT BALANCE
BILLING FROM AN EMERGENCY
DEPARTMENT VISIT. THE FAIR
PRICING ACT PROTECTS LOW INCOME
CALIFORNIANS FROM FACING- A
HIGH CHARGE IF THEY'RE
UNINSURED AND GO TO THE
HOSPITAL. AND IN CALIFORNIA HAS
VERY BROAD NETWORK ADEQUACY
PER- PROTECTIONS RELATIVE TO
OTHER STATES AND OF COURSE IF
YOU HAVE A BROAD NETWORK THE
CHANCES OF FACING AN OUT OF
NETWORK CHARGE ARE MUCH LOWER.
DESPITE ALL OF THESE FOR.
ALMOST AT THE OF CAL HAVE
RECEIVED AN UNEXPECTED BILL NOW
SOME OF THIS COULD BE YOU KNOW
PEOPLE DIDN'T UNDERSTAND THEIR
DEDUCTIBLE OR SOMETHING AD IT
WAS UNEXPECTED BUT WITHIN YOU
OFF THEIR HEALTH PLAN- BUT- BUT
SOME OF THIS IS OUT OF NETWORK
BUILDING. AND THE REASON THAT
WE MAKING WE CONTINUE TO SEE
THIS IN CALIFORNIA IS THAT
THERE ARE SOME GAPS AND SO I'VE
I'VE LISTED SOME HERE IN THIS
CHART- AND YOU CAN SEE ONE BIG
GAP IS SELF INSURED PLANS. AND
SO THIS IS BECAUSE OF A
RECESSION I'LL MENTION THAT-
THAT WRIST A PRE AMPS THE STATE
FROM REGULATING- SELF INSURED
HEALTH PLANS ARE INTERFERING IN
ANY WAY WITH THE CONTRACT
BETWEEN PROVIDERS AND THOSE
SELF INSURED HEALTH PLANS- BUT
THEN THERE'S SOME OTHER GAPS
INCLUDING SOME SERVICES THAT
ARE NOT COVERED UNDER EITHER.
ANY OF THESE LAWS SO FOR
EXAMPLE OUT OF NETWORK
AMBULANCE SERVICES. BILLS FOR
INPATIENT STAYS THAT ORIGINATE-
IN THE ET AND THEN ALSO THE
EMERGENCY DEPARTMENT BILLING
PROTECTIONS DON'T EXTEND TO
PLANTS REGULATED BY THE
CALIFORNIA DEPARTMENT OF
INSURANCE. SO WHAT ARE SOME
OPTIONS CALIFORNIA COULD TAKE
HERE- ONE EASY ONE WOULD BE TO
EXTEND THAT- THAT EMERGENCY
DEPARTMENT PROTECTIONS TO THE
CD I REGULATED PLANS- ALSO AT
THE STATE COULD CONSIDER-
EXTENDING PROTECTIONS TO COVER
AMBULANCE SERVICES AN INPATIENT
STAYS THAT ORIGINATE FROM THE
ET- AND THEN ALSO POTENTIALLY
THINK CREATIVELY ABOUT HOW TO
ADDRESS THE ARREST- ISSUE. SO
ONE- SOLUTION THAT'S BEEN
PROPOSED IS TO REQUIRE
ANCILLARY VISIT PHYSICIANS TO
CONTRACT WITH THE HOSPITALS IN
WHICH THEY'RE WORKING. AND SO
THAT YOU KNOW GETS THE STATE
OUT OF REGULATING THE CONTRACT
BETWEEN THE PROVIDER AND THE IN
SELF INSURED EMPLOYERS. IT
WOULD BE THE CONTACT BETWEEN
THE HOSPITAL AND THE PROVIDER.
ONE THING I DO WANT TO OUT OF
THE APPROACH IS TO ADDRESS OUT
OF NETWORK BILLING. THIS OF
COURSE OF THE PROBLEM FOR
CONSUMERS IN TERMS OF HEALTH
CARE AFFORDABILITY BUT HOW IT
AFFECTS TOTAL COST OF CARE WILL
DEPEND ON HOW IT'S IMPLEMENTED.
SO IN SOME SENSE PROTECTING
CONSUMERS MORE FROM OT OF
NETWORK CHARGES COULD RESULT IN
CONSUMERS EATING USING MORE
CARE- OR IF THERE'S A
REQUIREMENT THAT THE INSURANCE
COMPANY. PAY MORE- THAT COULD
AFFECT THEIR LEVERAGE
NEGOTIATION WITH PROVIDERS
ULTIMATELY LEADING TO INCREASED
COST OVERALL- ON THE ON THE
FLIP SIDE SOLUTIONS THAT WOULD
LIMIT WHAT THE PROVIDER IS ABLE
TO CHARGE MIGHT BE MORE LIKELY
TO REDUCE COST. SO THE CAREFUL
CONSIDERATION IS NEEDED IN
IMPLEMENTING THESE KINDS OF
POLICIES. OKAY SO I MOVED TO
HELP THEM REGULATION OTHER
STYLIZED FACTS THAT YOU'RE ALL
VERY FAMILIAR WITH BASICALLY
THE COST OF CARE HAVE.
INCREASED DRAMATICALLY FOR
INSURANCE PREMIUMS INSURANCE
DEDUCTIBLES OVER THE PAST TEN
TO FIFTEEN YEARS. SO I WANT TO
TURN NOW BACK TO RHODE ISLAND
IN THIS IS AN EXAMPLE FROM UP
ROAD ISLAND I KNOW THAT- GLENN
HAD ALREADY DISCUSSED THIS- BUT
JUST BRIEFLY YOU KNOW BIRD
ISLAND. IMPLEMENTED THESE VERY
COMPREHENSIVE AFFORDABILITY
STANDARDS- THAT INCLUDED A
MOVING TOWARDS VALUE BASED
PAYMENT- THE SETTING A LIMIT ON
WHAT AT THAT. PRICE INCREASES
COULD COULD OCCUR FROM YEAR TO
YEAR WITH AN INSURANCE
CONTRACTS. AND THEN ALSO
INCREASING SPENDING ON PRIMARY
CARE SAID THE STATE ACTUALLY
DIRECTED ON INSURANCE COMPANIES
TO SPEND MORE MONEY ON PATIENT
CENTERED MEDICAL HOMES- AND A
RECENT STUDY FOUND. THAT THIS
LED TO A FIVE POINT 8%
REDUCTION IN IN SPENDING AMONG
THE COMMERCIALLY INSURED
POPULATION. AND YOU CAN SEE
THAT BROKEN OUT HERE THERE WAS
A REDUCTION IN FEE FOR SERVICE
SPENDING OFFSET SOMEWHAT BY AN
INCREASE IN NON FEE FOR SERVICE
SPENDING BUT THE NET. EFFECT
WAS A 5% REDUCTION. NUMBER
DILATED VERY DIFFERENT FROM
HEALTH. AS YOU KNOW IN MANY
WAYS AND THIS IS THE
REGULATIONS THAT THEY PUT IN
PLACE WERE ALSO FAIRLY.
EXTENSIVE AND YOU KNOW MAYBE
IT. THAT BE TOO AMBITIOUS OR A
YOU KNOW I DON'T KNOW IF.
THEY'RE THERE AT WEB MY POINT
IS THAT THERE COULD BE. SOME
MORE OF THIS. TARGETED
APPROACHES THAT MIGHT ACHIEVE
SIMILAR RESULTS- IT SO
CALIFORNIA CURRENTLY DOESN'T
HAVE THE AUTHORITY IF YOU OF
COURSE THERE'S RATE REVIEW IN
CALIFORNIA BUT THE STATE DOES
NOT HAVE THE AUTHORITY TO DENY
RATES IT THEIR- EXCESSIVE- JUST
MOVING TO THAT IS. POTENTIALLY
SOMETHING THAT COULD SAVE COST
SO ANOTHER STATE STUDY FOUND
THAT STATES THAT HAVE THE
ABILITY TO DENY. HAVE LOWER
PREMIUMS THAN OTHER STATES AND
THE ESTIMATE WOULD BE ABOUT
FOUR PERCENT. FOR FOUR POINT 6%
SAVINGS- AT LEAST FOR THE
INDIVIDUAL INSURANCE MARKET.
OKAY LET ME MOVE NOW QUICKLY TO
THE PUBLIC OPTION FOR
CALIFORNIA. SO PUBLIC OPTION
HAS A LOT OF MEETINGS- WHEN WE
DEFINE PUBLIC OPTION WE MEAN A
PLAN THAT HAS GOVERNMENT
NEGOTIATED RATES THAT CAN
EITHER BE MEDICATED COULD BE
MEDICARE COULD BE SOME
PERCENTAGE OF OE OF THOSE TWO.
OR SOMETHING ELSE BUT THE KEY
IS THAT IT'S NEGOTIATED
PUBLICLY. SO HOW COULD IT COULD
PUBLIC OPTION SAVE MONEY WELL
ONE CHALLENGE IN ESTIMATING
THIS IS THAT A PUBLIC OPTION
JUST HAS NOT YET BEEN
IMPLEMENTED ANYWHERE AND SO WE
DON'T REALLY KNOW WE HAVE TO
RELY ON FORECAST SIMULATIONS-
THE CBO AND RAND HAVE ESTIMATED
628% SAVINGS OUT AT LEAST AMONG
THOSE CONSUMERS AFFECTED BY THE
PUBLIC OPTIONS SO THERE IS SOME
SOME EVIDENCE THERE AND IN
WASHINGTON STATE AND ALSO THE
STATE OF COLORADO ARE CURRENTLY
IMPLEMENTING WASHINGTON STATE'S
PUBLIC OPTION WILL GO INTO
EFFECT IN TWENTY TWENTY ONE AND
SO WE'LL KNOW MORE AFTER THAT
HAPPENS AS TO HOW EXACTLY THIS
PLAYS OUT IN TERMS OF COST
CONTROL- BUT YOU KNOW ONE.
IMPORTANT CONSIDERATION FOR
CALIFORNIA AND THINKING ABOUT
THIS IS THAT IT MAY BE
DIFFICULT TO GET PROVIDERS TO
AGREE ON ON SIX SUBSTANTIALLY
LOWER RATES SO IN WASHINGTON
STATE- ULTIMATELY THE PUBLIC
OPTION IS GOING TO HAVE RATES
THAT ARE ON OUR 110060% OF
MEDICARE BUT THE STATUS QUO IS
ABOUT A 174% OF MEDICARE SO
THIS IS A LESS THAN 10%
REDUCTION AND SO THAT WAS A LOT
OF WORK TO GET TO WHAT MIGHT BE
SOMEWHAT OF A MARGINAL CHANGE
AND THE OTHER ISSUE TO CONSIDER
IS THAT. IT TO THE EXTENT THAT
THIS IS AFFECTING ENROLLEES ON
THE MARKET PLACES THE MAJORITY
EVEN RELEASED ON THE MARKET
PLACE IN CALIFORNIA RECEIVE TAX
CREDITS AND THE WAY THOSE TAX
CREDITS OR STRUCTURE STRUCTURE
IS THE INDIVIDUAL PAYS A
PERCENT INCOME CONTRIBUTION AND
THEN THE TAX CREDIT COVERS THE
REMAINDER OF THE PREMIUM COST
UP TO THE PRICE OF THE
BENCHMARK PLAN. SO TO THE
EXTENT THAT THE PUBLIC OPTION
AFFECTS THE COSTS OF THE
BENCHMARK PLAN IT COULD HAVE
THE EFFECT OF LOWERING THE THAT
TAX CREDITS WITHOUT AFFECTING
THAT THE CONSUMERS BOTTOM LINE
AND SO ANOTHER IMPORTANT
CONSIDERATION- AND BEYOND THAT
YOU KNOW THE SAVINGS FROM
REDUCED TAX CREDITS WILL COURSE
GO PRIMARILY TO THE FEDERAL
GOVERNMENT. OKAY LET TURN TO MY
BEST OPTION THIS IS EXPANDING
PARTNER PRACTITIONER SCOPE. A
THIRTY AND SO CALIFORNIA IS
OFTEN A LEADER- IN TERMS OF
STATES AND IN TERMS OF ADOPTING
INNOVATIVE- SOLUTIONS. NOT AS
MUCH NECESSARILY WITH NURSE
PRACTITIONER SCOPE OF PRACTICE
CALIFORNIA IS ONE OF THE STAR
TWENTY FIVE STATES THAT DON'T
HAVE BROAD AUTHORITY FOR NURSE
PRACTITIONERS. THERE IS
EVIDENCE THAT NURSE
PRACTITIONERS A PROVIDE CARE IN
IN A LESS COSTLY MANNER THEN
THEN THEN EMPTIES SO THIS IS A
STUDY THAT COMPARED THE TOTAL
COST OF CARE OVER A YEAR. AMONG
PATIENTS ASSIGNED TO A NURSE
PRACTITIONER AS THEIR PRIMARY
CARE PROVIDER COMPARED TO THOSE
ASSIGNED TO A AND D. AS THEIR
PRIMARY CARE PROVIDER THE USER
RISK ADJUSTED SO WHERE WE'RE
DEALING WITH GOT READ THIS
ADDRESSES DIFFERENCES IN
PATIENT ACUITY AND CONDITIONS-
AND YOU CAN SEE ACROSS VARIOUS
MEASURES OF COST OF CARE- THE
NURSE PRACTITIONERS PROVIDED
LOWER COST OF CARE. RANGING
FROM ELEVEN TO. 29% SAVINGS.
ANOTHER IMPORTANT THAT WAS
RAISED WE HEAR THE DEBATE ABOUT
NURSE PRACTITIONER SCOPE OF
PRACTICE IS WHETHER QUALITY OF
CARE COULD BE AFFECTED. AND IN
THE LITERATURE REVIEW WE
REVIEWED FOR CALIFORNIA
HEALTHCARE FOUNDATION WE FOUND
THAT THAT AS NOT THE CASE AND
IN FACT WE FOUND EVIDENCE THE
QUALITY OF CARE MAY BE
IMPROVED. SO THIS IS FROM I
THOUGHT A CLEVER STUDY THAT
LOOKED AT- HOW CHANGES IN. IS
GO PRACTICE LOS ACROSS STATES
OVER TIME- WE'RE SO SEE IT WITH
CHANGES IN VARIOUS MEASURES OF
QUALITY- AND SO YOU CAN SEE
THAT THE STUDY FOUND THAT THERE
WAS AN INCREASE IN THE
PROBABILITY OF HAVING OF. A
ROUTINE CHECK UP AS COOPER
PRACTICE EXPANDED AND
INCREASING THE PROBABILITY OF
HAVING USUAL SOURCE OF CARE.
I'M INCREASING THE PROBABILITY
THAT PATIENTS RATED THEIR
HEALTHCARE QUALITY IS
EXCELLENT- AND INCREASING THE
PROBABILITYTHE PATIENTS RATED
THEIR HEALTH STATUS IS
EXCELLENT- WHAT WE WHERE WHERE
THEY DID FIND A DECREASE WAS AN
EASY VISIT SO A SLIGHT
REDUCTION EDIE DOES IT'S
PERHAPS BECAUSE PATIENTS WERE
HEALTHIER OR BECAUSE THEY WERE
USING. AT THAT THEY HAD A USUAL
SOURCE OF CARE. SO SOME RATES
THE RICE CONCLUDE THOUGHTS
THERE MANY PROMISE OPTIONS FOR
CAO IT'S IMPORTANT TO KEEP IN
MIND. IS A UNIQUE STATES YOU
KNOW THERE IS SOME. YOU IT BUT
WE HAVE TO THINK CAREFULLY
WHETHER THESE WILL ALTER.
DIRECTLY TO CALIFORNIA ONE
IMPORTANT DIFFERENCE IN
CALIFORNIA VERSUS OTHER STATES
IS THAT CALIFORNIA HAS A MUCH
GREATER PENETRATION OF MANAGED
CARE. AND SO TO THE EXTENT THAT
SOME OF THESE POLICIES ARE
CAPTURING LOW HANGING FRUIT.
MAYBE MANAGED CARE'S ALREADY
ADDRESSING SOME OF THAT IN AND
IT MAY BE A LITTLE MORE
DIFFICULT. ON THE OTHER THING
TO CONSIDER IS THAT MANY OF
THESE OPTIONS LOOK LIKE THEY
SAVE A HECK OF A LOT OF MONEY
WHEN YOU LOOK AT THE DOLLAR
VALUE. BUT WHEN YOU COMPARE
THAT TO CALIFORNIA'S YOU KNOW
THREE HUNDRED BILLION EVEN
BASED ON THE TWENTY FOURTEEN
ESTIMATE- ANNUAL SPENDING- ET
THEIR SMALL PERCENTAGES SO IT'S
PROBABLE THAT. THAT THE STATE
WILL HAVE TO IMPROVE MULTIPLE
POLICY OPTIONS IT WANTS IN
ORDER REALLY BEND THE COST
CURVE- AND THEN FINALLY I JUST
WANT TO CONCLUDE BY SAYING THE
CALIFORNIA. I'M HAS A TRADITION
OF BEING AN EARLY ADOPTER AND A
TREND SETTER ACROSS THE COUNTRY
YOU KNOW THAT. THAT'S TRUE IN
MANY AREAS FASHION- TECHNOLOGY-
BUT ALSO POTENTIALLY IN
HEALTHCARE AND I THINK THE
OFFICE OF HEALTH CARE
AFFORDABILITY REALLY A PRESENTS
A GREAT OPPORTUNITY FOR
CALIFORNIA TO BE A PEAK INTO
OTHER STATES- IN THIS IMPORTANT
POLICY ISSUE. THANK YOU. WOW
THANK YOU. MUCH REALLY
APPRECIATE THE AND- A LOT OF
THAT'S ME. TO MY. ANY QUESTION
MISTER THERE AND- THE OKAY. SO
A LOT TO TAKE A LOT TO TAKE AND
IT IS AND OF COURSE I'M I'M I'M
VERY DAY DRIVEN. AND SO
DATABASE SOMETHING THAT IS NEAR
AND DEAR TO MY HEART AS ARE
SOME OF THE OTHER
RECOMMENDATIONS AND THAT YOU'VE
WE PUT OUT THERE SO I THANK YOU
VERY MUCH FOR YOUR
PRESENTATION- WE LOOK FORWARD
TO- TAPPING INTO YOUR- VAST
INFORMATION NETWORK OF- FOR AS
WE LOOK FOR ADDITIONAL
RESOURCES OVER TIME. AND THANK
YOU SO MUCH FOR THANK. SO YEAH.
WE WOULD LIKE TO AYE AYE IT IS
NEW WE WERE GOING TO A NEW I DO
TO AB HOW OPPORTUNE FOR PUBLIC
SO CORRECT OF SEE A MUCH OF HIM
OF PEOPLE WHO WANT TO SPEAK THE
PUBLIC COMMENT. SURE SURE GREAT
SO WE COULD KIND OF LIMIT. TIME
THAT WOULD BE THAT WOULD BE
HELPFUL. BUT PLEASE THIS AHEAD
ALL RIGHT OF RAMON BECAUSE OF
LONG CAL WANTS HER AMERICANS ON
TO APPLY YOU SO WHEN WERE FOR
HAVING THIS HEARING THINK THIS
IS X. IMPORTANT TOPIC WE'RE NOT
GOING TO GET TO ACCESS TO
HEALTH CARE WITHOUT DEALING
WITH COSTS US AN ABSOLUTELY
ESSENTIAL FIRST STEP I HAVE TO
SAY THAT- DOCTOR AYE PREFERS A
PRESENTATION- OF WHAT I THOUGHT
WAS EXCELLENT. IN TERMS OF SOME
VERY PRACTICAL AND DURABLE OF
POLICY IDEAS I WOULD ALSO JUST
ADD THAT TO WELL OF HOSPITAL
ARE PUTTING ONLY A BECAUSE THE
BARREL SALAS OF. HE WAS A
MARYLAND FILL MAYBE IT WAS MASS
FELLA SO WELL IT'S ONLY IF WELL
TO THIRD OF ALL HELL COSTS I
THINK THE WORTH TROUBLE IN IN
TERMS OF GETTING A WAIVER WHO
KNOWS WHO THE NEXT PRESIDENT ON
STATES IS GOING TO BE SO AND
MAY NOT BE AS FAR FETCHED
NINETY AS POSSIBLE SO LOOK
FORWARD TO YOUR CONTINUED WORK
IN THIS AREA THANK. YOU THANK
YOU VERY MUCH. CHAIR MEMBER
BARBER CLAY WITH THE CAL HAAS
IS SO. REP CAL. FOR HOW PLUS.
TODAY WE HAVE FROM A NUMBER OF
POLICY EXPERTS ON THE NUMEROUS
FACTOR WE MUST CONSIDER IS THE
OFFICE OF HEALTH CARE
PORTABILITY. ANALYZES AND
ESTABLISHES SUSTAINABLE POLLS.
TO DO THIS RIGHT IN A WAY THAT
IS BOTH IN POLAND SUSTAINABLE
THERE MUST BE THOUGHTFUL A
THOUGHTFUL PLAN WITH
ESTABLISHING AN INDEPENDENT
OFFICE. THE WILL TAKE INTO
ACCOUNT COSTS FROM ALL INVOLVED
IN THE DELIVERY OF HEALTHCARE.
INCLUDING COMMERCIAL INSURANCE
CARRIERS AND HOSPITAL'S INPUT
COSTS. WE COMMIT TO WORK WITH
THIS COMMITTEE TO DEVELOP A
PROPOSAL THAT ENSURES TWO
THINGS AMONG OTHER ISSUES. THAT
HOSPITALS CAN CONTINUE TO
OPERATE IN THE MOST EFFECTIVE
WAY POSSIBLE TO MEET THEIR
MISSION OF CARE QUALITY. AND
THAT HOSPITALS ARE NOT THE ONLY
GROUP WITHIN THE HEALTHCARE
DELIVERY SYSTEM THAT ARE
OFFERING REAL SOLUTIONS TO THE
HEALTH CARE PORTABILITY ISSUE.
THE WILL PROVIDE ECONOMIC
QUICKLY TO CALIFORNIANS CJ
LOOKS FORWARD TO WORKING WITH
THE LEGISLATURE THE
ADMINISTRATION AND ALL
STAKEHOLDERS. ON THE FORMATION
OF THE OFFICE OF HEALTH CARE
PORTABILITY AND THANK YOU TODAY
FOR THIS. PANEL AN EXPERT I
THINK IT'S- EXTREMELY VALUABLE
AS WE MOVE FORWARD. THANK YOU
MUCH. KELLY BE ON BEHALF OF THE
CAL MEDICAL. THANK YOU SO MUCH
FOR THE HEARING TO. WE ARE VERY
SO OF THE GUY FOR TO OF. FOR
HEALTH CARE CONSUMERS INCLUDING
ADDRESSING UNDERLYING COST
DRIVERS LIKE DELIVERY SYSTEM
CONSOLIDATION. THIS EFFORT TO
CURB HEALTH CARE COST GROWTH
SHOULD ALSO INCLUDE PAYMENT
DELIVERY SYSTEM REFORM. AND THE
PROMOTION OF ADMINISTRATIVE
SIMPLIFICATION. WE LOOK FOR TO
THE DISCUSSIONS DURING THE
BUDGET- BUDGET PROCESS THANK
YOU. THANK YOU. GOOD MORNING
MISTER CHAIR AND MEMBERS BILL
BARCELONA FOR AMERICA'S
POSITION GROUPS- THE LARGE
ORGANIZATION UNITED STATES
REPRESENTING. PROVIDERS WHO ARE
PAID ON A PERFORMANCE BASED
MODEL- THANK YOU AGAIN FOR THE
EXCELLENT PRESENTATIONS TODAY
FOR THE DATA THAT'S BEEN
PROVIDED ON ONLINE- WE AGREE
WITH MUCH OF WHAT HAS BEEN
PRESENTED TODAY AND- WOULD
ENCOURAGE YOU TO HOLD MORE OF
THESE HEARINGS TO BRING IN MORE
EXPERTS TO TALK ABOUT MORE
SOLUTIONS. TO PROVIDING
AFFORDABILITY. AND WE AS WELL
AS A P. G. SUPPORT THE
GOVERNOR'S PROPOSAL FOR THE
OFFICE OF HEALTH CARE
AFFORDABILITY WE SUPPORT THE-
CREATION AND IMPLEMENTATION OF
THE ALL PAYER CLAIMS DATABASE.
AND LOOK FORWARD TO GREATER
TRANSPARENCY AROUND COSTING
QUALITY- IN OUR SYSTEM THANK
YOU. THANK YOU FOR MUCH IS
THERE ANYONE ELSE. SEE NO ONE
BRING IT BACK TO THE COMMITTEE
ANY COMMENTS OR ANY MISTER IS
THERE ANYTHING. WE GET YOU ALL
THE SLOW JACKSON. OKAY WELL
MAKE SURE WOULD MAKE SURE YOU
GET EVERY. I WAS A THANK YOU
OUR PAY AND EVERYBODY IN THE
AYE THIS BEEN. THIS IS BEEN
REALLY VALUE PERSONALLY
FASCINATING TO ME I AM A DAY
GEEK AND THIS IS I GUESS I'M DE
AND KEEP HIM TODAY. BUT BY IT
IS REAL REALLY BAD AND AS WE
WERE FORWARD WORKING WITH THE
GOVERNOR'S OFFICE ON THE OFFICE
OF HEALTH CARE AFFORDABILITY
AND REALLY BEGINNING TO TACKLE
SOME OF THE THESE COST DRIVERS-
IN IN HEALTHCARE IT'S IF YOU
LIKE IT'S LONG OVERDUE- IT'S
SOMETHING THAT HAS DRIVEN ME
PERSONALLY- AND I THINK WITH
THIS- WITH THIS NEW APPROACH WE
HAVE TO PUT. CHAU TO REALLY IN
TWO TO AN END TO AN OPPORTUNITY
TO REALLY LOOK HOLISTICALLY AT
THAT AT THE PROBLEM YOU KNOW I
AND AT THE CHALLENGE IN THE
LEGISLATIVE ARENA IS THAT. WE
AS AT LEGISLATOR APPROACH MY
CONSTANT SOME WE WORK AT AT
PARTS OF THE ISSUE BUT WE DON'T
ALWAYS GET THE OPPORTUNITY LOOK
HOLISTICALLY AT WHAT'S DRIVING
THESE. DRIVING THESE AND WHAT
ARE THE TO UNINTENDED
CONSEQUENCES SO I WILL GO BACK
TO THE- VALUE ASIA NIGHT AND WE
WILL BE LOOKING TO TRIED ONLY
TO MAKE SURE THAT THAT. COMES
ON. TO TRY TO MAKE IT ONLINE.
BUT ALSO LOOK TO FIND A WAY TO
GET THE DATA COLLECTION TO
HAPPEN SOONER OF A LOT THE
SOONER WE HAVE DATA- THE AND IS
A DATABASE TO OPERATE. THAT
JUST LIKE THERE'S MORE YOU FOR
EVERYONE AGAINST AS THOSE HELLO
TO ASSIST. AND I'M A MUCH
NEEDED IN LAPSED.