BEING HERE WHEREVER HERE IS I
KNOW WE'RE SPREAD OUT ALL OVER
THE STATE TO PUT A HEARING LIKE
THIS TOGETHER SO. VERY MUCH
APPRECIATE PEOPLE WORKING WITH
US AND TRYING TO HELP. HELP US
SO WE'RE THROUGH SOME REALLY
DIFFICULT- TECHNICAL CHALLENGES
SOMETIMES AND ALSO A VERY.
IMPORTANT ISSUE BEFORE US RIGHT
NOW. SO WELCOME TO THE ASSEMBLY
HEALTH COMMITTEE HEARING
EXPLORING HEALTH CARE
AFFORDABILITY AND HOW TO
CONTROL COSTS IN CALIFORNIA.
DUE TO THE CONTINUED STAY AT
HOME WATER WE ARE PRACTICING
PHYSICAL DISTANCE SEEN HERE IN
THE HEARING ROOM AND THROUGHOUT
THE CAPITOL BUILDING SO WE'RE
ONLY ABLE TO HAVE A LIMITED
NUMBER OF PEOPLE WATCH- AND
PARTICIPATE AT THE HEARING IN
PERSON. ROSS OF REQUIRING THAT
MASS BE WORN IN FISCAL
DISTANCING BE MAINTAINED BY ALL
MEMBERS OF THE PUBLIC
TESTIFYING WEATHER HERE IN THE
ROOM OR IN A VIDEO CONFERENCING
SITE. IF YOU DON'T HAVE A MASK
WE CAN PROVIDE ONE FOR YOU.
THANK YOU TO ALL OF OUR
SPEAKERS FOR COMPANY IN A
REQUEST TO PREVENT PRESENT AT
THIS HEARING DURING THIS ERA OF
THE PANDEMIC. NOW MORE THAN
EVER WITH OVER NINETEEN
CALIFORNIA RESIDENTS DESERVE
NOT ONLY QUALITY HEALTH CARE
BUT HEALTHCARE THAT IS
ACCESSIBLE AND AFFORDABLE.
HOWEVER MANY CALIFORNIANS ARE
STRUGGLING TO MEET THEIR
HEALTHCARE NEEDS. EVEN THOUGH
MORE THAN 50% OF OUR RESIDENTS
RECEIVE THEIR HEALTH INSURANCE
THROUGH THEIR EMPLOYERS. NO
FAMILY HAS ESCAPED THE
FINANCIAL BURDEN AND HARDSHIP
ASSOCIATED WITH RISING
HEALTHCARE COSTS. YESTERDAY THE
SACRAMENTO BEE REPORTED THAT
EVEN WITH THE HEALTH CARE
COVERAGE EVEN WITH HEALTH CARE
COVERAGE OPTIONS. CERTAIN
CALPERS PLANS ARE SPEEDING
TOWARDS COLLAPSE AS PRICES FOR
EXPENSIVE PLANS ARE BECOMING
INFLATED. AND BENEFITS AREN'T
GOOD ARE GOOD AS OUR PRICES
AREN'T AS GOOD AS OUR PRICES
SUGGEST. DUE TO THE YEAR- DUE
TO YEAR TO YEAR PRICE HIKES IN
HEALTH CARE- SURVEY AFTER
SURVEY REVEALED THE EXTREMES
CALIFORNIANS ARE GOING THROUGH.
CUTTING THEIR MEDICATIONS NOT
GETTING THEIR PRESCRIPTION
FILLED DELAYING PROCEDURES ARE
WERE SKIPPING CARE ALTOGETHER.
MILLIONS OF CALIFORNIANS ARE
FACING THIS REALITY THIS SHOULD
NOT BE. WE HAD A HEARING IN
FEBRUARY OF THIS. ON OF THIS
CUT YEAR ON COST CONTAINMENT
OPTIONS BUT DUE TO THE PANDEMIC
WE HAD TO PAUSE MANY OF OUR
PRIORITIES. THIS HEARING
EXPLORES THE SAME ISSUES
BECAUSE HEALTH CARE CAN COST
CONTINUE. TO DOMINATE THE
DISCUSSION I ALSO WHAT I THINK
WHAT WE ALSO WANT THE
LEGISLATURE TO UNDERSTAND THE
COMPLEXITY OF COST CONTAINMENT.
AND MEMBERS OF THE PUBLIC TO
KNOW THAT WE ARE LISTENING TO
YOU. WE HAVE AN OBLIGATION TO
FIND SOLUTIONS THAT IMPROVE THE
HEALTH CARE STATUS OF OUR
RESIDENTS. WHILE CONTROLLING
COSTS FOR TODAY FOR MEMBERS AND
THE PUBLIC IN THE ROOM. WE
ASKED- WHEN YOU- WHEN WE REACH
THE PUBLIC COMMENT PORTION OF
THE AGENDA. AND ASKED THAT MANY
MEMBERS OF THE PUBLIC HERE IN
THE ROOM PLEASE APPROACH THE
MIKE ONE PERSON AT A TIME. AND
PLEASE MAINTAIN SOCIAL
DISTANCING AS YOU MOVE AROUND
THE ROOM. BUT ASSET PUBLIC NOT
TOUCH THE MICROPHONE. AND FOR
WITNESSES- URICH AND YOU CAN
EXIT THE HEARING ROOM ONCE YOU
YOU'RE DONE PROVIDE YOUR
COMMENTS OR RETURN YOUR SEAT.
BE SURE TO OBSERVE PHYSICAL
DISTANCE IN UPON LEAVING THE
CAPITAL INCLUDING LIMITED
BEHAVIOR LIMITING BEHAVIOR HIM
ABOUT TO. LIMITED ELEVATOR USE.
TO HUNT PERSON AT A TIME. A
WITNESSES- VIDEO ROOM AND
REMOTE TESTIMONY STATION
WITNESSES IN ADDITION TO BEING
ABLE TO TESTIFY FROM INSIDE THE
HEARING. ROOM WE HAVE SOME
PANELISTS AND OTHER MEMBERS OF
THE PUBLIC MAKING USE OF ONE OF
OUR WITNESS COULD VIDEO
CONFERENCING ROOMS IN THE
CAPITAL. OR OUR REMOTE
TESTIMONY STATIONS LOOK AT ON
THE CAPITOL GROUNDS IN OTHER
LOCATIONS THROUGHOUT THE STATE.
THOSE WITNESSES WILL APPEAR ON
THE SCREEN SO MEMBERS CAN WATCH
THE TESTIMONY LIVE FROM OUTSIDE
OF THE HEARING ROOM. ALSO ASKED
HIM QUESTIONS. FOR DIALING
WITNESSES AND MEMBERS OF THE
PUBLIC CALLING IN WE WILL BE
USING A MODERATED TELEPHONE
SERVICE THROUGH WHICH ANY
MEMBER OF THE PUBLIC CAN
PROVIDE COMMENTARY WHEN WE GET
TO THAT POINT IN THE AGENDA.
PALACE HVE BEEN PROVIDED A
PHONE CALL A CALL THE NUMBER.
OF PRIOR TO THIS HEARING. OF
THE CALL IN NUMBER FOR PUBLIC
COMMENTS FOR THIS HEARING IS.
EIGHT SEVEN SEVEN. SIX NINE
TWO. EIGHT NINE FIVE SEVEN. AND
THE ACCESS CODE IS ONE THREE
ONE. FIVE FOUR THREE SEVEN YOU
CAN ALSO FIND THIS NUMBER ON
THE ASSEMBLY COMMIT HEALTH
COMMITTEE'S WEBSITE AS WELL AS
ON YOUR TELEVISION SCREEN AND
WITHOUT THAT WILL COME UP LATER
AS WE GET TO THE A PUBLIC
COMMENT SECTION AS WELL. THE
OPERATOR ON THE LINE WILL GIVE
INSTRUCTIONS ON HOW TO BE
PLACED IN THE QUEUE TO PROVIDE
YOUR TESTIMONY FOR CALLING IN
PLEASE LEMONADE ALL BACKGROUND
NOISE THIS INCLUDES MUTING YOUR
LIVESTREAM BROADCAST IN YOUR
SMART DEVICES TO REDUCE THE
SOUND DISTORTION. ONCE IN THE
QUEUE YOU'LL ALSO NEED TO MIGHT
MUTE YOURSELF UNTIL YOU'RE
CALLED UPON TO SPEAK YOU HAVE
ANY PROBLEMS WITH THE MODERATOR
PHONE SERVICE YOU CAN CALL THE
COMMITTEE AT. NINE ONE SIX
THREE ONE NINE TWO ZERO NINE
SEVEN AND MY STAFF WILL BE
THERE TO HELP ALTHOUGH THAT MAY
BE A PROBLEM BECAUSE MOST. WE
GOT IT COVERED OKAY THANK YOU.
WAS STATE THE STAFF THE USUALLY
DOES THAT IS HERE IN THE ROOM.
SO ANYWAY OKAY GOOD WE GOT IT
COVERED. I ALSO WANT TO KNOW
THEY WERE ACCEPTING WRITTEN
PUBLIC COMMENT THROUGH THE
HEALTH COMMITTEES PUBLIC EMAIL.
WHICH IS A H. E. A. DOT
COMMITTEE. ASSEMBLY DOT C. A.
DOT G. O. V. WHICH IT CAN ALSO
BE FOUND ON OUR WEBSITE WE MAY
NEED TO LIMIT HOW LONG EACH
PERSON HAS PROVIDE PUBLIC
COMMENT AS WILL NEED ACCESS AT
EXIT THIS HEARING ROOM IN TIME
FOR CLEANING PRIOR. TO OTHER.
ACTUALLY ACTUALLY THERE AREN'T
ANY THIS IS THE ONLY ONE TODAY-
SO IT WE STILL WE NEED TO
VACATE THE ROOM- ADDED IN A
TIMELY MANNER. THANK YOU FOR
YOUR PATIENCE AND WANT TO SEE
IF ANY OF OUR MEMBERS PRESENT
AND REMOTELY WOULD LIKE TO
OFFER ANY OPENING COMMENTS.
THANK YOU- THANK YOU SYSTEM
OVER WOULD ENTER STAFF AND
THEY'RE NOT SPEAKERS TODAY
FOCUSING ON. THE TIME OF PEOPLE
TRYING TO FIGURE OUT HOW TO
CONTROL COSTS AND I'M LOOKING
FOR THE QUESTION CAME UP. AGAIN
THANK YOU. OKAY I THINK I MIGHT
HAD YOU MUTED THERE SO. AND IT
WASN'T IT WAS IT WAS IT WAS
VERY COMMENTS I APPRECIATE THAT
THANK YOU THANK YOU MISS
AGUIAR-CURRY- MISTER NAZARIAN
WHO WOULD YOU LIKE TO SAY
ANYTHING. BEFORE WE START. I
I'M REALLY NOT GOOD AT LIP
READING I'M SORRY. BUT YOU HAVE
A REALLY NICE SMILE SO. OKAY
OKAY TRY THAT TRICK. ONE THERE
WE GO. THAT WOULD. COMMA THAT
ON OUR END HIS AND- ONCE YOU
TALK FORCING CHEN. THERE'S
ALWAYS A GOOD TIME HERE I GUESS
THIS IS ON YOUR END SO. YOU'RE
GOOD. OKAY YOU CAN HEAR US HE
SAID OKAY WE COULDN'T HEAR THE
ANSWER. OMAND OKAY ALL RIGHT
WITHOUT WE'RE GOING TO GO ON TO
OUR FIRST PANEL- AND WE HAVE TO
MEMBERS OF THE- OUR- HELLO I'M
SORRY MARIE HI. WE CAN'T HEAR
YOU EITHER. THAT'S MAKE ME
WONDER IF IT'S ON OUR END. SAY
SOMETHING MARIE HOW'S THE
WEATHER. FIRES. THERE ARE.
THAT'S WHY I'M HERE THEY ARE
APPARENTLY YOU'RE ON MUTE. TO
I'M SORRY.ALL THAT WAS THE
PROBLEM. OKAY LET'S TRY THIS
AGAIN HI MARIE. HOW ARE YOU
GOOD HOW ARE YOU FALL I NEVER A
PRIORITY BUT BEFORE ANYTHING
ALSO SO THAT'S COHEN I WONDER
WHAT THAT WAS SO OKAY COOL. HI
WHICH I SEE SOMETHING. WELL
JUST THAT THIS IS A VERY BIG
HEARING WITH ARE VERY BIG
POPPING. AND IT'S ALMOST LIKE
AS I WAS GOING THROUGH ALL THE
PAPERWORK. THAT IT'S- SOMETHING
THAT WOULD PROBABLY NEED
SEVERAL HEARINGS I THINK REALLY
DIVE INTO BUT IT'S DEFINITELY A
GREAT TOPIC OF DISCUSSION
ESPECIALLY AT THIS TIME AND I'M
REALLY GLAD THAT I CAN
PARTICIPATE. THANK YOU VERY
MUCH FOR BEING WITH US TODAY
MARIE- ASSEMBLY MEMBER WALDRON
EXCUSE ME- DO WE WANT TO GO
BACK TO MR IN HIS AREA- IN ALL
FAIRNESS. SINCE OBVIOUSLY THE
DIFFICULTY WAS ON OUR END. CAN
WE GET BACK TO ASSEMBLY MEMBER
IN HIS AREA. YOU GOT IT OKAY.
CAN YOU HEAR ME NOW YEAH HI
THERE. HI. WELL FIRST OF ALL
THANK YOU JIM FOR HOSTING THIS
GATHERING I'M ASSUMING YOU CAN
HEAR ME RIGHT YES WE CAN THANK
YOU. OKAY GOOD GOOD- I'M SORRY
I'M NOT THERE IN PERSON I THINK
THIS HEARING IS EXTREMELY
CRITICAL. SO I ACTUALLY WAS
PLANNING ON BEING THERE BUT
GIVEN EVERYTHING THAT'S BEEN
GOING ON. IN THE CAUCUSES AND
THE AGGRESSION AGAINST ARMENIA
RIGHT NOW THERE'S BEEN A QUITE
A BIT OF ACTIVITY HERE LOCALLY
IN LOS ANGELES. THAT I'VE BEEN
TRYING TO BE ENGAGE WITH AND BE
PRESENT FOR SO- SORRY I
COULDN'T BE THERE IN PERSON.
BUT BUT I'M LOOKING FORWARD TO
HEARING WHAT'S BEING DISCUSSED
WHAT'S BEING PRESENTED I'M
GONNA HAVE SOME QUESTIONS
MYSELF BECAUSE THIS IS A- OF A
VERY BIG ISSUE AREA AND AN AREA
THAT WE'RE- I'M SURE IS GOING
TO BE KEEPING US BUSY FOR THE
NEXT YEAR IF NOT AT LEAST THE
NEXT TERM- AND I LOOK FORWARD
TO. WORKING WITH YOU AS WELL AS
ALL OUR COLLEAGUES ON THE
COMMITTEE THANK YOU THANK YOU
VERY MUCH ASSEMBLY MEMBER
MEMBER NECESSARY AND WE HAVE
ANYONE ELSE WHO'S OUT THERE.
THIS POINT OKAY WE MAY HAVE
OTHERS WHO POP IN SO. SO AT
THIS POINT- AND I THINK- THANK
MR MAYES FOR HELPING KEEP ME ON
TRACK HERE SO. CLEARLY IDEA
NEED ALL THE HELP I CAN GET. I
DO WANT TO GO AHEAD WITH OUR
FIRST PANEL. MEMBERS PANEL IS-
INCLUDE IS DR GLENN MELNICK- A
SENIOR FELLOW AT THE USC
SCHAEFFER CENTER. THE USC PRICE
SCHOOL OF PUBLIC POLICY IS AN
EXPERT IN HEALTH ECONOMICS AND
FINANCE. AND LARA LUCY FROM THE
UC BERKELEY LABOR CENTER SHE'S
THE DIRECTOR OF THE HEALTH CARE
PROGRAM AND LABOR CENTER WHERE
SHE'S WORKED SINCE TWO THOUSAND
NINE AND ANALYZING HEALTH CARE
POLICY. WHO WILL YOU YOU EACH
HAVE ABOUT FIFTEEN MINUTES AND-
AFTER YOU AFTER EACH PANEL WILL
OUT ALLOW MEMBERS TO ASK
QUESTIONS AND SO. THESE
WHENEVER YOU'RE READY DOCTOR
MELNICK. HELLO EVERYONE THANK
YOU DOCTOR WOULD IT MEMBERS OF
THE COMMITTEE FOR CONVENING
THIS REALLY IMPORTANT HEARING
AND GIVING ME THE OPPORTUNITY
TO CONTRIBUTE MUCH OF MY
RESEARCH IS FOCUSED ON
UNDERSTANDING AND IMPROVING
HEALTH CARE SYSTEMS NEXT SLIDE
PLEASE. I DON'T SEE THE SLIDES.
WE SHOULD BE NOW ON SLIDE THREE.
YES ON'T WE'VE GOT HIM ON OUR
END SO. I THOUGHT. SO OUR SLIDE
SAYS HEALTH SPENDING LANDSCAPE.
SO WE DO HAVE A DOWN OF ON A ON
A SCREEN HERE BUT- DO NOT HAVE
IT ON YOUR COMPUTER. FIVE OF US.
IT IS ON I WON HIS GUN THAT'S
GREAT. I DON'T KNOW A LOT OF
PEOPLE WHO. OKAY. DO YOU HAVE
THE SLIDE THE SLIDES IN FRONT
OF YOU. OR YOU'RE YOU'RE A LINE
ON THE SCREEN. KAMALA COVER
LYING ON THE SCREEN. AND WE
DON'T HAVE A WAY TO GET THE
SLIDES. AM I HAVE A HARD COPY
IN FRONT OF ME OKAY I JUST NEED
SOMEONE TO ADVANCE THEM YES WE
WILL YEAH JUST SAY ADVANCE THE
SLIDE AND WE'LL DO THAT FOR YOU.
THANK YOU BYE NUMBER THREE. HEY.
OKAY LET'S SEE. HEALTH SPENDING
LANDSCAPE IS AFTER THAT LOOKS
LIKE PERFECT YES THANK YOU.
OKAY SO- TO MONITORS HEALTH
SPENDING WE'RE GOING TO NEED TO
BUILD A COMPREHENSIVE DATA AND
REPORTING SYSTEM BUT IN THE
MEANTIME WE CAN USE EXISTING
DATA TO HELP US UNDERSTAND-
SPENDING IN CALIFORNIA. AND WE
CAN USE BOTH EXISTING DATA FROM
NATIONAL SOURCES AS WELL AS
CALIFORNIA SPECIFIC DATA MY
PRESENTATION PAID TODAY WILL
DRAW ON THESE DATA SOURCES LET
LISTED ON THE SLIDE. NEXT SLIDE
PLEASE NUMBER FOUR. THIS SLIDE
SHOWS HEALTHCARE SPENDING
DISTRIBUTED ACROSS DIFFERENT
SERVICES IN CALIFORNIA. AS YOU
CAN SEE MORE THAN 60% GOES TO
HOSPITALS AND DOCTORS. AND
DRUGS INCLUDING RETAIL MAKES UP
ABOUT ONE FIFTH. NEXT SLIDE
PLEASE. THIS SLIDESHOW SPENDING
BY SERVICE SECTOR THE SERVICE
SECTOR OVER TIME IN CALIFORNIA
AS YOU CAN SEE SPENDING HAS
INCREASED IN ALL SECTORS. OVER
THIS TIME PERIOD YOU CAN SEE
IT'S BEEN LED BY OFFICE BASED
IN PATIENT CARE AND DRUG
SPENDING IN CALIFORNIA. NEXT
SLIDE PLEASE. WHAT FACTORS ARE
DRIVING THESE TRENDS CITIES AND
INCREASED HEALTH CARE SPENDING
WE CAN LOOK AT NATIONAL CLAIMS
DATA TO GAIN SOME INSIGHT WE
WILL CAPTAIN CALIFORNIA WILL
HAVE OUR OWN CLAIMS DATA IN THE
FUTURE BUT WE CAN LOOK AT
NATIONAL CLAIMS DATA TO GIVE US
SOME INSIGHT INTO THESE TRENDS.
NEXT SLIDE PLEASE. THIS LINE
RELIES ON A NATIONAL CLAIMS
DATABASE ANALYZED BY THE HEALTH
CARE COST INSTITUTE. IT SHOWS
TOTAL SPENDING PER CAPITA
INCREASE BETWEEN. TWENTY
FOURTEEN TO TWENTY EIGHTEEN BY
EIGHTEEN POINT 4% AND MOST OF
THAT INCREASE WAS DUE NOT TO
UTILIZATION BUT TO INCREASE
PRICES. NEXT SLIDE PLEASE. THIS
SLIDESHOW SIMILAR DATA BUT
REMOVES THE EFFECTIVE GENERAL
INFLATION WHICH ACCOUNTED FOR
ABOUT THREE HUNDRED DOLLARS OUT
OF A NINE HUNDRED DOLLAR
INCREASE OVER THAT TIME PERIOD
IN INCREASED SPENDING. THE DATA
SHOW THE PRICE INCREASES ABOVE
INFLATION. THAT'S THE ARE IN
SECTION OF THE CURVE OR PRICE
INCREASES YOU COULD SEE PRICE
INCREASES ARE DOMINATING
INCREASE SPENDING NOW IN
AMERICA. NEXT SLIDE PLEASE.
THIS LINE NOW PRESENTS
CALIFORNIA DATA FROM US BIT ON
THE PERCENTAGE CHANGE IN
HOSPITAL SPENDING AND
UTILIZATION FOR HOSPITALS
TREATING COMMERCIALLY INSURED
PATIENTS BETWEEN TWO THOUSAND
EIGHT AND TWENTY EIGHTEEN THE
BLUE LINE TRACKS HOSPITAL
UTILIZATION IN CALIFORNIA. AS
YOU CAN SEE CALIFORNIANS ARE
USING LESS AND LESS HOSPITAL
CARE OVER TIME TOTAL HOSPITAL
UTILIZATION OR VOLUME DECLINED
BY 15% OVER THIS TIME PERIOD
DESPITE INCREASED POPULATION
YET THE GOLD BARS WHICH
REPRESENTS THE AMOUNT OF MONEY
COLLECTED BY HOSPITALS FROM
COMMERCIALLY INSURED PATIENTS
WHEN UP A STAGGERING TWO
HUNDRED AND 83% OVER THIS TIME
PERIOD. USUALLY AND MARKETS ONE
VOLUME DECLINES WE SEE PRICE
CUTS IN ORDER FOR ORGANIZATIONS
TO MAINTAIN MARKET SHARE. IN
TH CASE OF HOSPITAL CARE
CALIFORNIA WHAT WE SEE IS
PRICES INCREASED NOT ONLY TO
OFFSET REDUCE VOLUME BUT WELL
ABOVE. TO INCREASE THEIR
REVENUE BY ALMOST 3100% THAT
INCREASE REPRESENTS PRICE
INCREASES. NEXT SLIDE PLEASE.
WHY ARE PRICES INCREASING SO
QUICKLY THERE'S AT LEAST TWO
FACTORS THAT ARE DRIVING
HOSPITAL PRICE INCREASES IN
CALIFORNIA. ONE IS THE
INCREASED CONSOLIDATION OF
HOSPITALS INTO MULTI HOSPITAL
SYSTEMS THAT CAN ACCUMULATE
MARKET POWER. AND RAPIDLY
RISING HOSPITAL BILL CHARGES
FOR OUT OF NETWORK EMERGENCY
CARE NEXT SLIDE PLEASE. SEE I
CAN'T TO THIS SIDE I CAN'T SEE
THE GRAPH IS THEIR GRAPH ON
THAT SLIDE YES YES. I'M HOPING
THAT THERE IS THIS IS ONE OF MY
FAVORITES LICENSE IT PROVIDES
EVIDENCE THAT COMPETITION CAN
WORK THERE WE GO CAN WORK IN
HEALTH CARE. WHEN MARKETS ARE
COMPETITIVE. THE DATA ON THIS
SLIDE TRACK HOSPITAL PRICES PER
DAY THE BLUE BARS BETWEEN
NINETEEN NINETY FIVE IN TWENTY
SIXTEEN FOR COMMERCIALLY SHORT
PATIENTS IN CALIFORNIA. IF YOU
LOOK TO THE EARLY YEARS WHICH
ARE ON THE LOWER LEFT HAND SIDE
THE BLUE BARS YOU CAN SEE
PRICES WERE LOWER IN NINETEEN
NINETY FIVE. BUT ALSO THEY WERE
LOWER IN THE NINETY SIX NINETY
SEVEN AND NINETY EIGHT PRICES
WERE ACTUALLY GOING DOWN. IN
CALIFORNIA. THIS IS WHEN
COMPARED MARKETS WERE
COMPETITIVE. THEN WE SEE THIS
TREND RE BEGIN TO REVERSE AND
PRICES IN HOSPITALS GROW
RAPIDLY. AS I MENTIONED THERE'S
TWO SETS OF FACTORS THAT ARE
DRIVING THIS CALIFORNIA IN
EARLY TWO THOUSANDS ADOPTED
PRUDENT LAYPERSON RULES. THAT
INCREASED UTILIZATION OF
HOSPITAL EMERGENCY DEPARTMENTS
AND MANDATED THAT HEALTH PLANS
PAY FOR OUT OF NETWORK
EMERGENCY CARE. IN ADDITION
MORE AND MORE HOSPITALS WERE
JOINING MULTI HOSPITAL SYSTEMS
AND MORE OF THOSE SYSTEMS WERE
DEMANDING ALL LEARN CONTRACTS.
REFLECTING INCREASED MARKET
POWER NEXT SLIDE PLEASE. THIS
NEXT SLIDE. THE LINE GRAPH
SHOWS INCREASES IN BILL CHARGES
OVER TIME AND YOU COULD SEE IN
THE EARLY PERIOD BILL CHARGES
PER DAY WERE GOING UP SLIGHTLY
AND THEN THEY STARTED TO
ACCELERATE AND EXPLODED. ALL
RIGHT THIS REFLECTS HOSPITALS
RAISING THEIR BILL CHARGES AS
THE DEFAULT PRICE FOR OUT OF
NETWORK EMERGENCY CARE. THESE
THESE BILL CHARGES BECAUSE THEY
WENT UP SO QUICKLY. REYES THE
IN NETWORK PRICES WHICH OF THE
BLUE BARS AND SO THERE'S A
DIRECT CORRELATION BETWEEN THE
ABILITY OF HOSPITALS TO RAISE
THEIR BILL CHARGES AND TO
DEMAND THOSE PRESS AS OUT OF
NETWORK PRICES THOSE DROVE IN
NETWORK PRICES HIGHER AND ARE
MAJOR FACTORS DRIVING INCREASE
HOSPITAL PRICES IN CALIFORNIA.
NEXT SLIDE PLEASE. THIS
SLIDESHOWS CALIFORNIA DATA AND
PRICE PERMISSION OVER TIME
BETWEEN NINETEEN NINETY FIVE IN
TWO THOUSAND SIXTEEN FOR
HOSPITALS IN THE TWO LARGEST
MULTI HOSPITAL SYSTEMS THAT'S
THE RED LINE AND ALL OTHER
HOSPITALS IN CALIFORNIA THAT'S
THE BLUE LINE. THE GREEN LINE
AT THE BOTTOM IS THE DIFFERENCE
BETWEEN THOSE TWO GROUPS OF
HOSPITALS IF YOU LOOK TO THE
LOWER LEFT HAND CORNER YOU CAN
SEE THE PRICES IN THOSE TWO
GROUPS OF HOSPITALS WERE ABOUT
THE SAME. THEN BEGINNING IN
EARLY TWO THOUSAND ONE HOSPITAL
STARTED TO DEMAND ALL OUR NON
CONTRACTS IT IS REPORTED THAT
THESE TWO SYSTEMS- STARTED THAT
PRACTICE AROUND THEN. WE SEE
THE PRICES START TO GROW FASTER
THAN THE REST OF HOSPITALS IN
THE MARKET. AND CONTINUE TO
GROW AND NOW YOU CAN SEE ON THE
LOWER RIGHT HAND SIDE THE GAP.
BETWEEN THOSE TWO GROUPS
HOSPITALS IS ALMOST SEVEN
THOUSAND DOLLARS. BILL CHARGES
PER DAY IN CALIFORNIA WITH MORE
RECENT OSCAR DATE AND OUR OVER
TWENTY TWO THOUSAND DOLLARS PER
DAY. AGAIN HOSPITALS USING.
THEIR ABILITY TO DEMAND OUT OF
NETWORK PRICES AS WELL AS ALL
IN ON CONTRACTING TO GAIN
HIGHER PRICES FOR IN NETWORK
CARE. INCIDENTLY THE PRICES
HERE ARE JUST A FOR CASE MIX.
DIFFERENCES A WAGE INDEX AND
HOSPITAL OUTPATIENT UTILIZATION
AS WELL. AND WE'VE DONE
ADDITIONAL ANALYSES.
CONTROLLING FOR MANY OTHER
FACTORS IS THE STATISTICAL
MODEL THESE DIFFERENCES STILL
REMAIN BETWEEN HOSPITALS AND
THE LARGEST SYSTEMS AND ALL
OTHER HOSPITALS REFLECTING
MARKET POWER DIFFERENCES. NEXT
SLIDE PLEASE. THIS SLIDE SHOWS
RECENT UNIQUE REAL TIME DATA ON
HOSPITAL ADMISSIONS ON EDIE
VISITS IN CALIFORNIA AN
INPATIENT ADMISSIONS COMPARING
POST CODE TO PRE COBIT. SO THIS
COMPARES UTILIZATION IT DIDN'T
SEEM TO AND TWENTY TWENTY
COMPARED TO THE SAME TIME
PERIOD IN TWENTY NINETEEN. AND
AS YOU CAN SEE VOLUME DROPPED
SUBSTANTIALLY IN THE EARLY
PERIOD OF COVE IT HAS REBOUNDED
BUT IS STILL WELL BELOW PRE
COVERT LEVELS INPATIENT
UTILIZATION CALIFORNIA'S
RUNNING ABOUT 10% BELOW AND
EDIE VISITS ARE RUNNING ABOUT
TWENTY PERCENT. BELOW SO
HOSPITALS HAVE LOST MONEY
DURING THIS TIME PERIOD WELL
THEY DID GET SOME FUNDING FROM
THE FEDERAL GOVERNMENT AND WERE
ABLE TO CUT SOME OF THEIR
EXPENSES THEY UNDOUBTEDLY LOST
MONEY DURING THIS TIME PERIOD.
ONE CONCERN IS ARE THEY LIKELY
TO LOOK FOR PRICE INCREASES
WHEN THEIR CONTRACTS EXPIRE TO
MAKE UP THESE LOSSES AND WHAT
DO THEY HAVE THE MARKET POWER
TO MAKE THOSE PRICE INCREASES
STICK. NEXT SLIDE PLEASE. RIGHT
THERE IS SOME POTENTIAL GOOD
NEWS FOR CALIFORNIA HEALTHCARE
CONSUMERS SO THIS SLIDE
PRESENTS DATA. FROM RECENT
FILINGS WITH THE FROM THE A. M.
EIGHT C. FOR HEALTH PLANS FOR
THE FULLY INSURED POPULATION
PROJECTING THEIR PREMIUM
INCREASES FOR TWENTY TWENTY
ONE. THESE DATA ARE COLLECTED
AND MADE AVAILABLE- BY I SPIT.
BUT IT SHOWS FOR THE TWENTY
SEVEN PLANTS REPRESENTING ABOUT
THREE AND A HALF MILLION
INSURED POPULATION. THE AVERAGE
INCREASE IN PREMIUMS IS ONLY
GONNA BE ONE PERCENT. FOR
TWENTY TWENTY ONE THIS IS THE
LOWEST LEVEL WE'VE SEEN IN A
LONG TIME. ALL RIGHT HOWEVER
GIVEN WHAT THE DATA WE SAW ON
THE PREVIOUS SLIDE WHERE
UTILIZATION IS RUNNING BELOW
THREE COVERT LEVELS. UP VOTE
FOR IN PATIENT CARE AND EDIE
VISITS AND ALSO WE SEE SIMILAR
DATA FOR DOCTOR VISITS AS WELL.
ONE MIGHT ASK WHY THESE PREMIUM
INCREASES ARE ACTUALLY NOT
NEGATIVE FOR NEXT YEAR. AND BE
INTERESTING TO SEE HOW THESE
TRENDS FLY OUT IN THE COMING
MONTHS AND THE REST OF THIS
YEAR. NEXT ABOUT NEXT SLIDE
PLEASE. SO THESE DATA.
HIGHLIGHT THE POTENTIAL VALUE
OF MORE COMPREHENSIVE DATA
SYSTEM IN CALIFORNIA. I HIGHLY
RECOMMEND THAT WE MOVE QUICKLY.
WE SHOULD FORMA CASF WITHOUT
FORCE OR WORKING GROUP TO
ADVISE POLICY MAKERS HOW WE CAN
SUPPLEMENT. THE FANTASTIC
GOLDMINE WE'RE GOING TO HAVE
WHICH IS THE HEALTH PAYMENTS
DATABASE WITH ADDITIONAL DATA.
AND WE SHOULD LEVERAGE OUR
EXTENSIVE NETWORK OF EXPERTS IN
WITHIN CALIFORNIA TO HELP US
FIGURE OUT HOW DO WE DEVELOP
QUICKLY A COST EFFECTIVE DATA
SYSTEM. SECOND LET US MONITOR
THESE TRENDS. LATER ON IN
TODAY'S SESSION BUT NEXT SLIDE
PLEASE. LATER ON A TODAY
SESSIONS I'LL PROVIDE SOME
LESSONS FROM OTHER STATES THAT
HAVE IMPLEMENTED AND DEVELOPED
STATE LEVEL COSTS COMMISSIONS
TO MONITOR SPENDING AND SET
SPENDING TARGETS FOR
AFFORDABILITY- THAT CONCLUDES
MY PRESENTATION THANK YOU.
THANK YOU DOCTOR MELNICK AND
WILL HAVE QUESTIONS FOR YOU
AFTER AFTER WE HEAR FROM- FROM
OF THE SIERRA AND HER SO A
LAURA MERCIER SO THANK YOU
THANK YOU VERY MUCH CAN I DO WE
KNOW DOES THE PUMP IS A PUBLIC
SEEN. THESE SLIDES ON THEIR
SCREEN THEY ARE OKAY OKAY
THAT'S AND THAT'S IMPORTANT
OKAY VERY VERY GOOD THANK YOU-
THANKS FOR BEING A GUINEA PIG
OUT THERE TOO DR MONICA NO THIS
IS. ALLAH ALLAH CHALLENGE ALL
CHALLENGING SO AT THIS POINT
WOULD LIKE TO GO ON TO MOVE ON
TO I MISS THE SIERRA THANK YOU
HI HOW ARE YOU. PLEASE GO AHEAD
WHEN YOU'RE READY. GOOD
AFTERNOON THANK YOU TO ASSEMBLY
MEMBER WOULD INTO THE COMMITTEE
FOR HOSTING THIS HEARING ON
THIS IMPORTANT TOPIC OF HEALTH
CARE AFFORDABILITY MY
PRESENTATION TODAY WILL FOCUS
ON THE- AVAILABLE RESEARCH AND
DATA ON THE IMPACTS THAT HEALTH
CARE AFFORDABILITY HAS. ON
CALIFORNIA WORKERS CONSUMERS
AND EMPLOYERS. NEXT SLIDE. IS
THERE A WAY ON OUR END TO
RETURN THAT A- WE CAN HEAR A
LITTLE BETTER. OKAY GO AHEAD
WE'LL SEE HOW THIS GOES. I
CAN'T SEE THE FIVE SO I AM NOT
SURE FOR ON THE RIGHT WE RUN
THE VIRUS ON SITE TO WEAR ON
THE CYTISUS CERTAIN HEALTH CARE
AFFORDABILITY CONCERNS HOUSE AT.
OKAY GREAT THANK YOU. SO IN
LATE TWENTY NINETEEN THE
CALIFORNIA HEALTH CARE
FOUNDATION SPONSORED A SURVEY
THAT FOUND THAT MORE THAN TWO
THIRDS OF CALIFORNIA ADULTS
REPORTED THAT THEY WERE VERY OR
SOMEWHAT WORRIED ABOUT
UNEXPECTED MEDICAL BILLS OR
AFFORDING THEIR OUT OF POCKET
COSTS WHEN ACCESSING HEALTH
CARE THIS IS A HIGHER
PERCENTAGE. THAN THAT 54% HE
SAID THEY WERE VERY OR SOMEWHAT
WORRIED ABOUT AFFORDING THEIR
RENT OR MORTGAGE. I THINK THIS
PUTS INTO PERSPECTIVE HOW DIRE
HEALTH CARE AFFORDABILITY
CONCERNS HAVE BECOME FOR
CALIFORNIANS. IN ADDITION TO
BEING WORRIED ABOUT UNEXPECTED
MEDICAL BILLS AN OUT OF POCKET
COSTS HALF OF ADULTS THAT THEY
WERE WORRIED ABOUT PRESCRIPTION
DRUG COSTS AND MORE THAN FOUR
OUT OF TEN WHO HAD HEALTH
INSURANCE WE'RE WORRIED ABOUT
AFFORDING THEIR MONTHLY
PREMIUMS. NEXT SLIDE PLEASE.
USING THE SAME SURVEY WE SEE
THAT HEALTH CARE AFFORDABILITY
CONCERNS ARE EVEN MORE COMMON
AMONG HISPANIC BLACK AND ASIAN
CALIFORNIA ADULTS THAN AMONG
WHITE ADULTS NEXT SLIDE PLEASE.
WELL HEALTH CARE AFFORDABILITY
CONCERNS ARE TOO COMMON ACROSS
ALL INCOME GROUPS LOW INCOME
CALIFORNIANS AND HOUSEHOLDS
WITH INCOME BELOW TWICE THE
FEDERAL POVERTY LEVEL WERE MORE
LIKELY TO WORRY ABOUT HEALTH
CARE AFFORDABILITY THAN THEIR
COUNTERPARTS WHO EARNED MORE.
NEXT SLIDE PLEASE. BE THE FORD
ABILITY CONCERNS MEAN THAT
PEOPLE AREN'T GETTING THE CARE
THEY NEED AT THE TIME THEY NEED
IT MANY CALIFORNIANS ARE
SKIPPING PRESCRIPTIONS ARE
CUTTING PILLS IN HALF SKIPPING
RECOMMENDED TESTS OR TREATMENTS
POSTPONING NEEDED MEDICAL CARE
WHETHER THAT PHYSICAL HEALTH
CARE MENTAL HEALTH CARE DENTAL
CARE. AND OVER HALF OF
CALIFORNIA ADULTS EXPERIENCED
AT LEAST ONE OF THESE ACCESS TO
CARE PROBLEMS DUE TO
AFFORDABILITY. IN ADDITION
HEALTHCARE AFFORDABILITY
CONCERNS HAVE FINANCIAL
CONSEQUENCES SUCH AS A PEOPLE
CUTTING BACK ON OTHER BASIC
NECESSITIES TAKING ON DEBT AND
EVEN IN SOME CASES DECLARING
BANKRUPTCY. NEXT SLIDE PLEASE.
HEALTH CARE AFFORDABILITY IS AN
ISSUE THAT AFFECTS NEARLY ALL
CALIFORNIANS BUT TODAY MAY
PRESENTATION WILL MOSTLY FOCUS
ON THE MAJORITY OF CALIFORNIA
ADULTS WHO HAVE COVERAGE THE
THEIR OWN JOB OR A FAMILY
MEMBER'S JOB AND- THE 11% OF
CALIFORNIA ADULTS WHO HAVE
COVERAGE. THROUGH THE
INDIVIDUAL MARKETS. BUT TWO OF
GROUPS I WANTED TO HIGHLIGHT
THAT PARTICULARLY FACE
AFFORDABILITY CHALLENGES DUE TO
HIGH AND RISING HEALTH CARE
COSTS ARE UNINSURED
CALIFORNIANS AND THOSE ENROLLED
IN MEDICARE. TURNING TO JOB
BASED COVERAGE TO FLY THE HEAD
PLEASE. IF. IT TOGETHER
CALIFORNIA EMPLOYERS AND
WORKERS SPENT A HUNDRED AND
FORTY FOUR BILLION DOLLARS ON
COVERED HEALTHCARE BENEFITS IN
TWENTY NINETEEN THAT'S
EQUIVALENT TO APPROXIMATELY 5%
OF OUR STATE'S ECONOMY. THIS
SPENDING INCLUDED FORTY FOUR
BILLION THAT WORKERS PAID IN
PREMIUMS AND OTHER COST
SHARING- AND I'M GONNA TALK
MORE IN A MINUTE ABOUT THE
CONSEQUENCES OF THIS WORKERS
SPENDING AND HOW IT RELATES TO
THE SPENDING BY EMPLOYERS. BUT
FIRST I WANT TO ADDRESS THE
HUNDRED BILLION- THAT EMPLOYERS
SPEND ON PREMIUMS EACH YEAR
INCLUDING FIVE BILLION THAT THE
STATE SPEND ON HEALTH BENEFITS
FOR STATE EMPLOYEES WHO GET
THEIR COVERAGE THROUGH CALPERS.
CALIFORNIA EMPLOYERS ARE
SPENDING THIS HUNDRED BILLION
DOLLARS. EACH YEAR AND A MARKET
THAT'S BROKEN IN A LOT OF WAYS
WHICH WE'VE ALREADY STARTED TO
HEAR ABOUT THIS HEARING IN
WHICH- I THINK WE'LL BE HEARING
MORE ABOUT. HEALTHCARE COSTS
ARE GROWING RAPIDLY AND WITHOUT
A CLEAR AND CORRESPONDING
INCREASE IN THE VALUE RECEIVED.
HEALTH CARE PURCHASERS OFTEN
LACK GOOD INFORMATION ABOUT
WHAT THEY'RE BUYING. HEALTH
CARE MARKETS IN THE STATE ARE
HIGHLY CONSOLIDATED AND OFTEN
LACK COMPETITION. NOT ONLY
LEADING TO HIGHER PRICES BUT
ALSO LARGE VARIATION IN PRICES
THAT DOESN'T NECESSARILY HAVE A
CORRESPONDING. VARIATION IN IN
QUALITY OR OUTCOMES. A LOT OF
LARGE EMPLOYERS INCLUDING
CALPERS. HAVE TAKEN STEPS TO
TRY TO BEND THE COST CURVE WITH
SOME SUCCESS BUT THEIR ABILITY
TO CONTROL COSTS IS CONSTRAINED
IN OUR CURRENT SYSTEM. EVEN THE
LARGEST COMPANIES IN THE STATE
HAVE OFTEN HIT ROADBLOCKS AND
ATTEMPTING TO TRY TO ENSURE THE
HIGHEST VALUE FOR THEIR HEALTH
CARE SPENDING. FOR SMALL
EMPLOYERS THE CHALLENGES WITH
PURCHASING HEALTH BENEFITS ON
BEHALF OF THEIR EMPLOYEES ARE
EVEN GREATER. NEXT SLIDE PLEASE.
IN TWENTY EIGHTEEN THE AVERAGE
TOTAL PREMIUM FOR FAMILY HEALTH
BENEFITS IN THE STATE EXCEEDED
TWENTY THOUSAND DOLLARS A YEAR
OF KAISER FAMILY FOUNDATION PUT
THAT THAT THE COUPLE INTO
BUYING A NEW CAR EVERY YEAR.
FOR SOMEONE WORKING FORTY HOURS
A WEEK ABOUT THE COMPLAINT TO
TEN DOLLARS AN HOUR AND HEALTH
BENEFITS ALONE WHICH IS AN
AMOUNT THAT APPROACHES THE
MINIMUM WAGE IN THE STATE. SO
HEALTHCARE IS A BIG PART OF
WORKERS TOTAL COMPENSATION AND
WHEN EMPLOYERS MAKE DECISIONS
ABOUT HOW TO ADDRESS RISING
HEALTH CARE COSTS. THEY'RE
GENERALLY THINKING ABOUT THEIR
RESPONSE IN THE CONTEXT OF THE
OVERALL COMPENSATION INCLUDING
WAGES RETIREMENTS PAID TIME OFF
AND OTHER BENEFITS SIX. NEXT
SLIDE. PREMIUMS ARE NOT ONLY
HIGH BUT GROWING RAPIDLY
AVERAGE FAMILY PREMIUMSHAVE
GROWN BY ALMOST 50% OVER THE
LAST DECADE AFTER ACCOUNTING
FOR INFLATION WHILE WAGES FOR
THE TYPICAL WORKER HAVE
ESSENTIALLY REMAINED FLAT AFTER
ACCOUNTING FOR INFLATION. IT'S
DIFFICULT TO ISOLATE THE A FACT
THAT RISING HEALTH CARE COSTS
ALONE HAVE HAD ON LIEGE'S
COMPARED TO THE OTHER FACTORS
THAT AFFECT WAGES. SO THIS
GRAPH IS NOT NECESSARILY SAY
THAT WAGE STAGNATION IS SOLELY
DUE TO RISING HEALTHCARE COSTS
BUT THERE HAS BEEN RESEARCH
SHOWING A CONNECTION BETWEEN
RISING HEALTH CARE COSTS AND
WAGE GROWTH. THAT IS SLOWER
THAN THE WAGE GROWTH THAT WOULD
HAVE OTHERWISE HAVE OCCURRED
WITHOUT RISING HEALTH CARE
COSTS. ANALYSTS AHEAD COUPLE
FOR TO FLY. THIRTEEN IN THE
INTEREST OF TIME. THANK YOU.
ONE EXAMPLE OF THIS TYPE OF
RESEARCH IS THE NATIONAL STUDY-
THAT WAS CO AUTHORED BY ONE OF
THE EXPERTS THAT WILL BE
TESTIFYING LEADER IN THIS
HEARING CHRISTOPHER WHALEY THIS
NATIONAL RAM STUDY FOUND THAT
HOSPITAL MERGERS OVER THE
TWENTY TEN TO TWENTY SIXTEEN
PERIOD LED TO A FIVE HUNDRED
AND TWENTY ONE DOLLAR INCREASE
IN HOSPITAL PRICES AND A
SIMILARLY SIZED INCREASE IN
HOSPITAL SPENDING AMONG PEOPLE
WITH PRIVATE INSURANCE AND A
SIMILARLY SIZED REDUCTION IN
WAGES. NEXT SLIDE. IN ADDITION
TO HAVING AN IMPACT ON WAGES
ANOTHER. WAY THAT EMPLOYERS
HAVE RESPONDED TO RISING
HEALTHCARE COSTS IS BY
INCREASING HOW MUCH WORKERS
HAVE TO PAY OUT OF POCKET WHEN
THEY ACCESS CARE THIS GRAPHIC
SHOWS- THAT OVER THE LAST
DECADE THE PERCENTAGE OF
CALIFORNIANS WHO HAVE A
DEDUCTIBLE AS PART OF THEIR JOB
BASED COVERAGE HAS INCREASED.
48% WHICH IS STILL LOWER. THAN
THE NATIONAL PERCENTAGE OF 82%
WITH THE DEDUCTIBLE- BUT IT'S
STILL GROWING. AND IMPORTANTLY
THE AMOUNTS OF THE DEDUCTIBLE
AMOUNT FOR PEOPLE WHO HAVE A
DEDUCTIBLE HAS NEARLY DOUBLED
OVER THE LAST DECADE. TO
FOURTEEN HUNDRED DOLLARS.
SENATE ADOPTABLE IS JUST ONE
MEASURE OF COST SHARING THAT'S
RELATIVELY EASY TO TRACK OVER
TIME- BUT PEOPLE WHO DON'T HAVE
THE DEDUCTIBLES HAVE ALSO SEEN.
AN INCREASE IN THEIR COST
SHARING AS WELL. AN ABILITY TO
AFFORD OUT OF POCKET COSTS AND
HEALTH CARE IS NOT ONLY DRIVEN
BY HEALTH CARE PRICES IT'S ALSO
TIED IN WITH THE LARGER
PROBLEMS OF INCOME AND WEALTH
INEQUALITY IN THIS COUNTRY- AS
ONE EXAMPLE THE FEDERAL RESERVE
ESTIMATED THAT 40% OF AMERICAN
ADULTS. DON'T HAVE FOUR HUNDRED
DOLLARS IN SAVINGS TO USE IN AN
EMERGENCY AND THAT THAT REALLY.
HELPS PUT THE FOURTEEN HUNDRED
DOLLAR DEDUCTIBLE AND CONTEXT.
NEXT SLIDE. SO GIVEN THAT THE
ACA OF THAT RISK AGAIN I WANTED
TO HIGHLIGHT BUT OVERTURNING
THE ACA WOULD ONLY MAKE MATTERS
WORSE FOR THOSE WITH JOB BASED
COVERAGE BOTH IN TERMS OF
ELIMINATING IMPORTANT
PROTECTIONS ON OUT OF POCKET
SPENDING THAT BENEFITED PEOPLE
WITH JOB BASED COVERAGE AND
ALSO IN TERMS OF THE COVERAGE
EXPANSIONS UNDER THE ACA MANY
CALIFORNIA YOUNG ADULTS ARE
ABLE TO BE ON THEIR PARENTS JOB
BASED COVERAGE AS A RESULT OF
THEIR ACA. AS A RESULT OF THE
ACA AND THE MAJOR ACA COVERAGE
EXPANSIONS THE MEDICAID
EXPANSION AND SUBSIDIZING
CHURNED THROUGH COVERED
CALIFORNIA ARE REALLY IMPORTANT
PROTECTION FOR PEOPLE WHO HAVE
JOB BASED COVERAGE IN CASE THEY
LOSE THAT COVERAGE OR LOSE
THEIR JOB. COURTEOUS BY THE
HEAD PLEASE. FIVE SEVENTEEN.
TURNING TO THE INDIVIDUAL
MARKETS- THERE ARE TWO
DIFFERENT GROUPS IN THAT
MARKET- THAT ARE AFFECTED BY
COSTS GROWTH DIFFERENTLY. FOR
THE MORE THAN ONE POINT THREE
MILLION CALIFORNIANS WHO GET
THEIR INSURANCE THROUGH COVERED
CALIFORNIA WITH A C. A. R.
STATE SUBSIDIES. THOSE
SUBSIDIES IMPROVE. AN AVERAGE
PREMIUM OF FIVE HUNDRED AND
EIGHTY TWO DOLLARS A MONTH DOWN
TO AN AVERAGE NET PREMIUM OF A
HUNDRED AND TWENTY SEVEN
DOLLARS AFTER SUBSIDIES.
BECAUSE OF THE WAY THAT THE ACA
AND THE STATE SUBSIDIES ARE
STRUCTURED THE THAN ROWLEY'S
ARE PROTECTED FROM THEIR
PREMIUMS INCREASING IN
ACCORDANCE WITH COST GROWTH.
BUT THERE ARE ANOTHER NEARLY
ONE MILLION CALIFORNIANS
PURCHASE COVERAGE THROUGH
COVERED CALIFORNIA OR DIRECTLY
FROM AN INSURER WITHOUT
SUBSIDIES. AND FEES AND
ROWLEY'S PREMIUMS ARE DIRECTLY
AFFECTED BY UNDERLYING COST
GROWTH AND THEIR PREMIUM GROWTH
AVERAGED SIX POINT 3% PER YEAR
IN TWENTY FIFTEEN AND TWENTY
TWENTY ONE THOUGH IN THE
CURRENT YEAR- AND NEXT YEAR
PREMIUM INCREASES ARE LESS THAN
1% NEXT SLIDE PLEASE. EVEN THE
SUBSIDIZED ENROLLEES ARE
LARGELY PROTECTED FROM COST
TRENDS IN TERMS OF THEIR
PREMIUMS THEY ARE NOT SHIELDED
FROM GROWTH IN OUT OF POCKET
COSTS. THIS GRAPH SHOWS ED THAT
FOR THE SILVER PLAN IN COVERED
CALIFORNIA WHICH IS THE
BENCHMARK PLAN THE MAXIMUM OUT
OF POCKET LIMIT HAS GROWN BY
29% SINCE THE START OF THE OF
COVERED CALIFORNIA. AND THE
MEDICAL DEDUCTIBLE HAS MORE
THAN DOUBLED AND IF GROWTH
RATES ARE A REFLECTION OF
HEALTHCARE COSTS GROWING MORE
RAPIDLY THAN THE FEDERAL
POVERTY LEVEL AND THEN COMPARED
TO CALIFORNIA INFLATION. THE
ACA DID SET STANDARDS FOR THE
SHARE OF COSTS THAT AN INSURER
PAYS. ACROSS AN AVERAGE
POPULATION FOR A GIVEN PLAN
LEVEL FOR EXAMPLE INSURANCE PAY
70% OF COSTS ON AVERAGE IN
SILVER PLANS AND CONSUMERS PAY
THE REMAINING THIRTY PERCENT.
THROUGH COST SHARING BUT WHEN
UNDERLYING MEDICAL COSTS ARE
GROWING RAPIDLY THE CONSUMER IS
SHARE OF COSTS ALSO GROWS
RAPIDLY AN ABSOLUTE DOLLARS. I
WANTED TO HEAR THAT MOST
CONSUMERS DON'T REACH THEIR
DEDUCTIBLE OR THEIR OUT OF
POCKET MAXIMUM BUT THESE ARE
EXAMPLES TO ILLUSTRATE THE
GROWTH AND EXPOSURE TO OUT OF
POCKET COSTS OVER TIME. NEXT
SLIDE PLEASE. AT TWENTY
SEVENTEEN SURVEY OF CALIFORNIA
INDIVIDUAL MARKET ENROLLEES
SHOWED THAT A SUBSTANTIAL
FRACTION HAD DIFFICULTY PAYING
THEIR PREMIUMS AND OUT OF
POCKET COSTS- AND THAT THAT WAS
TRUE ACROSS THE INCOME SPECTRUM.
THE SURVEY WAS DONE BEFORE THE
STATE SUBSIDY PROGRAM THAT
BEGAN THIS YEAR. LAKE WITH JOB
BASED COVERAGE THESE AND OF
THESE AFFORDABILITY CONCERNS IN
THE INDIVIDUAL MARKET TRANSLATE
TO BARRIERS TO CARE AND
FINANCIAL DIFFICULTIES. NEXT.
FIVE SO TO SUMMARIZE CALIFORNIA
ADULTS HAVE EXPRESSED A HIGH
DGREE OF WORRY ABOUT HEALTH
CARE AFFORDABILITY AND THOSE
WORRIES ARE MORE COMMON AMONG
BLACK LATINO AND ASIAN
CALIFORNIANS AND LOW INCOME
CALIFORNIANS HEALTH CARE
AFFORDABILITY CONCERNS CAN
HINDER ACCESS TO CARE AND CAUSE
FINANCIAL HARDSHIP. CALIFORNIA
WORKERS AND EMPLOYERS SPEND A
TREMENDOUS AMOUNT ON TOPICS
COVERAGE EACH YEAR AND PREMIUMS
HAVE BEEN GROWING MORE RAPIDLY
THAN WAGES AND INFLATION. THESE
TRENDS HAVE CONTRIBUTED TO WAGE
STAGNATION AND RAPIDLY
INCREASING. AT END HAVE RAPIDLY
INCREASED THE EXPOSURE TO OUT
OF POCKET COSTS OVER THE LAST
DECADE. IN THE INDIVIDUAL
MARKET UNSUBSIDIZED ENOLLEES
FACE THE FULL WRATH OF
HEALTHCARE RISING HEALTH CARE
COSTS WELL SUBSIDIZED ENROLLEES
ARE LARGELY PROTECTED ON THE
PREMIUM SIDE BUT FACE THE FULL
IMPACT OF RISING HEALTH CARE
COSTS IN TERMS OF THEIR OUT OF
POCKET COSTS. THANK YOU AGAIN
FOR THE OPPORTUNITY TO
PARTICIPATE IN THIS HEARING AND
I LOOK FORWARD TO YOUR
QUESTIONS. THANK YOU VERY MUCH
MR SEAH AND I'D LIKE AT THIS
POINT TO TURN THIS OVER TO THE
COMMITTEE FOR QUESTIONS OF.
EACH EITHER WITNESSES. DO YOU
HAVE ANY QUESTIONS. YES THIS IS
MISS AGUIAR-CURRY- THANK YOU
FOR PRESENTATION- SO WHEN THE
DUST SETTLES- ON TWENTY TWENTY
DO YOU BELIEVE THAT THE HEALTH
CARE MARKET. IN CALIFORNIA WILL
COMPLETELY REVERT BACK TO THE
PRE COVERED STRUCTURE. MR A
DOCTOR MELNICK MAYBE I CAN
ANSWER THAT IS THAT OKAY THE
APOLOGIES I WAS. HOBBLING THAT
AND FORTH HERE DR MONICA STORY.
I KNOW HE IS BECAUSE HE'S GONNA
BE TALKING AGAIN LATER YES. SO
I THAT IT I MIGHT DEFERRED TO
DOCTOR MAY ON THE ONE OKAY
DOCTOR MELNICK. MORE THAN. THAT
OKAY NO GO AHEAD THERE WE GO
PERFECT. SO WHAT YOU HAD REPEAT
YOUR QUESTIONS OKAY WE BACK ON.
WHEN THE DUST SETTLED ON TWENTY
TWENTY PEOPLE THEY WERE
HEALTHCARE MARKETING CALIFORNIA
WILL COMPLETELY REVERT BACK TO
THE PEOPLE THAT STRUCTURE. SO
THERE'S A COUPLE OF- PIECES FIT
TO ANSWER THAT QUESTION FIRST
OF ALL I THE- I THINK THAT THE
CODE WOULD AFFECT ON
UTILIZATION. IS GOING TO BE
WITH US THROUGH TWENTY TWENTY
ONE. SO I THINK WE'RE GOING TO
SEE IT CONTINUE TO SEE
DEPRESSED UTILIZATION. YEAH
EVEN THOUGH I TOLD YOU I WE I
LOOKED AT THESE TWENTY SEVEN
FILINGS FOR- INSURANCE POLICIES
FOR NEXT YEAR. ONLY TO THE
TWENTY SEVEN BUILT IN ANY
ASSUMPTIONS ABOUT KOVIC IT. BUT
I BELIEVE THAT THAT WE'RE GONNA
THAT UTILIZATION AND SPENDING
WILL BE DOWN AGAIN. NEXT YEAR
UNLESS WE HAVE SOME KIND OF
HUGE SPIKE IN COVERT RELATED
UTILIZATION AND EVEN THAT MOST
OF THAT WOULD BE COVERED BY
MEDICARE. SO I THINK SPENDING
WILL BE DOWN- WE AVE SEEN THE
L. POTENTIAL SILVER LINING SAID
THE FED THAT THAT TELEHEALTH.
WHICH HAD BEEN SLOW TO GROW
XCELERATED AND THERE COULD BE
POTENTIAL LONG TERM STRUCTURAL
CHANGE THERE THAT COULD COULD
COULD DELIVER VALUE IF WE
FIGURED OUT HOW TO DO THAT
RIGHT- BUT THEN I ALSO WORRY
ABOUT- BECAUSE MARKETS ARE NOT
COMPETITIVE ARE WE GONNA SEE
PRICE SPIKES. ON THE PROVIDER
SIDE WHICH ARE THEN GOING TO
FILTER INTO THE TWENTY TWENTY
TO PREMIUMS. THANK YOU. MISTER
PRESIDENT IS MCCARTY FIRST AND
THEN MISTER MAY SOME SORT.
THANK YOU- ALL THIS FOR BEING
LATE WE HAD A EDUCATION BUDGET
SUB COMMITTEE HEARING THIS
MORNING. AS WELL- SO I MISSED
THAT THE BEGINNING OF MISTER
MELNICK'S PRESENTATION BUT- I
GUESS KIND OF THE BIG PICTURE
TO THIS IS. LOOKED AT THE COST
OF HEALTHCARE FOR CALIFORNIANS
AND BUSINESSES HAS BEEN
INCREASING A LOT OF PEOPLE
COMPLAIN DIFFERENT DIRECTIONS
THERE'S- A BIG DEDUCTIBLES FOR
INDIVIDUALS THERE'S DRUG
PRICING THERE'S- HOSPITAL OF
PRICING THERE IS THE
DIFFERENTIAL BETWEEN WHAT YOU
PAY IN CALIFORNIA FOR EXAMPLE
IF YOU'RE GOING TO. THAT HAVE A
CHILD IN A HOSPITAL VERSUS
NEVADA ARIZONA SO THERE A LOT
OF FACTORS BUT I GUESS TO DR-
NAMIK OR TO THE REPRESENTED FOR
THE LABOR CENTER. YOU KNOW MY
LOCAL SCHOOL DISTRICT IS ON THE
VERGE OF BANKRUPTCY. RUNNING
OUT OF MONEY. AND IT'S A SCHOOL
DISTRICT AND SOME EDUCATION
ABOUT THE ISSUE THAT THEY KEEP
TALKING ABOUT OUR HEALTH CARE
COSTS. HEALTHCARE COSTS AND
PEOPLE CALL MY OFFICE ABOUT
TALKED ABOUT THEIR FAMILY
BANKRUPTCY OR TROUBLES. A LOT
OF IT GOES BACK TO- MAJOR
HEALTH CARE EXPENSES SO IT'S
SUCH A DRIVER IN SO MANY
ASPECTS OF OUR LIFE. AND WE
HAVE SEEN THAT THE COST OF
HEALTHCARE- HAS BEEN
INCREASING. HIGHER THAN-
INFLATION AND GROWTH AND IN THE
CPI SO I GUESS MY QUESTION IS
THIS SUSTAINABLE AND SO YOU
KNOW. BUT IF WE CONTINUE AT
THIS AT THIS TREND AND DO
NOTHING. IS IT SUSTAINABLE FOR
THE ECONOMY OF CALIFORNIA FOR
YOU KNOW GOVERNMENT CALIFORNIA
FOR OUR SCHOOL DISTRICTS LIKE
RIGHT HERE FOR. FAMILIES FOR
SMALL BUSINESSES SO. IF ANYBODY
WANTS TO TACKLE THAT PLACE
THANK YOU. GO GO AHEAD DOCTOR
MELNICK ENSURE DYSLEXIA WILL
HAVE SOMETHING TO SAY YES WELL.
AND PLEASE TRY TO SPEAK UP AS
MUCH AS YOU GO AND WORK WE'RE
HAVING A HARD TO GET YOU'RE
EXACTLY RIGHT. THESE TRENDS YOU
KNOW IT IN MY OPINION ARE NOT
SUSTAINABLE. THE YOU KNOW THE
CHALLENGES- THE- THERE WILL BE
NO FINITE BREAKING POINT THE
PROBLEM IS THE BREAKING POINT
WILL HIT DIFFERENT FAMILIES. AT
DIFFERENT ECONOMIC LEVELS
EARLIER AND LATER. THE WAY OUR
SYSTEM IS SET UP- AND SO BUT
THESE THE SPENDING IS HAVING
MANY AND NEGATIVE- ECONOMIC AND
HEALTH EFFECTS RIGHT FAMILY
TAKE HOME PAY IS BEING
DEPRESSED. OUT OF POCKET.
SPENDING IS INCREASING WHICH IS
REDUCING FAMILY BUDGET SO
THERE'S ALL KINDS OF NEGATIVE
CONSEQUENCES- THAT JUST ARE
GOING TO CONTINUE TO ACCELERATE
ACCUMULATE. AND I AGREE WITH
YOU I DON'T THINK IT IS
SUSTAINABLE. THIS LUCY A DO YOU
HAVE A COMMENT ON THAT. IN A
POT OF PLEASE GO AHEAD
APOLOGIES I COULDN'T HEAR
PROFESSOR MELNICK THE ANSWER IF
I MAY REPEAT SOME OF WHAT HE
SAID- BUT I DEFINITELY THINK
THAT THIS COST GROWTH IS
UNSUSTAINABLE- FOR FINANCIAL
REASONS THAN FOR HEALTH REASONS
M. FINANCIALLY M. HEALTHCARE
COST GROWTH IS HAVING SUCH A
BIG IMPACT ON WORKERS WAGES IT
SAYS A STRUGGLE FOR EMPLOYERS
TO FIGURE OUT WHAT THEY'RE
GONNA DO EVERY YEAR IN RESPONSE
TO RISING HEALTHCARE COSTS- AND
ED THE PROBLEM IS ONLY GOING TO
GET WORSE OVER TIME AS AND IN-TERMS OF THE HEALTH IMPACTS WE
ALREADY SEE SO MANY
CALIFORNIANS. NOT GETTING THE
HEALTH CARE THAT WE NEED AND-
IT THE HEALTH IMPACTS OF
AVOIDING CARE DUE TO COST ARE
JUST GOING TO GET WORSE AND
WORSE OVER TIME. THANK YOU.
MISTER MASON. I THINK STARTER
WOULDN'T I'M NOT SURE AND I
KNOW THAT OF THEM LOOKING AT
THE AGENDA YOU KNOW WE'RE GONNA
BE TALKING ABOUT HEALTH CARE
COST DRIVERS- WE'RE GONNA GET
DOWN TO HEALTH CARE INDUSTRY
CONSOLIDATION AND RIGHT TOWARDS
THE- LOOKS LIKE OPTIONS TO
CONTROLLING COSTS. BUT THE I'VE
BEEN ON THIS COMMITTEE NOW FOR.
SEVERAL YEARS- AND- IT SEEMS AS
THOUGH WE CONTINUE TO KEEP.
ASKING THESE QUESTIONS SO WE
CAN CONTINUE TO KEEP TALKING
ABOUT CONTROLLING COSTS BECAUSE
COSTS KEEP GOING UP. AND EVEN
THOUGH I'VE BEEN ON THIS
COMMITTEE FOR A COUPLE YEARS
THIS IS NOTHING NEW. TO THIS
COMMITTEE IN ARE NOTHING NEW TO
THIS LEGISLATURE- THE SEVEN
RICCARDI WAS TALKING ABOUT THE
SCHOOLS OPENING UP BUT I KNOW
SOME OF THE MCCARTY SERVED ON.
OF THE SACRAMENTO CITY COUNCILS
I SERVED ON. MY SMALL TOWN-
CITY COUNCIL BACK IN STARTING
IN TWO THOUSAND TWO YOU KNOW
WHAT WE ARE TALKING ABOUT TWO
THOUSAND TWO. AND TWO THOUSAND
THREE. AND TWO THOUSAND AND
FOUR AND TWO THOUSAND FIVE.
WE'RE TALKING ABOUT RISING COST
OF HEALTHCARE AND HOW THAT WAS
TAKING A LARGER LARGER CHUNK.
OF OUR BUDGETS THIS IS NOTHING
NEW OR NOW TWENTY YEARS. AS THE
TIME THAT I'VE- AT IN MY PUBLIC
SERVICE HAVE BEEN TALKING ABOUT
THIS. AND EVERYBODY KEEPS
TALKING ABOUT COSTS GOING UP
BUT WE NEVER GET DOWN TO WHAT
THE SOLUTION. IS AND SO. I'M
GONNA KEEP ASKING THIS QUESTION
OF THESE EXPERTS BECAUSE WE
KEEP WE KNOW WHAT THE PROBLEM
IS RIGHT WE CAN START TO POINT
THINGS OUT OF THE BIG PHARMA OR
ITS CONSOLIDATIONS OR WHATEVER
IT MIGHT BE. HOW DO WE SOLVE
THIS PROBLEM A FEW YEARS AGO
WHEN THE ACA CAME UP THAT SEEM
TO BE OF THE OVERALL ANSWERED
YET WE NOW KNOW EVEN FOR THE
ACA. I'M ISN'T AS IN A FACT
THAT COSTS ARE STILL GOING UP
AND SO WOULD LIKE TO ASK THE
QUESTION OF BOTH OF YOU. IS
WHAT'S THE ANSWER TO THIS WE
KNOW THAT THIS ISN'T A FREE I'M
A FREE MARKET KIND OF A GUY.
BUT THERE'S BEEN MARKET FAILURE
WITH OUR HEALTH CARE SYSTEM TO
FACT. SO HOW DO WE HOW DO WE
SOLVE THAT MARKET FAILURE TO BE
ABLE TO ULTIMATELY GET REAL
COST REDUCTIONS WITH OUR HEALTH
CARE SYSTEM HOW DO WE MAXIMIZE
VALUE. OF FOR THE PEOPLE THAT
WE SERVE BECAUSE I DON'T WANNA
BE HERE TWENTY YEARS AROUND
TWENTY YEARS FROM NOW AND STILL
TALKING ABOUT. THIS VERY SAME
THING. ACTUALLY YOU PROBABLY
WON'T BE BECAUSE OF TERM LIMITS
BUT I DIDN'T I DIDN'T EVEN LIKE
AS ASSEMBLY MEMBER BUT I'M-
TALKING ABOUT. IN CALIFORNIA-
AND IN SOME IN SOME CAPACITY.
YEAH SORRY WE HAVE TO HAVE A
LITTLE FUN HERE. PLEASE EITHER
BOTH OF YOU WOULD LOVE TO HEAR
YOUR THOUGHTS. PLEASE UP MS
WITH VIA. YES. GO AHEAD. WELL I
THINK WE THAT WE ARE GOING TO
BE HEARING ABOUT SOME OF THE
SOLUTIONS LATER IN THIS HEARING
AND FROM WHAT I'VE SEEN FROM
THE AGENDA IT LOOKS LIKE THAT
YOU KNOW THE RIGHT KIND OF
SOLUTIONS ARE ON THE- ON THE
AGENDA A WE DEFINITELY NEED
BETTER DATA ABOUT THEM BUT M.
HOWEVER MANY OF CURRENTLY BEING
SPENT AND END UP THE FOUNDATION
FOR IMPROVING UPON THE SYSTEM
IT'S CERTAINLY NOT SUFFICIENT-
AT IT WE NEED TO EARNED. IT
MORE ACCOUNTABILITY WITHIN THE
SYSTEM AND ONCE WE HAVE THAT
DATA FOR REDUCING THE COST
GROWTH- THE PROPOSAL THAT WAS
MADE LAST YEAR AND THE
LEGISLATURE BY A FAMILY MEMBER
WOULD AND BY THE GOVERNOR IN
TERMS OF THE OFFICE OF HEALTH
CARE AFFORDABILITY I THINK
WOULD MOVE US SENATE A GREAT
DIRECTION IN TERMS OF- CAPPING
HOW MUCH ARE COST GROWTH IN OUR
COSTS ARE GROWING EACH YEAR-
AND PUTTING SOME ACCOUNTABILITY
IN THE SYSTEM FOR THAT WE ALSO.
NEED TO ADDRESS THE ISSUE OF
EMERGENCY. OUT OF NETWORK.
PRICE OF THE- AT PROFESSOR
MILLER TALKED OF. AND THERE
HAVE BEEN SOLUTIONS PROPOSED AT
THE STATE LEVEL AND THE FEDERAL
LEVEL TO ADDRESS THAT CONCERN-
AND THOSE ARE JUST A FEW OF
THE- EXAMPLES. OF SOLUTIONS
THAT I THINK ARE VERY POSSIBLE
AT THE STATE LEVEL. THANK YOU
DOCTOR MELNICK. MAGIC BULLETS
HERE GUESSES BUT STILL HOLDING
OUT HOPE THAT WE CAN HAVE A
COMPETITIVE SYSTEM BUT I AGREE
WITH. THAT YEAH THERE'S MARKET
FAILURE THROUGHOUT OUR SYSTEM
RIGHT NOW AND SO I'M NOT A BIG
FAN OF REGULATION BUT
REGULATION IS NEEDED TO RESTORE
COMPETITION TO OUR MARKET. AND
UP STILL HAVE HOPE THAT IF WE
UNDERTAKE THE RIGHT PUBLIC
POLICIES AND GET US BACK TO A
COMPETITIVE MARKET THAT CAN BE
PART OF THE SOLUTION HERE AND
SO WHAT WE'RE TALKING ABOUT
HERE IS DATA AND TRANSPARENCY
WHICH IS AN ESSENTIAL ELEMENT
TO COMPETITIVE MARKETS SO WE'RE
GOING TO MAKE THE INVESTMENT.
TO GET THE DATA OUT THERE SO WE
COME MORE TRANSPARENT SO ALL OF
US UNDERSTAND WHAT THE TRADE
OFFS ARE ALL RIGHT THEN YEAH IT
IN MY MIND THAT YOU KNOW
THERE'S A COUPLE OF SPECIFIC
THINGS UP I'M GOING TO TALK
ABOUT THEM LATER. BUT YEAH WE
REALLY SHOULD FOLLOW THE
ATTORNEY GENERAL JUST SETTLED A
BIG ANTI TRUST CASE IN THE
HOSPITAL MARKET IN CALIFORNIA
WE SHOULD LOOK AT THAT
SETTLEMENT BECAUSE THAT CASE
PRODUCED EVIDENCE THAT SHOWS.
THE POWER OF MARKET POWER BY
BIG SYSTEMS AND THAT'S
SETTLEMENT INCLUDES TERMS THAT
WOULD RESTORE COMPETITION TO
THE BIGGEST DRIVER OF
HEALTHCARE SPENDING WHICH IS
HOSPITAL SPENDING IN CALIFORNIA
SO THERE ARE THINGS WE DO KNOW
ENOUGH NOW THAT WE CAN MOVE
QUICKLY. AND THEN GET MORE DATA
AND FIGURE OUT OTHER AREAS TO
RESTORE COMPETITION. SO THAT'S
DRIVING EFFICIENCY. QUALITY AND
VALUE GOING FORWARD. THANK YOU
THANK YOU DO YOU HAVE ANY
QUESTIONS YOU HAVE ANY
QUESTIONS FOR. ONLY THING I
HAVE TO ASK ABOUT TRANSPARENCY
IN DATA BUT WE'RE GOING TO TALK
ABOUT THAT LATER. OKAY MISTER
NAZARIAN. ARE YOU OUT THERE IF
YOU HAD TO HAVE A QUESTION. I'M
GOOD THANK YOU ABOUT YOU MISS
WALDRON CAN YOU CAN YOU I KNOW
YOU'RE HAVING DIFFICULTY
HEARING US. YES I HAVE A- A
COUPLE QUICK QUESTIONS. BOB
PERMISSIBLE THEA I GUESS I
COULD START. REGARDING THE DAY
OUT OF POCKET COSTS WHICH ARE
YOU KNOW. WHAT ROSE UP AS A BIG
CONCERN- IN THE COST ISSUES
THAT PEOPLE WORRIED ABOUT- WHEN
YOU LOOK AT OUR HEALTHCARE
SYSTEM IN GENERAL THE WAY IT'S
SET UP- YOU KNOW IT'S BASICALLY
OF QUALCOMM'S THERE ARE
THOUSANDS HOW CAN YOU NAVIGATE.
THE COMPLEX SYSTEM WHEN WE LOOK
AT YOU KNOW WHAT. WHAT ARE CO
PAYS ARE. WE'VE THAT ONE WHERE
THERE MAY BE WERE IN THE
EMERGENCY ROOM THEN ABOUT A
MONTH OR SO AGO FIVE WILL GET
AN ESTIMATE FROM THE INSURANCE
COMPANY THAT YOU KNOW. IS SO
HIGH THAT YOU'RE SCARED TO
DEATH THINKING HOW CAN I HAVE A
PAY THAT THEN ALL THE SUDDEN
ANOTHER MONTH OR TWO GOES BY
HERE IS THE NOTHING. AND THEN
YOU GET A BILL AND IT. HARDLY
ANYTHING OR IT COULD BE QUITE A
LOT SO I CAN DEFINITELY SEE HOW
PEOPLE CAN BE WORRIED ABOUT
THOSE OUT OF POCKET COSTS
SPECIALLY WHEN THEY DON'T KNOW
WHAT THEY'RE GOING TO BE- WHEN
YOU GO IN AND BE NICE IF YOU
KIND OF KNEW WHAT YOU'RE PAYING
FOR WHEN YOU GO AND WHAT THAT
WOULD COST. BUT IT'S SUCH A
CALM. THIS YOU KNOW IF ENGLISH
OF THE FACT LET. CO YOU KNOW
HOW CAN YOU EVER TRY TO
NAVIGATE THE NIGHT I KNOW.
ANOTHER ISSUE IS YOU KNOW YOU
LOOK AT DENTAL INSURANCE. AND I
KNOW I DO IT MYSELF IF- IT RUNS
OUT BUT THAT THAT DOESN'T PAY
FOR ALL THAT MUCH ANYWAY YOU
JUST CARRIED OVER AND CONTINUE
THE TREATMENT NEXT YEAR AND THE
NEXT CALENDAR YEAR RATHER THAN
FINISHED IT YOU KNOW WHEN IT
NEEDS TO BE SO. I MEAN THAT
THOSE ARE ISSUES THAT I SAW
WHEN I WAS I WAS GOING THROUGH
THE SLIDE AHEAD OF TIME. THAT
CAME TO LIGHT TO ME AS THE WAY
PEOPLE IN GENERAL BEHAVE- DUE
TO WHAT THEY'RE PRESENTED WITH
IN OUR HEALTHCARE SYSTEM AND- I
DON'T KNOW WHAT THE SOLUTION S
TO THAT. AND THE MORNING IF
THAT'S WHAT YOU THOUGHT HE WAS
YOUR DATA CAME UP. MR SEAH. ED
THE QUESTION HERE. YOU COULDN'T
EGGMAN IN THE REMAIN WOMEN'S
ACKERMAN I COULD REPEAT IT I
COULDN'T HEAR ANY OF IT. I WELL
I DIDN'T REALIZE THAT YOU CAN
HEAR THAT. MAYBE WE CAN EMAIL
THE QUESTION TO YOU AND- WE'LL
GET AN OUTLET THAT WAY I
APOLOGIZE MISS WALDRON IT SEEMS
TO BE THAT THERE WE WE'VE GOT.
A TECHNICAL CHALLENGE IN
GETTING AND I WILL DO A BETTER
JOB IN THE FUTURE I WILL BE TRY
TO WRITE DOWN THE QUESTION AS
OUR OUR MEMBERS ARE TRYING TO
ASK QUESTIONS REMOTELY SO ALL
RIGHT THEM DOWN SO AGAIN I
APOLOGIZE MISS WALDRON I THINK
THAT SOME OF WHAT YOU'RE ASK IT
WAS MISS WALDRON IS ASKING WILL
BE. PROBABLY ADDRESSED AS WE GO
FORWARD IN THE PROGRAM HERE- I
THINK WE'RE GENERAL GENERAL
QUESTION IN GENERAL CONCERNS
ABOUT YOU KNOW AS THE COST
CONTINUE YOU KNOW CAN CONTINUE
TO RISE IN THE OVERALL EFFECT
ON PEOPLE WHICH- IS I AM I AM I
FEEL PRETTY CONFIDENT THAT THAT
THAT WILL COME UP HOWEVER IF.
MISS WALDRON DOESN'T GET THAT
QUESTION ANSWERED IT WILL HAVE
FOR WHAT WILL GET YOU IN
WRITING WE'LL GET WE'LL SEE WE
GET A DIRECT ANSWER THAT WAY SO
ANYWAY BUT IT DANCE AROUND THAT
ONE A LITTLE BIT SO- THANK YOU
I WANT TO AND FIRST BUT THAT
WAS A THANK YOU TO BOTH BOTH
PANELISTS I THINK THIS IS
REALLY INFORMATION GOOD
INFORMATION TO HELP TO SET THE
STAGE FOR THINGS AND I WANT TO
GO TO DOCTOR MELNICK. AS OF A
COUPLE KIND OF SPECIFIC
QUESTIONS AND THEN IT WILL MOVE
ON IN THE INTEREST OF TIME SO.
TO QUESTIONS HERE FIRST OF ALL.
YOUR SLIDE ON. PAGE NINE IT'S
SAYS IT SAYS CALIFORNIA DATA
SHOW SIMILAR TRENDS. PRICES
INCREASING OR DRIVING INCREASED
HOSPITAL SPENDING SO WHAT YOU
SAID WITH YOUR SLIDE SAYS. THAT
BETWEEN TWO THOUSAND AND EIGHT
AND TWO THOUSAND AND EIGHTEEN
WE HAD A FIFTEEN PERCENT. DROP
IN. VOLUME AND A TWO HUNDRED
AND 83% INCREASE IN SPENDING
SO. YOU KNOW YOU'RE THE
ECONOMIST HERE. IS THAT THOSE
INCREASES TRYING TO MAKE UP FOR
THE FOR THE LOST REVENUE IN IN
THE VOLUME AND FOR WHAT IS
THERE ANOTHER DELTA THERE AS
WELL BECAUSE IF YOU'RE VOLUMES
GOING DOWN. YEAH AND YOU'RE NOT
AND YOU'RE NOT TRYING TO
INCREASE EFFICIENCIES THE ONLY
WAY YOU'RE GOING TO RESTORE
THAT REVENUE IS TO INCREASE
PRICES SO. SO DOES THOSE
INCREASE PRICES LEAD TO. INDEED
ADDITIONAL PROFITS OR ARE THEY
TRYING TO MAKE UP FOR THE
DECREASE IN VOLUME. WELL IT'S A
CUT IT'S A GOOD QUESTION IS A
COMBINATION OF FACTORS SO- YOU
KNOW IT PART OF THAT INCREASE
2210083% INCREASES THERE'S THE
GENERAL INFLATION. BUT
INFLATION WAS RELATIVELY LOW
DURING THAT TIME PERIOD I CAN'T
REMEMBER THE NUMBERS BUT MAYBE-
YOU YOU'RE A BABY 30% OF THAT
TWO HUNDRED EIGHTY PERCENT. IS
UNDERLYING CPI YEAH THEN ONE OF
THE THINGS THAT HAPPENED IS-
HOSPITALS HAVE ALSO BECOME
QUIETLY OVER TIME GIANT
EMERGENCY CENTERS. SO IN
CALIFORNIA TWO THIRDS OF THE
PATIENTS ADMITTED TO A HOSPITAL
COME THROUGH THE EMERGENCY ROOM.
AND SO THEY TEND TO BE SICKER.
AND MORE OF THE LESS SEVERELY
ILL PATIENTS ARE BEING TREATED
NOW AS OUTPATIENTS SO PART OF
THAT INCREASE IS CHANGING
PATIENT MIX SEVERITY OF ILLNESS
CHANGES IN TECHNOLOGY AND
THINGS LIKE THAT. SO THAT
210083% IS NOT A FEWER PRICE
INCREASE BUT A BIG CHUNK OF IT
IS AND ONE ONE COMMERCE TALK
ABOUT A FEW OUR PRICE INCREASE
WHAT THEY MEAN IS. IT'S NOT
DRIVEN BY CHANGES IN THE
PRODUCT BUT RATHER IN THIS CASE
WERE TRIPPING IT TO. MARKET
POWER THE ABILITY TO RAISE
PRICES NOT BECAUSE THE PRODUCT
IS BETTER OR SERVICES BETTER
WHATEVER SIMPLY BECAUSE WE CAN
WE HAVE THE POWER TO RAISE
PRICES- TO USE THAT MONEY TO DO
OTHER THINGS. IN SOME CASES
HOSPITAL PROFITS YOU KNOW
INCREASED DRAMATICALLY. YOU
KNOW FOR THE CENTER CASE THERE
WERE THERE'S DATA IN THE RECORD
THAT SHOWED. UP FOR TEN YEAR
PERIOD- SUTTER WAS AVERAGING
FORTY PLUS PERCENT PROFIT
MARGIN ON COMMERCIAL PATIENTS
EVERY YEAR FOR TEN YEARS.
BECAUSE OF THEIR MARKET POWER
SO IN THAT CASE THEY WERE
GENERATING PROFITS FROM THOSE
INCREASE PRICES. OF STOP THEIR
IN A KIND OF A FOLLOW UP TO
THAT SO IT WHAT ARE YOUR SLIDES
AND I'M JUST LOOKING FOR A KIND
OF A GENERAL ANSWER HERE AS HE
TALKED ABOUT OUT OF NETWORK.
CAUGHT UP COSTS IN EMERGENCY
ROOMS WHAT POINT DID YOU START
WE START TO SEE THAT BEGIN TO
SPIKE. BECAUSE YOU KNOW WE DID
WE HAVE WE HAVE A SURPRISE
BILLING. WE HAVE SURPRISE
BILLING BILL IN CALIFORNIA AB
SEVENTY TWO WAS PASSED IN TWO
THOUSAND AND SIXTEEN. AND IT
DOESN'T COVER EMERGENCY ROOMS
AND ENOUGH YOU'RE IN AN
EMERGENCY SOMETIMES IF YOU'RE
BROUGHT TO A HOSPITAL YOU DON'T
HAVE A CHOICE WHERE YOU'RE
GOING. SO YOU MAY BE OUT OF
NETWORK. AND YOU KNOW WE HAVE
TRIED AND THE LET'S INTEREST
TRIED TO MOVE. YOU KNOW THE
SURPRISE BILLING INTO THE E. R.
AND HAS NOT BEEN SUCCESSFUL IN
THAT SO I'M CURIOUS. WHERE WHAT
TIME FRAME DID WE START TO SEE
THAT SPIKE. AND BECAUSE IT IT
FEELS LIKE IT'S IT HAS IT IS A
SPIKE AND IT'S HAPPENED FAIRLY
RECENTLY. IT EVOLVED OVER TIME
AND SO WITH THE PASSAGE OF THE
OF THE LEGISLATION IN
CALIFORNIA WHICH WAS A GOOD LAW
BASICALLY SAID YOU KNOW FOR
PUBLIC HEALTH PURPOSES IF YOU
HAVE AN EMERGENCY USUALLY GO TO
THE NEAREST EMERGENCY ROOM AND
YOUR PLAN HAVE TO PAY. BUT THE
HOSPITAL'S FIGURED OUT A WE
RAISE OUR BILL CHARGE WE DON'T
HAVE A CONTRACT WE'RE GOING TO
NOW SUBMIT THAT AS THE PRICE.
AND SO THAT HAS CONTINUALLY
GROWN AND GROWN AND GROWN OVER
TIME AT THE SAME TIME AS I
MENTIONED. HOSPITALS HAVE
BECOME GIANT EMERGENCY CENTERS
AND SO MORE OF THEIR VOLUME
COMES THROUGH THE E. D. SO- WE
DID A STUDY THAT SHOWED
HOSPITALS WHEN THEY- EVEN IF
THEY CANCEL THEIR CONTRACTS.
THEY KEEP HALF OF THE EMERGENCY
VALUE EVEN THOUGH THEY'RE NOT
IN THE NETWORK. AND THEN THEY
COULD CHARGE FULL BILLS BILL
CHARGES AND SO THAT PUTS
TREMENDOUS PRESSURE ON THE
PLANTS TO SAY OKAY WE CAN'T
AFFORD TO LET THIS HOSPITAL OUT
OF THE NETWORK BECAUSE THEY'RE
GONNA COME BACK INSTEAD OF IT
BEING A FIVE HUNDRED DOLLAR
BILL. FREDDIE OUR VISIT COULD
BE FIVE THOUSAND DOLLARS AND
WE'RE GONNA HAVE TO PAY. SO
THAT IS IF YOU WANTED TO CUT
COSTS. YOU LIMITED AND WE DIDA
STUDY OF THIS A HUNDRED AND 60%
OF THE COST OF A- FOR EACH
POSSIBLE YOU LIMIT THEIR ER
PRICE. FOR OUT OF NETWORK
210060% OF THEIR CALL. WE WOULD
SAVE BILLIONS OF DOLLARS IN
CALIFORNIA OVERNIGHT. JUST FROM
THAT CHANGE. THANK YOU MISTER
MAYES HAD ANOTHER. AND WE MIGHT
GETTING TO THIS A LITTLE BIT
LATER BUT DOCUMENTED BECAUSE
YOU BROUGHT UP THE HOSPITAL'S
BECOME EMERGENCY CENTERS OUR
MINDS ME OF- TOUR THAT I HAD
DONE ONE OF MY SMALLER
HOSPITALS IN MY DISTRICT. THE
AND THE NUMBER OF- OF THE
BEHAVIOR HEALTH. THAT PATIENTS-
THAT THEY HAD MENTAL HEALTH OF
PATIENTS- THAT THEY HAD. IN THE
EMERGENCY ROOM AND HOW LONG
THAT THEY WERE HAVING TO STAY.
THERE CAN YOU ADDRESS- THAT A
BIT WHEN YOU'RE TALKING ABOUT
COSTS. IT HAS NOT BEEN STUDIED
ENOUGH BUT THERE'S A CHANGING
MIX. OF EDIE OF EIGHTY PATIENTS
OVER TIME AND MENTAL HEALTH
VISITS AND MENTAL HEALTH
ADMISSIONS. HAVE BEEN TAKING AN
INCREASING SHARE. OF THAT AND
WE REALLY. REALLY HAVEN'T
APPRECIATED THAT STUDY THAT AND
FIGURED OUT HOW TO HANDLE THAT.
CHANGE IN UTILIZATION
EFFICIENTLY. MR THANK YOU THANK
YOU DR RON- I HAVE A QUESTION A
AND WANT TO GO BACK TWENTY SAID
PUSH YOUR BUTTON THERE I IT'S
PUSHED OUT OKAY I'M SORRY I
HAVE MY MASK IN MY LITTLE BOYS
DON'T TRAVEL WELL- SO. HAS
THERE BEEN A STUDY ON HOW WHAT
PERCENTAGE OF PEOPLE WHO ARE
UTILIZING THE EMERGENCY ROOM I
KNOW IN MY DISTRICT WHICH IS.
MORE CHALLENGE COMMUNITY- WE
TEND. OUR FOLKS TEND TO USE THE
EMERGENCY ROOM BECAUSE THEY
DON'T HAVE ACCESS TO THE
REGULAR DOCTOR. AND SO I GUESS
MY QUESTION WOULD BE AND THEY
WILL WAIT FOR HOURS BECAUSE-
THAT'S BETTER THAN WAITING FOR
DAYS. NOW THAT THERE ARE TRULY
SICK. WHAT PERCENTAGE AND
THAT'S MY DISTRICT BUT WHAT
PERCENTAGE YOU THINK OF HAS
THERE BEEN STUDIES ON HOW MANY
PEOPLE WHAT PERCENT OF PEOPLE
ARE DOING USING THE EMERGENCY
ROOM BECAUSE THEY DO NOT HAVE
ACCESS TO PROPER HEALTH CARE.
THAT BE MY FIRST QUESTION AND
THEN MY SECOND QUESTION IS NOT
YOU'VE IDENTIFIED YOUR AN
IMPORTANT. DEFICIENCY IN OUR
SYSTEM SO BASICALLY THERE ARE
LITERALLY THOUSANDS OF VISITS
IN THE E. D. WHERE PATIENTS ARE
SUBSTITUTING THE E. D. WHICH IS
A HIGHER LEVEL MORE EXPENSIVE
LEVEL OF CARE. FOR WHAT COULD
BE HANDLED. WITH A DOCTOR VISIT
NOW THE GOOD NEWS IS IF WE
LEVERAGE WHAT HAPPENED WITH
TELEHEALTH DURING THE PANDEMIC.
WE CAN ACTUALLY IMPROVE ACCESS-
UP AND MAKE IT MORE ACCESSIBLE
TO COMMUNITIES PARTICULARLY
RURAL AREAS BUT ALSO OTHER
COMMUNITIES WHERE THERE'S A
SHORTAGE OF LOCAL DOCTORS TO
TREAT THOSE PATIENTS SO THERE
IS A POTENTIAL SILVER LINING-
IF WE FIGURE OUT HOW TO DO IT
CORRECTLY. AND THEN MY FOLLOW
UP QUESTION WOULD BE IS THAT.
IS THERE A BALANCING ACT
BETWEEN IF ARE THERE STATES
THAT HAVE ACTUALLY PUT THIS
KIND OF LIMIT ON EMERGENCY ROOM
COSTS- DO THEY BALANCE THAT OUT
WITH REIMBURSEMENT SO THAT
LOWER INCOME COMMUNITIES
ACTUALLY. HAVE A LITTLE BIT
MORE ACCESS I MEAN IS THERE A
BALANCING ACT THAT HAS TO BE
DONE IF YOU WOULD DO ONE IS
THERE ANY SORT OF SCALE THAT IS
IN BALLOTS IF YOU DO ONE
WITHOUT THE OTHER. WELL IF I
UNDERSTAND YOUR QUESTION SO THE
ONLY STATE THAT THAT HAS
LIMITED. EMERGENCY OUT OF
NETWORK HOSPITAL THERE ARE
STATES THAT HAVE DONE POSITION
BUT NOT THE HOSPITAL FEES THE
ONLY STATE AS MARYLAND. AND IF
YOU LOOK AT THE DATA IT'S
AMAZING THEIR BILL CHARGES HAVE
HARDLY GROWN. BECAUSE THERE'S
NO REASON THE RAISE YOUR
CHARGES BECAUSE YOU CAN'T GET
THEM. HEY SO THE L. WHICH SHOWS
THAT LIMITING THE NET PRICE
THAT YOU WOULD GET FROM HIGH
BILL CHARGES COULD BE AN
EFFECTIVE MECHANISM. AS I
MENTIONED WE STUDIED- WE DID A
SIMULATION THAT SAID WE COULD
PAY EVERY HOSPITAL CALIFORNIA
IF THEY TREAT AN EMERGENCY
PATIENT OUT OF NETWORK. WE
COULD PAY THEM A HUNDRED AND
60% OF THEIR COSTS. GUARANTEE
THEM A 60% OFF OF MARGIN AND
STILL. REDUCE THE LEVERAGE THAT
LEADS TO THESE HIGH PRICES
SYSTEM WHY SO WE YEAH WE HAVE
THE POWER TO DO THAT IF WE KNOW
IF WE HAVE SUPPORT TO DO IT.
THANK YOU. THANK YOU VERY MUCH
AND WE WILL GO AHEAD AND MOVE
ON TO OUR SECOND PANEL NOW AND-
WILL CALL FORTH A WE CAN WE CAN
FIND I'M NOT SURE WHERE DR
BENNETT OR BOND OR FITNESS. BUT
DR KATE BOND OR IF IS AN
ASSOCIATE PROFESSOR OF MEDICINE
AND SENIOR FELLOW STANFORD
INSTITUTE FOR ECONOMIC POLICY
RESEARCH. AND SHE WILL BE
TALKING TO US ABOUT. HEALTHCARE
COSTS DRIVERS SO- AND THE MORE
YOU IF YOU CAN SPEAK UP AS MUCH
AS YOU CAN I KNOW THESE MASKS
REALLY MUTE US AND- YOU KNOW
MUTING CAN BE A NICE THING IF
YOU GOT TO THROW VOIGTS BUT-
SOMETIMES IT'S A LITTLE HARD TO
HEAR SO- PLEASE GO AHEAD AND-
SPEAK BOLDLY IF YOU CAN. THE
WHENEVER YOU'RE A I WILL DO MY
BEST TO SPEAK BOLDLY. I CAN
THINK OF ANOTHER WORD TO. THINK
OF ANOTHER WORD. SO THERE'S A
LITTLE ECHO HERE FOR ME NOW.
AND THAT MUCH MUCH MUCH BETTER
OKAY THANK YOU SO MUCH FOR
HAVING ME I'M HERE TODAY TO
TESTIFY ON THE TOPIC OF A
HEALTHCARE COSTS DRIVERS. AN
LET'S GO TO THE FIRST SLIDE
PLEASE X. OKAY SO YOU FOLKS I
I'VE BEEN ABLE TO HEAR SOME OF
THE QUESTIONS ALTHOUGH NOT ALL
OF THE QUESTIONS AND VERY FEW
THE RESPONSES RIGHT SO I'LL TRY
TO ADJUST. MY PRESENTATION
ACCORDINGLY I'M GOING TO FOCUS
MOSTLY ON THE NATIONAL LEVEL
AND THINK ABOUT RESEARCH ON THE
TOPIC OF HEALTH CARE COSTS
GROWTH IN THE SOURCE OF
HEALTHCARE COST GROWTH. SO
FOLKS ARE PROBABLY FAMILIAR
WITH THESE NUMBERS. ON MY
SCREEN IS VERY BLURRY SO I
ACTUALLY CAN'T EVEN SEE THEM
BUT WE SPEND A LOT ON
HEALTHCARE IN THE AGGREGATE AS
A PERCENT SEVENTEEN POINT 7% OF
GDP. AND NEARLY ARE OVER ELEVEN
THOUSAND PER PERSON. SECOND
FLIGHT. OUR NEXT SLIDE. OKAY ON
THIS FIGURE AT YOU CAN SEE THE
TRENDS IN HEALTH CARE
EXPENDITURES PER CAPITA AS WELL
AS I HEALTHCARE SPENDING AS A
PERCENT OF GDP. SUIT IF YOU
LOOK AT HEALTHCARE EXPENDITURES
PER CAPITA NO SURPRISE AND
HEALTH YOU KNOW THAT THE BIG
ISSUE IN THE U. S. HEALTHCARE
ECONOMY IS KIND OF THE-RELENTLESS RISE OF HEALTHCARE
SPENDING PER CAPITA YEAR OVER
YEAR IT GROWS THE LINE SHOWS US
YOU KNOW WHAT SOME OF THE
OTHERS SPEAKERS HAVE TALKED
ABOUT. NOT ONLY IS HEALTHCARE
SPENDING GROWING BUT IT'S
GROWING AS A PERCENTAGE OF GDP
SO WE'RE DEVOTING MORE OF OUR
RESOURCES TO HEALTHCARE OVER
TIME. ABOUT SLIGHTLY MORE
SUBTLE POINT I WANNA MAKE WITH
THIS AN WITH THE SLIDE IS TO
REALLY THINK ABOUT THE
DIFFERENCE. BETWEEN THE LEVEL
AND THE GROWTH OF SPENDING.
RIGHT SO IF WE LOOK AT THE
LEVEL OF SPENDING AND IF WE
THINK ABOUT AN INTERVENTION.
THAT DECREASED THE LEVEL OF
SPENDING IN A GIVEN YEAR. THAT
WOULD BE NICE WE WOULD REDUCE
OUR HEALTHCARE COSTS COULD.
REDUCE THEIR HEALTHCARE COSTS
FOR THAT YEAR. BUT THAT'S NOT
REALLY GOING TO SOLVE OUR
PROBLEM THAT'S GOING TO IF WE
DON'T ADDRESS THE COST GROWTH
WE'RE GOING TO BE SPENDING FROM
A WE'RE GOING TO RESUME TO OUR
OLD LEVELS OF HEALTHCARE COST
GROWTH. FROM THAT NEW LOWER
LEVEL SO ECONOMIST THINK ABOUT
THAT WELL THAT'S A ONE TIME FIX
BUT AS A ONE TIME INTERVENTION
WHAT WE'RE REALLY LOOKING FOR
IT WHEN WE THINK ABOUT
HEALTHCARE COSTS IS HOW CAN WE
SLOW THE RATE OF GROWTH OF
HEALTH EXPENDITURES. NEXT SLIDE.
OKAY AND WHAT HOW AND I'D LIKE
YOU TO IT- I'D LIKE TO
ENCOURAGE YOU TO THINK ABOUT
THE COST PROBLEM. YOU KNOW
MAYBE A LITTLE BIT DIFFERENTLY
THAN YOU THOUGHT ABOUT BEFORE
WHEN I THINK ABOUT THE COST
PROBLEM I THINK OF TWO
PROBLEMS. THE FIRST IS A VALUE
PROBLEM AND THE SECOND IS THE
AFFORDABILITY PROBLEM. SO THE
VALUE PROBLEM IS THE FOLLOWING
SO WHEN WE THINK ABOUT OUR
HEALTH CARE SPENDING WHAT WE
REALLY WANT TO THINK ABOUT IS
DOES THE BENEFIT THAT WE GAIN
FROM HEALTH CARE EXCEED THE
PRODUCT COST US OF PRODUCING
THOSE SERVICES. SO WE WANT TO
THINK ABOUT KIND OF OUR BANG
FOR OUR BUCK WHAT ARE WE
GETTING FROM HEALTH CARE
SPENDING. IN THIS IS AN
IMPORTANT CONCEPT IN THE U. S.
HEALTHCARE SYSTEM BECAUSE- YOU
KNOW WE'VE GOT. TONS OF
PHENOMENAL YOU KNOW THINGS
TECHNOLOGY SERVICES THAT ARE
GOOD FOR PATIENTS. BUT WE'VE
ALSO GOT YOU KNOW OTHER THINGS
WE HAVE LOTS OF EVIDENCE OF
WHAT PEOPLE CALL LOW VALUE CARE
RATES SO THAT. CARE FOR WHICH
THE COST YOU EITHER SLIGHTLY OR
VASTLY EXCEEDS THE BENEFITS-
AND WE ALSO HAVE LOTS OF
EVIDENCE OF NOT PROVIDING HIGH
VALUE CARE. SO OUR COST PROBLEM
IS NOT REALLY A PROBLEM OF JUST
LIKE DOING LESS OR SPENDING
LESS IT'S DEEPER THAN THAT AND
YOU KNOW UNFORTUNATELY IT'S A
LITTLE BIT HARDER THAN THAT
IT'S KIND OF. RE ORGANIZING OUR
CARE TO MOVE AWAY FROM LOW
VALUE CARE AND TOWARDS HIGH
VALUE CARE. I'LL GIVE YOU SOME
EXAMPLES OF THAT IN THE NEXT
SLIDE. THE PROBLEM YOU KNOW IF
WE PULL THE COST PROBLEM APART
AND YOU'VE HEARD A LOT ABOUT
THIS ALREADY THIS MORNING AND
SOME YOU KNOW GREAT EXAMPLES OF
THIS. IS YOU KNOW IT OUR ISSUES
OF AFFORDABILITY SO THE THOUGHT
EXPERIMENT I'D LIKE YOU TO YOU
KNOW CONSIDER. IS YOU KNOW I
TALKED IN THE LAST SIDE ABOUT-
WHAT WE REALLY WANT TO DO IS
SLOW THE RATE OF GROWTH OF
HEALTH CARE SPENDING. NOW I'M
SAYING WE WANT TO DO IN A GOOD
WAY INA WAY THAT PRESERVES
VALUE. BUT EVEN IF WE SLOW THE
RATE OF GROWTH OF HEALTH CARE
SPENDING WE'RE STILL GONNA HAVE
AFFORDABILITY PROBLEM RIGHT SO
RIGHT NOW YOU KNOW HE HAD WITH
MANY EXAMPLES OF THIS FROM THAT
FROM THAT LET YOU KNOW LAST
DAM- FROM THE LAST
PRESENTATION. YOU KNOW THE
AVERAGE PREMIUM IN THE U. S.
FOR FAMILY COVERAGE JUST WENT
OVER TWENTY THOUSAND DOLLARS
THE MEDIAN INCOME IN THE U. S.
A SIXTY THOUSAND DOLLARS. EVEN
IF WE CAN SLOW THE RATE OF
GROWTH OF HEALTHCARE SPENDING
TOMORROW WE'RE STILL GONNA HAVE
THIS AFFORDABILITY PROBLEM WE
STILL HAVE TO MAINTAIN. WAYS TO
KEEP PEOPLE ON. YOUR PROTECT
THEM FROM THE FINANCIAL RISK OF
HEALTHCARE SPENDING. OKAY NEXT
FLIGHT PLEASE. OKAY SO I WANT.
YOU TO GIVE YOU SOME EXAMPLES
OF VALUE OR IF IT REALLY YOU
KNOW THINK THROUGH THIS VALUE
ISSUE. I DO WANT TO PREFACE MY
COMMENTS BY GIVING YOU EXAMPLES
OF THAT PARTICULAR SERVICES.
AND I AM NOT ADVOCATING FOR
EXAMPLE A BAN ON THE ANNUAL
EXAM. I'M TRYING TO MAKE YOU
KIND OF THINK THROUGH- HOW WE
COULD DO YOU PRIMARY CARE EXAMS
BETTER OKAY SO THAT MAY BECOME
A LITTLE MORE CLEAR AFTER I GO
THROUGH THIS BUT- YOU KNOW WHY
I'M NOT REALLY FOCUSING ON. ANY
OF THESE PARTICULAR SERVICES
FOR. A SPECIFIC POLICY BUT JUST
TO DEMONSTRATE A CONCEPT. OKAY
SO WHAT HOW DO WE THINK ABOUT
VALUE SO WE CAN THINK ABOUT THE
TYPES OF HEALTH CARE WE
PROVIDE. AN ARRAY IT ALONG TWO
DIMENSIONS WE CAN THINK ABOUT
WHETHER. IT'S EFFECTIVE OR NOT
YOU KNOW DOESN'T WORK OR
DOESN'T IT. AND WE CAN THINK
ABOUT WHETHER IT'S CHEAPER
EXPENSIVE. RIGHT AND THINGS
THAT ARE NOT EFFECTIVE. WE
PROBABLY DON'T WANT TO DO.
RIGHT SO I'M GONNA PUT THE- AND
WE DON'T WANT TO DO THEN EVEN
IF THEY'RE CHEAP. SO I'M GONNA
PUT THE ANNUAL EXAM FOR HEALTHY
PEOPLE. IN THAT BUCKET THAT IS
SOMETHING THAT IS NOT
PARTICULARLY EXPENSIVE. BUT ALL
THE EVIDENCE WE HAVE SUGGESTS.
THAT IT'S NOT PARTICULARLY
EFFECTIVE. THIS IS ONE THAT
REALLY. STRIKES AT THE HEART OF
PEOPLE THEY FEEL VERY
PROTECTIVE OF THE ANNUAL EXAM.
SO I'M NOT SAYING YOU SHOULDN'T
GO TO YOUR DOCTOR AND SAYING.
AN ANNUAL EXAM FOR PEOPLE ARE
HEALTHY AND DON'T HAVE CON- YOU
KNOW CHRONIC CONDITIONS AND-
ARE GETTING MAYBE THE
RECOMMENDED SCREENINGS YOU KNOW
THROUGH OTHER MECHANISMS. WE
HAVE VERY LITTLE EVIDENCE THAT
THIS ANNUAL EXAM IS A IS A
WORTHWHILE. MAYBE WE WANT TO
REDO THE ANNUAL EXAM FOCUS THE
ANNUAL EXAM USE THE ANNUAL EXAM
BETTER BUT AND IT'S YOU KNOW
KIND OF CURRENT FORM- IT IS AT.
A LOW VALUE SERVICE. WE HAVE
SERVICES THAT ARE NOT EFFECTIVE
AND THEY ARE EXPENSIVE THOSE
ARE THINGS THAT WE WANT TO GET-
WOULD WONDER WHO REALLY THINK
TWICE ABOUT. YOU CAN THINK
ABOUT PCI- FOR PEOPLE WITH
STABLE ORDINARY ARTERY DISEASE.
IF ARE HAVE A HEART ATTACK IN
MANY SITUATIONS YOU SHOULD
ABSOLUTELY GET THIS AND THIS
WILL SAVE YOUR LIFE. BUT IF
YOU'RE NOT IF YOU HAVE SYMPTOMS
OF CORONARY ARTERY DISEASE
THERE IS A VERY LARGE CLINICAL
TRIAL THAT SUGGESTED THAT
OUTCOMES FOR THESE PATIENTS
GETTING THIS EXPENSIVE
PROCEDURE. WERE NOT BETTER THAN
AND OUTCOMES FOR PATIENTS WHO
DIDN'T GET THE PROCEDURE SO
THAT'S AN EXAMPLE OF SOMETHING
THAT'S EFFECTIVE. I'M SORRY
THAT IS NOT VERY EFFECTIVE IN
IS EXPENSIVE YOU KNOW SEEMS
LIKE THOSE ARE THE TYPES OF
THINGS WE'D LIKE TO DO LESS OF.
IT WE CAN ALSO THINK ABOUT
THINGS THAT ARE. EFFECTIVE AND
CHEAP SO A GREAT EXAMPLE OF
THIS IS SCREENING FOR
COLORECTAL CANCER CANCER WE
HAVE MANY DIFFERENT MODALITIES
OR SEVERAL DIFFERENT MODALITIES
FOR SCREENING FOR COLORECTAL
CANCER. THERE IS A FICKLE BASED
ATTESTED THAT IS VERY CHEAP
VERY EFFECTIVE IT'S ONE OF THE
VERY FEW PREVENTIVE SERVICES.
THAT IS ACTUALLY COST SAVING.
WHAT DO WE DO IN THE U. S. WE
ASK THAT WE ACTUALLY DO
COLONOSCOPY WHICH IS ACTUALLY.
IT'S EFFECTIVE AND IT IS EVEN
BY. A RELEVANCE AT AT METRICS
COST EFFECTIVE. BUT IT'S NOT
COST SAVING LIKE THE OTHER
TESTS RIGHT SO EVEN IN THE C.
WHERE WE HAVE. A AND EFFECTIVE
SERVE. WE OFFER TO USE THEM.
AND THEN RE WHETHER HITS ROAD
IN THE DIFFICULT THIS. ARE ARE
THINGS THAT IF. IN THEIR- RIGHT
SO PROBLEM DRUG PERHAPS WERE
THE BEST EXAMPLE OF THIS
INCREDIBLY EFFECTIVE.
INCREDIBLY EXPENSIVE IN THOSE
ARE DIFFICULT DECISIONS THAT
THAT THAT WE NEED TO MAKE. OKAY
NEXT SLIDE PLEASE. OKAY SO
THERE IS A- I'LL YOU LISTEN
ABOUT WHAT DRIVES GROWTH IN
HEALTHCARE SPENDING THERE IS A
IN AN ACADEMIC LITERATURE.
LOOKING AT OVER THE LONG RUN
WHAT DRIVES GROWTH IN
HEALTHCARE SPENDING AND
REMEMBER WE'RE NOT THINKING
ABOUT LEVELS WERE THINKING
ABOUT GROWTH RIGHT ARCHITECT
BUT THE GROUP. GROWTH IS THE
THING THAT WE REALLY CARE
ABOUT. AND I THINK THE ACADEMIC
LITERATURE IS SURPRISING TO
FOLKS AND HOW AND WHAT IS THIS
LITERATURE LOOK LIKE WELL. WHEN
IN THE ACADEMIC THEY LOOK AT
YOU KNOW TRENDS OVER TIME AND-
HEALTH CARE SPENDING. AND THEN
THEY LOOK AT THE THINGS THAT
THEY CAN MEASURE RIGHT LIKELY
WHAT ARE THE PRIMARY CULPRITS
WATER THAT. YOU KNOW THINGS
THAT PEOPLE POINT TO IN THE
CONTEXT OF A HEALTHCARE COST
GROWTH WILL BEGIN TO GET THE
AGING OF THE POPULATION YOU
KNOW CHANGES IN PRICE INCREASES
IN INSURANCE- HE HAS IT TO A
CERTAIN EXTENT THINGS ABOUT.
ABOUT YOU KNOW THAT IF WE CAN
MEASURE ADMINISTRATIVE COSTS WE
CONTROL FOR THE THINGS THAT WE
CAN MEASURE. AND THEN WE SEE
HOW MUCH IS LEFT IN THE
RESIDUAL. AND WHEN YOU LOOK AT
THE SLIDE YOU CAN SEE THERE
SEVERAL DIFFERENT STUDIES IN
SEVERAL OF THE THINGS THAT
PEOPLE OFTEN TALK ABOUT. FOR
EXAMPLE THE AGING OF THE
POPULATION. OVER THAT TIME.
WHICH WERE IN ADMITTEDLY WAS A
WHILE AGO AGING OF THE
POPULATION ACTUALLY HAD A VERY
SMALL CONTRIBUTION TO GROWTH
AND HEALTH CARE SPENDING.
INCREASES IN INSURANCE RIGHT
LIKE. THE ACT THAT YOU KNOW
ADDING ONE MORE INSURANCE
PERSON TO THE INSURANCE ROLES-
IN THE SPREAD OF THIRD PARTY
PAYMENT HAD A RELATIVELY SMALL
CONTRIBUTION TO HEALTH CARE
SPENDING. WHAT THAT'S THE SAME
THING AS SAYING WELL THE
RESIDUAL WAS VERY LARGE THE
PORTION WE COULDN'T EXPLAIN IS
VERY LARGE. AND HOW IT WOULD
HOW COMMON IS THINK ABOUT THAT
IS YOU KNOW WE KIND OF PUT THIS
IN A BUCKET OF TECHNOLOGY.
THAT'S BASICALLY SAYING WE'RE
DOING MORE STUFF WE HAD NEW
THINGS WE HAVE NEW SERVICES.%
AND WE ARE TAKING THIS THING
SERVICES AND APPLYING THEM AND
USING THEM IN NEW WAYS NEW
POPULATION NEW PEOPLE ETCETERA
RIGHT SO THE RESIDUALS
TECHNOLOGY. AND MANY OF THE
STUDIES AGREE. THAT THE THAT
THAT TECH NOT THAT BIG
TECHNOLOGY BUCKET IS THE
BIGGEST CON. CONTRIBUTOR TO
HEALTH CARE SPENDING. OKAY SO
IT WHEN YOU LOOK AT THE DATES
ON THE STUDIES YOU'LL BE LIKE
OH THOSE ARE VERY OLD STUDIES
KATE- AND- YOU KNOW YOU WOULD
BE RIGHT TO SAY THAT. I DO WANT
TO POINT OUT TWO THINGS WHICH I
THINK ARE OF GROWING IMPORTANCE
I THINK THE- THRUST OF THIS
LITERATURE. IS A RIGHT RIGHT IN
THE SENSE THAT IT'S STILL
TECHNOLOGY IT'S SILL WERE
DOING MORE STUFF- BUT THE TWO
FACTORS THAT I THINK ARE- YOU
KNOW A LITTLE BIT MORE
IMPORTANT NOW. ONE IS THE AGING
OF THE POPULATION IF YOU REALLY
LOOK CLOSELY AT THE- AT. THE
FORECAST FOR MEDICARE SPENDING
YOU CAN SEE THIS STORY OVER
TIME- THE ACTUARIES WHO
FORECAST MEDICARE SPENDING- ARE
ATTRIBUTING A GREATER PORTION
OF SPENDING GROWTH TO THE-
AGING OF THE POPULATION. IT'S
STILL CERTAINLY DOESN'T WORK
THAT TECHNOLOGY ARGUMENT BUT
IT'S BECOMING MORE IMPORTANT.
ON THE OTHER THING THAT I THINK
IS VERY IMPORTANT TOUCH ON A
LITTLE BIT MORE IN THIS
PRESENTATION AND I THINK YOU'VE
ALREADY HAD A LITTLE BIT
DISCUSSION. OF DISCUSSION ON IS
PRICES. RIGHT SO PRICES I THINK
YOU DO TO CONSULT INDUSTRY
CONSOLIDATION. UP PRICES ARE.
GROWING IN WAYS THAT THEY WERE
NOT GROWING DURING THAT TIME.
OF THE STATE. ON SLIDE PLEASE.
OKAY A. I. MANAGING OF MANY OF
YOUR PANELISTS WILL HAVE THEIR
FAVORITE MARKET CONSOLIDATION
SLIDE AND HERE'S MINE- THIS IS
RESEARCH THAT I'VE DONE WITH
MY- COLLEAGUES AND DAN KESSLER
AND LAUREN BAKER BOTH ALSO AT
SANFORD. AND WHAT WE'RE
LOOKING AT HERE IS- MARKET
CONSOLIDATION AND HOSPITAL
SPENDING N. THIS PAPER THE
FOCUS OF THIS PAPER WAS
VERTICAL INTEGRATION HOSPITAL'S
MERGING- WITH- HOSPITALS IN A
MERGING OR PURCHASING PHYSICIAN
PRACTICES AND THAT BAR ON THE
LEFT YOU CAN SEE THAT SAY A
PERCENTAGE PRICING CHANGE FOR A
ONE PERCENTAGE- ONE STANDARD
DEVIATION INCREASE. IN THAT IN
VERTICAL AND CONSOLIDATION IN A
HEALTH CARE MARKET LEADS TO
HIGHER SPENDING REMEMBER
SPENDING IS PRICE TIMES
QUANTITY SO EITHER OF THOSE
THINGS COULD BE GOING UP THERE.
TO GO OVER TO THAT RIGHT BAR
THE LIGHT BLUE BAR THAT IS
COMPARING DEACON VERTICAL
CONSOLIDATION TO HORIZONTAL
CONSOLIDATION TO HOSPITALS
GETTING TOGETHER AND MERGING
AND YOU KNOW HORIZONTAL
CONSOLIDATION ALSO IN A HAS A
VERY BIG THAT AFFECT ON PRICES.
WHEN YOU GO OVER TO THE RIGHT A
YOU CAN SEE THE EFFECT AND
QUANTITY THE LAST FIGURE WITH
PRICE TIMES QUANTITY SPENDING
GOING UP THE RIGHT IS QUANTITY
ONLY- THIS IS BASICALLY SAYING
WELL THE RELATIVELY LITTLE
EFFECT AND QUANTITY OF THESE
TYPES OF CHANGES IN PROVIDER
ORGANIZATION AND MARKETS SO YOU
KNOW KIND OF BY DEFAULT IT
LOOKS LIKE IT WAS PRICES. RIGHT
SO THERE ARE LOTS OF THE
GROWING LITERATURE LOTS OF
STUDIES THIS IS A VERY
IMPORTANT PROBLEM FOR A HEALTH
CARE SYSTEM NOW IN PART BECAUSE
ONCE WE DO CONSOLIDATION IT'S
HARD TO DO IT RIGHT S OF THE
CONSOLIDATION INSPECTS AFFECTS
SOME PRICES IMPORTANT WHEN NO I
WANT TO MAKE ON THIS STUDY IS
THAT THIS IS ALL ABOUT HOSPITAL
ADMISSIONS- AND IT'S A VERY
IMPORTANT AND THINKING ABOUT-
HOSPITAL CONSOLIDATION IN
HOSPITAL INTEGRATION. ALSO TO
THINK ABOUT OUT ASIAN HOSPITAL
SERVICES THERE'S A LAW OF
ACTION THERE TO WELL. A NEXT
SLIDE PLEASE. OKAY SO HERE I
WANNA I WANNA MAKE A POINT
ABOUT- EXPANSIONS INSURANCE AND
INSURANCE COVERAGE AN OUT OF
POCKET SPENDING SO WHAT I'VE
DONE HERE IS I'VE PLOTTED-
NATIONAL HEALTH EXPENDITURES BY
A FUNDING SOURCE AND ON THE
BOTTOM IN THAT GRAY AND- I ON
IN THOSE GRAY BARS YOU CAN SEE
THE PROPORTION OF HEALTH CARE
EXPENDITURES THAT ARE FUNDED
OUT OF POCKET. N. I MEAN WHO AT
THIS IS A VERY LONG TIME PERIOD
I THINK THAT NUMBER OVER THERE
AND THE LEFT ISN'T EARLY
NINETEEN SIXTIES AND YOU CAN
SEE THAT PROPORTION OF HEALTH
EXPENDITURES THAT IS FUNDED BY
OUT OF POCKET PAYMENTS NON
INSURED PAYMENTS HAS ACTUALLY
BEEN DECLINING OVER TIME SO THE
DECLINE HAS BEEN LESS DRAMATIC
IN RECENT YEARS. BUT IT'S BEEN
DECLINING- AT THE SAME TIME
WE'VE HAD PRETTY DRAMATIC
INCREASES OVER TIME- IN THE
PROPORTION OF EXPENDITURES THIS
ISN'T THE PORTION OF PEOPLE
THIS IS A PROPORTION OF
EXPENDITURES THEY'RE COVERED BY
EITHER PUBLIC OR PRIVATE
INSURANCE AND IF YOU YOU KNOW
SQUINT REALLY HARD AT THAT YOU
CAN SEE THAT MAYBE THERE'S A
SLIGHTLY BIGGER INCREASE AND-
PUBLIC INSURANCE. AND PRIVATE
INSURANCE DURING THIS TIME
RIGHT SO THIS IS THIS LITTLE
BIT SURPRISING TO PEOPLE
BECAUSE WE HEAR A LOT ABOUT OUT
OF POCKET PAYMENTS AND THAT IS
ABSOLUTELY IMPORTANT OURSELVES
A LITTLE BIT MORE ABOUT THAT ON
THE NEXT SLIDE IT'S ABSOLUTELY
IMPORTANT BUT REALLY ARE OUT OF
AND ANOTHER THING I WANT TO
MAKE A POINT I WANT TO MAKE
ABOUT THE SLIDE IS WHEN I SAY
OUT OF POCKET PAYMENTS THESE
ARE PEOPLE WHO ARE INSURED AND
PAY FOR SOME OF THEIR SERVICES
OUT OF POCKET. AS WELL AS
PEOPLE WHO ARE UNINSURED RIGHT
SO THERE'S A MIX BETWEEN
BENEFIT GENEROSITY AND HEALTH
INSURANCE COVERAGE FOR EXAMPLE
BENEFIT GENEROSITY COULD BE
DECLINING AND MORE PEOPLE ARE
GETTING HEALTH INSURANCE AND
THAT COULD BE AN OFFSETTING
EACH OTHER AND IN INTERESTING
WAYS. BUT THE POINT I WANT TO
MAKE HERE IS THAT YOU KNOW WE
TALK A LOT ABOUT OUT OF POCKET
SPENDING IN OUT OF POCKET
SPENDING IS ACTUALLY EITHER. AS
A PERCENTAGE OF TOTAL HEALTH
EXPENDITURE IS THAT GOING TO SO.
MAY THINGS STATE IN RECENT
YEARS. THE BIG PROBLEM THE
ELEPHANT IN THIS ROOM IS TOTAL
SPENDING- I AND I'M NOT SAYING
OUT OF POCKET EXPENSE SPENDING
IS NOT IMPORTANT FOR CONSUMERS.
BUT I'M SAYING THE THING THAT
IS DRIVING OUT OF POCKET
SPENDING FOR CONSUMERS IS TOTAL
SPENDING. OKAY NEXT SLIDE
PLEASE. OKAY THIS KIND OF MAKES
THE SAME POINT CERVANTES TOO
QUICKLY THIS IS BASICALLY
SHOWING THAT YOU KNOW OUT OF
POCKET EXPENDITURES ARE OUR PER
CAPITA INDEED ARE GOING UP AT
THE SAME TIME THE SHARE OF A
EXPENDITURES FINANCE OUT OF
POCKET IS GOING DOWN ONCE AGAIN
THAT'S BECAUSE HEALTH CARE
EXPENDITURES PER CAPITA ARE
GROWING SO QUICKLY. EXIDE
PLEASE. AND OKAY SO I WANT TO
JUST TALK A LITTLE BIT ABOUT
THE DISTRIBUTION OF SPENDING BY
SECTOR YOU KNOW HERE WE HAD THE
BIG THREE ARE REALLY HOSPITAL
SERVICES AND OFTEN PEOPLE ARE
SAYS SURPRISE AT THE LARGE
SHARE SPENDING DEVOTED TO
HOSPITAL SERVICES IT SOUNDS
FROM THE QUESTIONS I COULD HEAR
THAT YOU GUYS PROBABLY ARE NOT
THAT SURPRISED. BY THAT
PHYSICIAN SERVICES ALSO
IMPORTANT PHARMACEUTICALS
REPRESENT ABOUT 10% OF
HEALTHCARE EXPENDITURES THAT IS
FOCUSED ON RETAIL
PHARMACEUTICALS AND INJECTABLES
ARE IMPORTANT ALSO BUT THEY
DON'T SHOW UP IN THAT
PHARMACEUTICALS AND PIECE OF
THE PIE BECAUSE THEY OUGHT TO
SHOW UP IN EITHER THE HOSPITAL
OR THE PHYSICIAN. SERVICES ON
IT'S HARD TO GET GREAT DATA ON
WHAT PROPORTION OF HOSPITAL OR
PHYSICIAN SERVICES YOU KNOW HOW
ARE DEVOTED TO- INJECTABLE AND
OTHER TYPES OF DRUGS THAT YOU
WOULD GET IN- A HOSPITAL OR
PHYSICIAN'S SETTING- BUT SOME
PEOPLE OF ESTIMATED THAT MAYBE
THAT BRINGS UP THE
PHARMACEUTICAL SHARE AT TWO
FIFTEEN YOU KNOW SOME PEOPLE
SAY 20% IT HARD TO GET GRADED
ON THAT. CAN EXCITE. OKAY HERE
I JUST WANNA TALK A LITTLE BIT
ABOUT THE GROWTH RATE AND GROW
YOU KNOW ONCE AGAIN. I STARTED
BY SAYING THE GROWTH RATE IS
MORE IMPORTANT THAN THE LEVELS-
THAT IS A TRUE HERE YOU CAN SEE
IN OF TRENDS AND THE GROWTH
RATE OVER TIME. THE NINETIES
WAS A PERIOD OF LARGE INCREASES
IN THE- ORDER RAPIDLY RISING
EXPENDITURES FOR
PHARMACEUTICALS- THE CURRENTS
AND A GROWTH RATES ARE OVER
THERE. ON THE RIGHT IT'S NE
THING TO KEEP IN MIND AS WELL
THE GROWTH RATE OF THESE THINGS
HAS ANOTHER ROUGHLY IN A
SIMILAR THEY DON'T TO OF EACH
OF THESE SECTORS. BUT WHEN WE
APPLY A SIMILAR GROWTH RATE ON
A VERY LARGE BASE A VERY LARGE
BASE OF HOSPITAL SPENDING FOR
EXAMPLE. THAT AND TRANSLATES
INTO A LOT OF DOLLARS RIGHT SO
A GOOD AS A YOU KNOW A GROWTH
RATE ON A SMALL SHARE RELATIVE
TO A GROWTH RATE ON A LARGE
SHARE THE SAME GROWTH RATE ON A
LARGE SHARE. MEANS A DIFFERENT
THING FOR OVERALL SPENDING.
OKAY NEXT SLIDE PLAY. AND HERE
IS SOME INFORMATION THAT THE-
THE NATIONAL X. HEALTH
EXPENDITURES FOLKS PUT TOGETHER
TRYING TO KINDA DECOMPOSE IN TO
ODD THAT THE HEALTHCARE COST
GROWTH INTO ONCE AGAIN AGING OF
THE POPULATION PRICE AND
QUANTITY AND YOU CAN SEE IN A
KIND OF IN THE NINETIES OVER
THERE ON THE LEFT ESPECIALLY
THAT SECOND BAR FROM THE LEFT
YOU KNOW THERE IS A PERIOD OF
RELATIVELY LOW HEALTH CARE
COSTS GROWTH. BUT DURING THAT
TIME IT'S INTERESTING WHAT HEAD
YOU KNOW WHAT HEAD- PRICES WERE
STILL GROWING BUT QUANTITY
WASN'T RATE ONCE WE EMERGED
INTO A TIME PERIOD WHERE
HEALTHCARE SPENDING GROWTH TOOK
OFF AGAIN WE WERE MOVING MOVING
MORE TOWARD MORE TOWARDS
QUANTITY AND ONCE AGAIN THAT IS
YOU KNOW QUANTITY IS A BIG
BROAD CATEGORY OF STUFF GRADING
OF NEW STUFF- EXISTING AND NEW
APPLICATIONS FOR EXISTING
PROCEDURES AND BILLS ETCETERA I
DO WANT TO ADD ONCE AGAIN BRING
ATTENTION TO ASIAN THE
POPULATION YOU KNOW IMPORTANT
BUT NOT INCREDIBLY IMPORTANT
AND. AND RELATIVE TO THESE
OTHER FACTORS. NEXT SLIDE
PLEASE. OKAY SO- YOU KNOW WHAT
CAN WE DO WELL AND YOU KNOW WE
NEED TO FOCUS ON- YOU KNOW WHAT
WE NEED TO FOCUS ON- QUANTITY
AND THINKING ABOUT YOU KNOW HOW
WE CAN MOVE AWAY FROM WE CAN
MOVE TOWARD A HIGH VALUE
HEALTHCARE SYSTEM IF YOU THINK
ABOUT THE HEALTHCARE SYSTEM IN
A VERY SIMPLE WAY- AS I'VE
DRAWN ON THE SLIDE RIGHT THERE
ARE. THERE ARE PATIENTS AND
PEOPLE THERE ARE PAIRS AS OUR
ROUGHLY INSURERS ARE MEDICARE
MEDICAID AL ON IN THEIR
PROVIDERS WE REALLY HAVE THREE
PLACES THAT WE CAN INTERVENE
RIGHT WE CAN WE CAN THINK ABOUT
HOW- THAT CONSUMERS ARE
CHOOSING HEALTH PLANS RIGHT SO
THAT'S IN THE UPPER LEFT HAND
CORNER. WE WANT TO THINK ABOUT
INCENTIVES FOR CHEETAH FOLKS TO
CHOOSE HIGH VALUE COVERAGE WITH
PREMIUMS SIGNALS WE CAN THINK
ABOUT- HOW WE PAID PROVIDERS
THAT'S THE RELIEF OVER THERE ON
THE TOP RIGHT THAT'S THE
RELATIONSHIP BETWEEN PAYERS AND
PROVIDERS WE CAN INTERVENE
THERE TO CREATE INCENTIVES TO
DELIVER HIGH VALUE CARE AND
THEN WE CAN THINK ABOUT THE
BOTTOM WE CAN THINK ABOUT HOW
PATIENTS INTERACT WITH THEIR
HEALTH PLANS AND THINK ABOUT
THE INCENTIVES THAT WE'RE
GIVING TO PATIENTS TO USE HIGH
VALUE SERVICES. OF COURSE
PEOPLE WOULD WEIGH THESE
DIFFERENT MECHANISMS THE
IMPORTANCE OR THAT YOU KNOW
EFFECTIVENESS OF THESE
DIFFERENT YOU KNOW TYPES OF
MECHANISMS DIFFERENTLY- BUT YOU
KNOW THOSE ARE KIND OF THE
CHOICES THAT WE HAVE ON THE
TABLE. X. SLIDE PLEASE. OKAY SO
IF I A N. ADDISON US SUMMARIZE
I BASICALLY WANT TO REINFORCE
THIS IDEA THAT I THINK YOU KNOW
WE WANT TO SEE IS THAT IT'S NOT
NECESSARILY THE COST PROBLEM
BUT AS A VALUE PROBLEM AND
AFFORDABILITY PROBLEM AND IF
WE'RE GOING TO MOVE TOWARD
VALUE WE HAVE TO DO YOU KNOW WE
HAVE TO CHANGE THE INCENTIVES
INTACT CENTER FACING INSURERS
WOULD HAVE TO ADD THE SENTENCES
FACING PROVIDERS AN INCENTIVE
FACING CONSUMERS- IN A RISING
MARKET CONCENTRATION I THINK IS
A PROBLEM IN PRICES SENATE
FOCUSED ON THAT. BUT I THINK
IT'S ALSO A PROBLEM BECAUSE IT
MAY IT CREATES A BARRIER PUTS A
LOT OF POWER IN THE HANDS OF-
OF PROVIDER ORGANIZATIONS AND
EVEN INSURERS- TO THAT YOU KNOW
TO PUSH BACK AGAINST THE TYPES
OF CHANGES THAT WOULD MOVE US
TOWARD A MORE HIGH VALUE
SYSTEM- AND THEN OF COURSE WE
NEED TO ADD SUBSIDIES TO MAKE
HEALTH CARE AFFORDABLE BUT YOU
KNOW WE HAVE TO ACTUALLY REALLY
THINK ABOUT THE DESIGN OF
SUBSIDIES- IN ORDER TO MAKE
SURE THAT THE WAY WE'RE
SUBSIDIZING CONSUMERS AND THE
AREA. OF HEALTHCARE IS
PROMOTING HIGH VALUE CARE.
THANK YOU. WELL THANK YOU VERY
MUCH FOR THAT THAT-
PRESENTATION AND WITH A LOT OF
REALLY VALUABLE INFORMATION
LIKE TO SEE IF THERE MIGHT
QUESTIONS FROM THE COMMITTEE I
THINK WERE THEY WERE ABSORBING
A LOT HERE SO. PLEASE
SEMICIRCULAR CURRY THANK YOU
VERY MUCH GOOD PRESENTATION I
AM ASKING THE QUESTIONS A
LITTLE OFF- A BECAUSE I
REPRESENT RURAL AREAS AND I'M
CONCERNED ABOUT ACOSTA KEEPS
COMING UP. AND I KEEP GETTING
ASKED AND. REGULATIONS FOR
HOSPITALS ARE ESTIMATED BY RAN
TO COST MORE THAN A HUNDRED
BILLION DOLLARS. DO YOU BELIEVE
THIS EXPENSE WOULD BE BORNE BY
HEALTH CARE CONSUMERS AND WOULD
THIS BE CONSIDERED AS A MAJOR
HEALTH CARE COST DRIVER. PLEASE
THAT IS A GREAT QUESTION- I
DON'T AND I DON'T KNOW THE
ANSWER TO THAT QUESTION- I
THINK YOU KNOW AS AN ECONOMIST
I WILL SAY- DEFINITIVELY IT
DEPENDS- AND WHAT DOES IT
DEPEND ON- I THINK IT DEPENDS
ON YOU TO THE EXTENT TO WHICH
PUBLIC SUBSIDIES ARE AVAILABLE
FOR- HELPING HOSPITALS RESPOND
TO THIS- AND- IF YOU KNOW
HOSTAGE YOU KNOW IT AND THE
EXTENT TO WHICH HOSPITALS HAVE
TO- ED GENERATE THE FUNDS FOR
RETROFITTING US THROUGH THE
SALE OF SERVICES TO CONSUMERS
THAN IT DEFINITELY WILL RAISE
PRICES SO DEPENDS ON YOU. AS IN
MOST THINGS I THINK IT DEPENDS
ON WHO PAYS. THANK YOU THANK
YOU AND THAT THAT UMBER IS A
HUNDRED AND THIRTY FOUR BILLION
DOLLARS AS I RECALL THANK YOU
SO IT'S A LARGE NUMBER. MISTER
MASON. SO I REPRESENT AN AREA
THAT'S- FAIRLY THE RULED BY
ACTUALLY PART OF MY DISTRICT IS
VERY REPEAT IT IS IT IS VERY
RURAL- AND THERE IS OF ABOUT
HALF OF MY DISTRICT POPULATION
OF MY DISTRICT- THERE IS FOR
HOSPITALS- AND THERE WAS TWO
HOSPITALS THAT WERE. HAD
CONTRACTED OUT WITH ONE
PARTICULAR SYSTEM THE END OF
THE RURAL COMMUNITY THAT I
SERVE I HAD A PUBLIC HOSPITAL
THEY JUST WEREN'T MAKING IT-
AND- THE BOARD MADE THE
DECISION A FEW YEARS AGO- TO.
CALL YOU THE TERM CONSOLIDATE-
WITH THAT THAT OTHER SYSTEM SO
OF THE FOUR HOSPITALS THERE'S
THREE. I'M HOSPITALS ARE NOW
WITH THAT THAT THAT SYSTEM AND
THE REASON WHY THE BOARD MADE
THAT DECISION BECAUSE THERE'S A
LACK OF PROVIDERS IN THOSE
RURAL COMMUNITIES. AND THEY
FOUND THAT THEY WOULD ACTUALLY
GET BY HIGHER THAT THEY THOUGHT
THEY WOULD GET HER HEALTH CARE
MORE PROVIDERS OR ACCESS TO
THOSE PROVIDERS. SO WE'RE
TALKING ABOUT COST DRIVERS HOW
DO YOU FACTOR THE AREAS THAT
ARE RURAL VERSUS THOSE THAT ARE
MORE SUBURBAN TO URBAN WHERE
THEY'RE MOST MORE PROVIDERS. TO
THAT QUESTION MAKE SENSE. THAT
QUESTION. YEAH I MEAN I THINK
THERE'S A LOT GOING ON THERE I
THINK ISSUES OF RURAL HEALTH
CARE AND HOSPITAL AND
COMPETITION ARE YOU PROBABLY
TRICKY AND SOME OF THE MORE
TRICKY AREAS WE HAVE BECAUSE
YOU KNOW IF YOU THINK ABOUT THE
YOU KNOW WHAT ARE THE LONG TERM
TRENDS IN WHAT HOSPITALS DO
HOSPITALS ARE REALLY MOVING
THINGS TO OUTPATIENT CARE RATES
SO- YOU KNOW MANY OF THE THINGS
THAT WE STUDENT PATIENT YOU
KNOW AND WE CAN NOW DO
OUTPATIENT. SO IN SOME SENSE
THAT'S GOOD YOU KNOW IN THE
CONTEXT OF RURAL HEALTH CARE
PROVIDERS BECAUSE MAYBE YOU
KNOW THEY'RE LOWER FIXED COST
TO ME WE CAN SUPPORT LARGER
COMPETITION ARE MORE
COMPETITION BUT IT DOES SUGGEST
THAT YOU KNOW THERE'S A THERE'S
A PROBLEM WITH COMPETITION- IN
RURAL AREAS FOR ACUTE CARE
SERVICES YOU KNOW SOME YOU KNOW
WILL ALWAYS NEED WORK AT LEAST
FOR THE FORESEEABLE FUTURE WE
WILL NEED SOME ACUTE CARE
SERVICES AND YOU KNOW
COMPETITION IT'S- IT'S TOUGH TO
GENERATE ENOUGH SCALE AND
HOSPITALS TO SUPPORT
COMPETITION IN THESE AREAS SO.
I MEAN I THINK THAT I WOULD SAY
THAT I AM NOT AN EXPERT AND
RURAL HEALTH BUT THAT DOES SEEM
LIKE AN AREA IN WHICH- YOU KNOW
POLICY COULD THINK ABOUT HOW
TO- A SUPPORT HOSPITALS OR AT
LEAST REGULATE HOSPITAL PRICES
IN AREAS YOU KNOW ECONOMISTS
WOULD CALL THAT A NATURAL
MONOPOLY YOU KNOW IF THAT
INDEED IS THE CASE WE MIGHT
WANT TO THINK ABOUT. HOW TO
TREAT THOSE HOSPITALS
DIFFERENTLY. THANK I BELIEVE
MISTER NAZARIAN HAS A QUESTION.
THANK YOU MISTER CHAIR CAN YOU
HEAR ME YES. OKAY AND THEN DOES
THE PRESENTER ALSO HEAR ME. DR
BHANDARI I DON'T THINK SO I'M
GONNA DO MY BEST TO WRITE YOUR
QUESTION DOWN. AN ADULT OKAY
OKAY. SORRY MISTER CHAIR I GOT
A FEW. ONE IT'S SO THE FIRST
ONE IS ON THE- ON THE SLIDE
THAT SAYS WHAT DRIVES GROWTH IN
HEALTHCARE SPENDING. I'M
LOOKING AT THE AGING POPULATION
AT 2% IN TWO THOUSAND I'M JUST
WONDERING WHAT WOULD THAT
NUMBER BE IN TWENTY TWENTY
GIVEN THAT IN THE LAST TWENTY
YEARS. WE'VE ALSO SEEN. SEEN AS
SPIKE IN A LOT OF THE-
DEGENERATIVE DISEASE. DISEASES
AND THE COST AND CONSUMPTION
THAT THAT. TAKES A AND THE TOLD
THAT IT'S TAKING SO- I'M
WONDERING IF THAT WE WOULD SEE
OF MORRIS AT THAT DIFFERENT
PERCENTAGE AND A GREATER
CONTRIBUTION OF COST. OKAY
THAT'S ONE I DON'T KNOW IF YOU
WANT TO ASK THAT FIRST OR WHAT
ROUTE ME TO CAN YOU ABOUT
HOUSTON'S LET'S PUT THEM ALL
TOGETHER AND I'M I'M WRITING
NOTES AND THEN. WE'LL A WE'LL
GO FROM THERE IF I SCREWED UP
OKAY NAMA. TEXT TEXT ME. OKAY
AND THEN AND THEN THE SECOND
ONE IS ON THE TWO TWO SLIDES
LATER- DISTRIBUTION OF NATIONAL
HEALTH EXPENDITURES. WHERE
WHERE WE'RE LOOKING AT THE COST
SHARE CHANGING SINCE NINETEEN
SIXTY TO TWO THOUSAND EIGHTEEN
BETWEEN. THE OUT OF POCKET
COSTS PUBLIC INSURANCE PRIVATE
INSURANCE AND OTHER. WHAT I'M
INTERESTED TO KNOW IS HOW DOES
THIS COMPARE. TO OTHER ADVANCED
COUNTRIES. GREAT QUESTION GREAT
QUESTION OKAY SO I WILL. GO
AHEAD AND- WHAT ONE LAST WELL
AND THEN ONE LAST ONE ANY COULD
BE EITHER ON THIS- THIS SLIDE
FOR THE NEXT SLIDE BUT WHICH
WHICH HAS TO DO WITH THE OUT OF
POCKET COSTS WHERE SHOULD THE
OUT OF POCKET COST B. MA'AM I'M
A BELIEVER THAT THERE SHOULD
BE. A SMALL COST BORN ON THE
INDIVIDUAL. BECAUSE THAT ALSO
KEEPS IN CHECK AND
ACCOUNTABILITY THAT THAT
INDIVIDUALS DON'T TAKE
ADVANTAGE OF THE SYSTEM SO
THERE SHOULD BE A SMALL COST
BUT OVER HERE IT SAYS BASICALLY
IT'S AROUND. 10% RIGHT WHERE
SHOULD IT ACTUALLY HE WHERE
IT'S BEEN THE SUCCESS THAT
WE'VE SEEN IN OTHER COUNTRIES
THAT HAVE BEEN ABLE TO ACHIEVE
THAT. GREAT KEEP SUCCESS OKAY
THANKS THANK YOU THANK YOU SO
OKAY SPRING DR BEND OR BACK AND
I'M GONNA DO MY BEST ON THESE
QUESTIONS. OKAY SO WE'VE GOT
THREE QUESTIONS FOR YOU. THE
FIRST ONE IS- YOUR SLIDE THE
SAYS WHAT DRIVES GROWTH IN
HEALTHCARE SPENDING. AND WE'VE
GOT- AGING OF THE POPULATION
YOU GO FROM. NINETY TWO TO
NINETY FIVE TO TWENTY TWO
THOUSAND AND IT'S LIKE 2% EACH
OF THOSE. WHERE YOU KNOW WHERE
DO YOU SEE WHAT CAN YOU GIVE US
AN IDEA WHERE YOU SEE THAT.
NUMBER MIGHT BE IN TWENTY
TWENTY TWENTY YEARS IS A LONG
TIME AND WE HAVE AN AGING
POPULATION SO DO YOU DO YOU SEE
WHERE WHERE WOULD YOU SEE THAT
PROJECT IN AN OBVIOUSLY WELL
WE'RE NOT GONNA HOLD YOU TO IT.
BUT BUT YOU KNOW GIVE US YOUR
BEST SHOT AT IT. YEAH OKAY
THANK YOU FOR NOT HOLDING ME TO
THAT. BUT I DO HAVE I DO HAVE A
SLIDE RIGHT SO I FEEL CONFIDENT
THREE. REJECTION SO ONE OF THE
SLIDES TOWARDS THE END- THERE
WERE UPDATED NUMBERS I THINK
THE TWO THOUSAND EIGHTEEN KIND
OF YOU KNOW IS THAT SLIDE IN
THE END WHERE WE DECOMPOSED-
RIGHT AND COST GROWTH INTO. A
PRICE QUANTITY AND AGING OF THE
POPULATION. RATIO AND YOU KNOW
I ACTUALLY CAN'T SEE MY SLIDES-
SO I THINK IT WAS A VERY SMALL
BAR YES THE ROLE KNOWN
LICENSING. THANK YOU THIRTY
GOOD AT. HELPING YOU WITH THAT
NUMBER. YEAH THERE WE GO
PERFECT THAT'S AWESOME YEAH SO
I CAN SEE THE RED BAR BUT I
CAN'T SEE THE POINT IS THAT
LIKE LAKE. LAKE FIVE INCH FOUR
INCH 66% DOWN THEIR- WAY OVER
ON THE RIGHT. YEAH IT'S
ACTUALLY YEAH IT'S ACTUALLY
EVEN SMALLER THAN THAT BUT I
THINK THAT THE IMPORTANT TREND
THERE IS THAT IT SEEMS TO BE
FAIRLY STABLE. THAT IS ISN'T IN
OTHER WORDS THAT YES YOU KNOW
IT'S SO AT THE ABSOLUTELY SO
THAT WAS MY NEXT AT POINTS
THAT'S THE TWO THOUSAND
EIGHTEEN AND THEN YOU KNOW YOU
KNOW DEBTS. AS YOU SAID IT'S
BEEN PRETTY STABLE SO IT'S NT
A HUGE LEAP OF FAITH TO THINK
THAT IT WILL BE SIMILAR IN
TWENTY TWENTY. OKAY THAT BEING
SAID- I WANT TO MAKE TWO
QUALIFICATIONS TO THAT SO. IF
YOU GO AND YOU KNOW AND MAYBE I
CAN SEND SOME OF THE STATE THAT
AFTERWARDS AND YOU LOOK AT THE
EXPENDITURES. FOR MEDICARE-
DONE BY THE AND MEDICARE
ACTUARIES. THEY FORECAST THAT
FOR MEDICARE THIS THIS SHARE IS
INCREASING RIGHT IT'S- YOU KNOW
IT'S A YOU KNOW IT USED TO
EXPLAIN YOU KNOW SO MAYBE 5210%
OF MEDICARE AND MAYBE IT'S
GOING UP TO FIFTEEN THOSE ARE.
THOSE ARE BALLPARK NUMBERS
THERE THAT'S WHERE I'M GONNA
TAKE YOU UP ON YOUR OFFER OF
YOU KNOW NOT. AN EXACT ESTIMATE
THAT WILL SURELY A. B. AND
COULD. AS WE GO FOR. BECAUSE
THE- IS GOING TO AGE RAPIDLY
THAN IT DID IN THE PAST. OKAY
SO THAT'S ONE THING I WANNA SAY
THE OTHER THING I THINK YOU
MENTIONED NEUROSURGEON DIGITAL
DEGENERATIVE DISEASES. THE
OTHER THING IS A LITTLE TRICKY
ABOUT THIS IS THAT. THE
COMPOSITION OF THE POPULATION.
WILL DRIVE WHAT TYPES OF
TECHNOLOGIES ARE DEVELOPED IN
THE FUTURE RIGHT SO YOU KNOW WE
HAVE A LOT OF LITTLE
ENTREPRENEURS AND BIG
ENTREPRENEURS OUT THERE AND
HEALTH CARE SYSTEM AND THEY'RE
LOOKING AT THE POPULATION AGING
AS WELL. SO YOU KNOW PEOPLE
WILL BE INVESTING THEIR MONEY
AND NEW TECHNOLOGIES TO TREAT
OUR AGING POPULATION- AND THAT
IS NOT OFTEN NOT DIRECTLY
ACCOUNTED FOR IN THESE NUMBERS
RIGHT SO- SO WE CAN THINK THAT
MAYBE THAT THE AND THAT AND I
GUESS WHAT I'M SAYING OR WHAT I
AM SAYING. IS THAT THERE'S AN
INTERACTION BETWEEN THE AGING
OF POPULATION THE DEVELOPMENT
OF NEW TECHNOLOGIES. THAT WE
HAVE TO KEEP IN MIND AND MAYBE
THE AGING OF THE POPULATION
WILL EITHER BE MORE IMPORTANT
IN THE FUTURE BECAUSE OF THE
INTERACTION. THE OTHER THING I
WANT TO SAY THAT I ACTUALLY
FORGOT TO SAY N. M. WHAT I WAS
TALKING ABOUT THOSE STUDIES
AND- A DAD YOU KNOW. A PULLED
APART THE SOURCES OF HEALTH
CARE COSTS GROWTH USING THE
HISTORICAL DATA. IS INTO IT AS
JUST AS THERE IS AN INTERACTION
BETWEEN AGING OF THE POPULATION
IN THE DEVELOPMENT OF NEW
TECHNOLOGY. THERE ISN'T
INTERACTION BETWEEN INSURANCE
COVERAGE AND THE DEVELOP OF NEW
TECHNOLOGY SO ENTREPRENEURS OUT
THERE SAYING OKAY SO. YOU KNOW
WHEN MEDICARE AND EXPANDED
HEALTH INSURANCE COVERAGE FOR
PHARMACEUTICALS TO AND- OLDER
ADULTS WE SAW. A YOU KNOW A
BURST OF. INNOVATION FOR DRUGS
USED TO TREAT THE CONDITIONS
THAT PRIMARILY ARE YEAH YOU
KNOW RELEVANT FOR THESE OLDER
ADULTS SO THE- INTERACT AND
WHEN WE THINK OF LONG TERM
COSTS GROWTH THE INTERACTION OF
INSURANCE AND TECHNOLOGY IS
ALSO IMPORTANT. AND SO THAT WAS
THE FIRST. OKAY THREE YEAH
THING THAT I COULD HEAR FUMBLE
OF THEM. YEAH THE SECOND IS
SHOULD I GO AHEAD AND ANSWERED
YEAH THAT'S REGARDING THE
DISTRIBUTION OF NATIONAL HEALTH
EXPENDITURES. SPECIFICALLY
RELATED TO OUT OF POCKET
EXPENSE. AND HOW DOES THAT
COMPARE TO WHAT WE SEE IN OTHER
ADVANCED COUNTRIES. SO ARE NOT
SO IT. YEAH GO AHEAD I'M SORRY.
YEP YEP SO THAT'S THAT'S A
GREAT QUESTION IT VARIES I
WOULD SAY THAT WE TEND TO BE ON
THE HIGHER SIDE OF OUT OF
POCKET PAYMENTS THAN OTHER
COUNTRIES OTHER THAT'S THAT'S
NOT UNIVERSALLY TRUE GREAT SO
BUT WE TEND TO BE ON THE HIGHER
SIDE. WE HAVE HAD A- I WOULD
SAY A BIGGER CHANGE OVER THAT
LAST LONG TIME PERIOD RIGHT AS
WE YOU KNOW A IN OTHER
COUNTRIES EXTENDED. INSURANCE
COVERAGE YOU KNOW PARTICULARLY
YOU KNOW IN THE EIGHTIES AND
WHATNOT EARLY TO A BROADER SET
OF THE POPULATION EARLIER THAN
WE DID RIGHT SO. MAYBE THE
CHANGE HAS NOT BEEN AS DRAMATIC
AND I THINK OUR LEVELS ARE A
BIT HIGHER. ON IN PART BECAUSE
JUST OUR EXPENDITURES ARE
HIGHER SO IT'S A DIFFERENT THAT
THIS THE DIFFERENCE IS MORE
STRIKING IF YOU LOOK AT LEVELS
OF HEALTHCARE SPENDING. THAT IF
YOU LOOK AT THE PROPORTION OF
HEALTH CARE EXPENDITURES FUNDED
OUT OF POCKET. I'M RELATED TO
THE I THINK IT WAS THE NEXT
PART OF THAT QUESTION- YOU KNOW
ONE POINT I WANT TO MAKE IS.
OTHER COUNTRIES IN THE COUNTRY
TO HAVE LOWER HEALTH CARE
EXPENDITURES RELIED LESS. ON
OUT OF POCKET EXPENDITURES
DRESS ADDRESSED A DIRECTED
WORKING TOWARD CONSUMERS. TO
CONTROL HEALTH CARE COSTS RIGHT
BUT THEY RELY AND OTHER
MECHANISMS RIGHT THEY HAVE
TIGHTER CONTROLS AT THE CENTRAL
LEVEL. OR YOU KNOW THEY MAY BE-
YOU KNOW HAVE DIFFERENT WAYS OF
PRICING PHARMACEUTICALS AND
MOVING PEOPLE TOWARD YOU KNOW
LET YOU KNOW THAT MOVING. AT
PEOPLE TOWARD LOWER COST
PHARMACEUTICALS. SO IT'S- IT'S
AN E. DIFFERENT COUNTRIES EVEN
ROUGHLY THINKING ABOUT LAST
NIGHT THAT I HAD OF YOU KNOW
THEY'RE BASICALLY THREE PLACES
TO INTERVENE RIGHT YOU KNOW THE
WAY PAY PROVIDERS THE WAY
CONSUMERS CHOOSE PLANS AND COST
SHARING ANOTHER- INTERVENTIONS
TARGETED AT CONSUMERS.
DIFFERENT YOU CAN THINK OF
DIFFERENT COUNTRIES CHOOSING
DIFFERENT BASKETS OF THOSE
THINGS RIGHT SOVIET LOW COST.
GOT TO DO SOMETHING ELSE. GRAY
AND I THINK I THINK YOU OF
THEIR YOU WE THE THIRD QUEST
WAS REALLY WHERE IDEALLY SHOULD
THAT BE BUT I THINK. IT THAT
THAT'S REALLY KIND OF A MOOT
POINT BECAUSE THE SYSTEMS ARE
ARE ARE DIFFERENT AND- IN
COUNTRIES LIKE YOU SAID THAT
HAVE LOWER. LOWER COST FOR CARE
THE OUT OF POCKET IS LOWER
BECAUSE THERE OF OTHER
CENTRALIZED CONTROL SO- SO I
KNOW MISTER NAZARIAN SAID HE HE
HE WOULD LIKE TO FOLLOW UP WITH
YOU- AT A LATER DATE ON THIS
AND SO WE'LL FIND A WAY TO
CONNECT THE TWO OF YOU. MISTER
NAZARIAN JUST SO YOU KNOW IS
THE CHAIR FOR AGING A LONG TERM
CARE. COMMITTEE AND SO. THAT
YOU KNOW THESE ARE THESE ARE
REALLY CRITICAL ISSUES RELATED
TO OUR TO OUR AGING POPULATION
SO. SO AND WITH THAT I THINK
WE'LL GO AHEAD AND- SAY THANK
YOU VERY VERY MUCH FOR YOUR-
PRESENTATION AND REALLY
APPRECIATE THE INFORMATION. AND
WE WILL MOVE ON TO OUR NEXT
PANEL SO THANK YOU SO MUCH
APPRECIATED DR UNDER. OUR NEXT
PANEL. IS A IS A BIGGER PANEL.
AND OUR FIRST SPEAKER ON THE
PANEL IS GOING TO BE DR CHERYL
BURKE. HE'S THE CHAIR IN HEALTH
CARE PAYMENT POLICY IN
PRINCIPLE SENIOR RESEARCHER.
FOR THE RAND CORPORATION. DR
DAM BERG THE FLOOR IS YOURS.
THANK YOU DOCTOR WOULD AND THE
REST THE COMMITTEE FOR THE
OPPORTUNITY TO SPEAK HERE
TODAY. I AM GOING TO SPEND MY
TIME. THE RECOVERING TO BROAD
SPACES ONE IS TO PROVIDE A
REFRESHER ON WHAT ALL PAYER
CLAIMS DATABASE THESE ARE- AND
TO HELP THE COMMITTEE THINK
ABOUT- THE INFORMATION THAT
THEY CONTAIN AND THEN- SHOWING
YOU SOME EXAMPLES SOME USE
CASES. TO LET YOU KNOW HOW THE
DATA THAT WILL BE AGGREGATED
HERE IN CALIFORNIA CAN BE PUT
TO USE TO TRY TO ADDRESS- THE
VERY QUESTION THAT WAS AISED
EARLIER WHICH IS HOW DO WE
SOLVE. THE AFFORDABILITY AND
COST PROBLEMS HERE IN
CALIFORNIA. SO LET ME START BY
JUST. DOING SOME SET UP- IF WE
CAN GO TO SLIDE TO. SO JUST SO
EVERYBODY'S ON THE SAME PAGE IN
TERMS OF ONE AND ALL PAYER
CLAIMS DATABASE SAYS SO THIS
IS- THE DATABASE THAT
AGGREGATES PULLS TOGETHER
INFORMATION FROM BOTH PUBLIC
AND PRIVATE PAYERS OF HEALTH
CARE. AND IT PULLS TOGETHER
INFORMATION ON MEDICAL PHARMACY
AND DENTAL CLAIMS AND THERE'S
ALSO INFORMATION ON THE
ELIGIBILITY SO WHO'S ELIGIBLE
FOR WHAT TYPES OF INSURANCE
COVERAGE ON WHAT TYPES OF
BENEFITS- AS WELL AS THE
PROVIDERS- THAT THEY SEE AN
CHARACTERISTICS ABOUT THOSE
PROVIDERS. WE MOVED TO THE NEXT
SLIDE. SLIDE. THREE SO IF
YOU'RE LOOKING AT THE MAP OF
THE UNITED STATES WHAT YOU CAN
SEE AND THIS IS A BEEN A MAP
THAT'S BEEN IN TRANSITION-
RIGHT NOW THERE'S EIGHTEEN
STATES THAT HAVE ALL PAYER
CLAIMS DATABASE SIS- SIX THAT
ARE CURRENTLY IN THE PROCESS OF
IMPLEMENTING- INCLUDING
CALIFORNIA- AND I WOULD SAY
THAT- THERE'S BEEN TREMENDOUS
INTEREST AROUND THE COUNTRY AND
TRYING TO BUILD THESE
DATABASES. FOR VARIETY OF
REASONS- WHICH I'LL GET TO AND
A COUPLE OF SLIDES SO IF WE
MOVE ON TO SLIDE- I THINK IT'S
FOR. SO AND YOU CAN KEEP
FLIPPING THROUGH TO ALL THE
BULLETS SHOW UP SINCE I'M NOT
CONTROLLING- THE SLIDES MYSELF.
CLAIMS DATABASES HAVE A LOT O
ADVANTAGES OVER THE CURRENT
DATA SAID THAT- PEOPLE LIKE MY
COLLEAGUES WHO SPOKE BEFORE
HAVE BEEN TRYING TO LEVERAGE
FOR YEARS BOB HAVE BEEN DOING
IMPORTANT WORK TO TRY TO
DESCRIBE THE HEALTH CARE MARKET
PLACE- AND SOME OF ITS SHORT
COMINGS- BUT THE REAL ADVANTAGE
OF THESE DATASETS ARE THAT- YOU
ARE ABLE TO PULL TOGETHER DATA
FROM ALL THESE DIFFERENT
SOURCES TO DESCRIBE A COMPLETE
PICTURE OF WHAT'S GOING ON IN
THE CALIFORNIA HEALTH CARE
MARKET PLACE- MANY STUDIES-
THAT HAVE EXISTED TO DATE HAVE
LOOKED AT SEGMENTS OF THE
MARKET SO MAY LOOK JUST AT THE
MEDICAID PORTION OR MEDICARE-
AND- I THINK AS WE ALL KNOW
THESE DIFFERENT INSURANCE
MECHANISMS HAVE DIFFERENT-
STRUCTURES. AND SORT OF HOW THE
OUTCOMES THAT ARE DELIVERED
FROM THOSE PROGRAMS VERY- AND-
WE KNOW THAT PROVIDERS BEHAVIOR
VARIES BASED ON SORT OF THE
STRUCTURE OF A SET OF-
INCENTIVES THAT ARE BUILT INTO
THE IT'S- INSURANCE- PACKAGES
IF YOU WELL AND- SO ONE OF THE
THINGS THAT ALL PAYER CLAIMS
DATABASE IS ALLOW YOU TO DO IS
GET A COMPLETE PICTURE FOR
SENATE GIVEN PROVIDER OR SET OF
PROVIDERS IN THE MARKET PLACE
NOT TO TRY TO UNDERSTAND AS SHE-
APPLY PRESSURE IN ONE SEGMENT
OF THE MARKET PLACE WHAT IS THE
LIKELY A FAX- FOR THAT SAME
PROVIDER IN ANOTHER PART OF THE
MARKETPLACE- THE OTHER THING
THAT I THINK- WHEN WE'VE SORT
OF SLICED AND DICED- THE HEALTH
CARE MARKET BY THESE. SORT OF
NARROW DATABASE SIS IS- THE
SHORTCOMINGS ARE YOU END UP
WITH VERY SMALL SAMPLE SIZES
AND- IT'S HARD TO GET WHAT I
CALL RELIABLE ESTIMATES ON
PROVIDER. PERFORMANCE WHETHER
THAT'S QUALITY PER BERMAN. ON
THE EXISTING OF DISK AND HEALTH
CARE- OR- IN MANY CASES COSTS.
OF THE DELIVERY OF THAT CARE-
SO PULLING THAT INFORMATION
TOGETHER GIVE SHOUP'S OF
STRENGTH IN NUMBERS IF YOU
WILL- TO TRY TO- MAKE SURE THAT
YOUR ESTIMATES ARE STARS SOUND.
SO IF WE GO ON TO THE NEXT
SLIDE- I THINK EVERYBODY HERE
IS FAMILIAR WITH THE FACT THAT
WE'VE HAD- TO BILLS PASSED- IN
THIS PAST YEAR- AND THEY- ARE
REALLY PUSHING CALIFORNIA TO
THE FOREFRONT OF BUILDING THE
LARGEST ALL PAYER CLAIMS
DATABASE- IN THE COUNTRY- WHICH
IS REALLY EXCITING- THE AND I
KNOW NOT ONLY THE RESEARCHERS
HERE- IN CALIFORNIA BUT-
NATIONALLY ARE LOOKING FORWARD.
TO TRYING TO TAKE ADVANTAGE OF
EXPLORING THESE DATA AND-
HELPING TO BUILD EVIDENCE-
AROUND- SAVE- DIFFERENT TYPES
OF PAYMENT MODELS THAT ARE MARK
SUCCESSFUL- AS WELL AS TRYING
TO UNDERSTAND. WHAT HAPPENS
WHEN A DIFFERENT STAKEHOLDERS
IMPLEMENT CERTAIN POLICIES-
WHETHER IT'S AROUND COST
CONTAINMENT OR IMPROVING THE
QUALITY OF CARE. WHETHER OR NOT
THOSE TYPES OF INTERVENTIONS
ARE EFFECTIVE. SO ASSEMBLY BILL
EIGHTEEN TEN- ALLOWED ALL SHE
COULD TO CONVENE A REVIEW
COMMITTEE A FULL DISCLOSURE I
WAS ON THAT COMMITTEE- AND THIS
WAS A MULTI STATE GOVERNMENT
STAKEHOLDER GROUP THAT CAME
TOGETHER. TO HELP ADVISE OFSHE
COULD AT THE VERY EARLY STAGES
AROUND THE ESTABLISHMENT-
IMPLEMENTATION AND
ADMINISTRATION OF THIS
DATABASE. I SUBSEQUENTLY- A. B.
EIGHTY- NOW IT HAS PROVIDED
OFSHE FITTED WITH THE AUTHORITY
TO ESTABLISH THE HEALTH CARE
PAYMENT DATABASE HERE IN
CALIFORNIA. AND I WHAT I WANT
TO LEAVE THE COMMITTEE WITH IS
THIS A P. C. D. IT'S GOING TO
BE A VITAL RESOURCE TO SUPPORT
THE EFFORTS OF CALIFORNIA TO
TRY TO IMPROVE THE
AFFORDABILITY ISSUE- THAT SOME
OF THE PREVIOUS SPEAKERS HAVE.
SPOKEN TO. AND IF WE MOVE TO
THE NEXT SLIDE SO THIS IS
REALLY WHERE THE RUBBER MEETS
THE ROAD ABOUT WHY ARE WE
MAKING THIS HUGE INVESTMENTS-
IN DATA SYSTEMS- AND PULLING
ALL THIS INFORMATION TOGETHER
BECAUSE WE KNOW THIS IS NOT-
SORT OF A FREE ENDEAVOR- BUT
WHAT WE KNOW IS THAT- IT CAN
HELP SPOTLIGHT OPPORTUNITIES
FOR IMPROVING. OUR HEALTH CARE
DELIVERY SYSTEM AND I THINK
WE'VE ALREADY SEEN EVIDENCE OF
THIS BASED ON SOME WORK THAT'S
BEEN GOING ON IN THE STATE OF
THROUGH THE INTEGRATED
HEALTHCARE ASSOCIATION WHICH
HAS COMPILED A MULTI STE- PAYER
DATABASE- AND HAS BEEN USING
THOSE DATA TO- ADDRESS MANY OF
THE ITEMS THAT ARE SHOWN ON THE
SLIDE- AND SO THE A. P. C. D.
IS GOING TO TAKE THAT. EVEN
FURTHER- SO WE WILL BE ABLE TO
NOT ONLY UNDERSTAND TRENDS AND
SPENDING SOME OF WHICH- KATE
HAD SHOWN- AND THAT PASSED
PRESENTATION- BUT WILL BE ABLE
TO LOOK AT. THE EFFECTS OF
PROVIDER CONSOLIDATION ED MAYBE
BE ABLE TO HAVE- EARLIER
WARNING SIGNS WHERE THAT'S
HAPPENING AND BE IT WILL TO
THINK ABOUT HOW TO MOD
DIFFERENT POLICIES TO AFFECT
CONSOLIDATION- AND TO
UNDERSTAND WHETHER THOSE
POLICIES HAVE BEEN EFFECTIVE-
SIMILARLY- THERE'S A LOT OF
EXPERIMENTATION GOING ON. THE
PLACE AROUND ROOF AND THINKING
ABOUT WHETHER AS WE MOVE TO A
DIFFERENT TYPES OF PAYMENTS SO-
TOWARDS MORE CAPITATION- OR
HOLDING UP PROVIDERS AT RISK-
FOR NOT ONLY COST BUT ALSO
QUALITY PERFORMANCE- ARE THOSE
EFFECTIVE MECHANISMS FOR TRYING
TO DRIVE IMPROVEMENTS IN OUR
DELIVERY SYSTEM. SO LET'S GO ON
TO THE NEXT SLIDE- SAID- SIDE
SEVEN. SO IN ADDITION TO
ADDRESSING COST ISSUES- THE
HEALTH CARE PAYMENT DATABASE
ALSO HAS- AT THE ABILITY TO
HELP PROVIDE A LOT OF INSIGHTS
INTO OTHER KEY QUESTIONS THAT
WE AS CALIFORNIANS ARE VERY
CONCERNED ABOUT- AND THAT
INCLUDES DISPARITIES IN HEALTH
CARE- AND UNDERSTANDING THE
ROLE OF SOCIAL RISK FACTORS-
IN- QUALITY PERFORMANCE BUT
ALSO IN TERMS OF HEALTH CARE
OUTCOMES- WE ALSO ANT TO TRY
TO UNDERSTAND ARE CERTAIN
PROVIDERS MORE EFFICIENT THAN
OTHERS. AND IF SO WHAT
CHARACTERIZES THOSE PROVIDERS
AND WHAT CAN WE LEARN FROM
THOSE PROVIDERS THAT CAN BE
POTENTIALLY- ADOPTED BY OTHER
PROVIDERS IN THE MARKET PLACE-
AND IMPORTANTLY- AND- SPEAKING
TO- ONE OF THE SLIDES THAT KATE
SHOWED YOU ABOUT VALUE IN
HEALTH CARE- WE NEED TO KNOW
WHAT THE QUALITY OF CARE IS
THAT'S BEING DELIVERED IN THE
MARKETPLACE- AND WHAT WE ARE
GETTING FOR THE MONEY WE ARE
SPENDING. SO THESE ARE ALL- THE
ARRAY OF THINGS THAT CAN BE
CONSIDERED- FOR- LOOKING AT
WITH THE ALL PAYER CLAIMS DATA
SO LET'S MOVE ON TO THE NEXT
SECTION WHICH I THINK IS REALLY
KIND OF WHERE THE ACTION IS-
WHICH IS HOW WILL WE USE THE
DATA THIS THIS GREAT RESOURCE
THAT'S GOING TO BE IN FRONT OF
US. TO THINK ABOUT SOLVING
PROBLEMS AND IF YOU GO TO THE
NEXT SLIDE I'M GONNA GIVE YOU
SOME EXAMPLES FROM WHAT OTHER
STATES HAVE BEEN DOING WHAT
THEY'RE ALL PAYER CLAIMS DATA.
SO FIRST THE STATE OF VIRGINIA
USE THEIR DATA TO MEASURE
WASTEFUL SPENDING THEY WANTED
TO SPOTLIGHT AREAS WHERE LOW
VALUE CARE WAS BEING DELIVERED
SO THAT THEY COULD BRING
ATTENTION TO- PROVIDERS IN THE
MARKET PLACE THAT THIS IS AN
AREA WHERE WE ARE NOT GETTING A
BETTER VALUE FOR THE SPEND- AND
WE NEED TO THINK A ABOUT WAY.
OF REDUCE. THE USE OF THESE
SERVICES SO THAT WE CAN RE
DIRECT- DOLLARS WHETHER IT'S
TOWARDS OTHER HEALTH CARE AREAS
OR OTHER AREAS THAT THE STATE
NEEDS TO SPEND MONEY ON SUCH AS
PUBLIC EDUCATION. IF YOU GO TO
THE NEXT SLIDE. NEW HAMPSHIRE
HAS USED ITS ALL PAYER CLAIMS
DATA TO CREATE SOMETHING THAT'S
CALLED HEALTH COST- THIS IS A
COST COMPARISON SHOPPING TOOL
AND I PROVIDED- A SINGLE
SCREENSHOT THIS IS FOR- A
REGULAR COLONOSCOPY AND- WHAT
YOU CAN SEE- I KNOW THE SIDES
NOT SUPER CLEAR BUT- PROVIDERS
DO VERY IN TERMS OF THEIR PRICE
FOR OFFERING THESE SERVICES-
THE AND THERE'S ADDITIONAL
INFORMATION ON QUALITY OF CARE
PROVIDED AS WELL. BOB AND
INDIVIDUALS CAN- ENTER
DIFFERENT PROCEDURES THAT
THEY'RE GOING TO- UNDERGO IN
THIS WEBSITE- LOOK UP AND SEE
WHAT PROVIDERS IN THEIR AREA
ARE CHARGING BOB FOR THESE
DIFFERENT PROCEDURES. THESE
TYPES OF TOOLS CAN BE-
EXCEEDINGLY HELPFUL- NOT JUST
FOR CONSUMER EDUCATION BUT ALSO
FOR PAYER- EDUCATION JUST IN
TERMS OF THINKING ABOUT HOW
THEY MIGHT BE. MORE EFFECTIVE
IN NEGOTIATING PRICES WITH
PROVIDERS BUT ALSO THEY CAN
BUILD BENEFIT PACKAGES THAT
TRIED TO ENCOURAGE THE USE OF
THESE TOOLS BY CONSUMERS- SUCH
AS IN THE CASE OF REFERENCE
PRICING- WHERE. A PAIR MIGHT
SAY WE ARE GOING TO PAY UP TO-
THE MEDIAN PRICE IN YOUR MARKET
PLACE AND YOU THE CONSUMER ARE
ON THE HOOK FOR ANYTHING THAT
EXCEEDS THE MEDIAN PRICE. THAT
TYPE OF- TOOL HAS ENCOURAGED
PATIENCE I CONSUMERS TO SHOP
FOR HEALTH CARE. SO THAT'S AN
EXAMPLE FOR HOW THIS
INFORMATION COULD BE USED. IF
WE GO TO THE NEXT SLIDE
SIMILARLY- IN COLORADO- THERE'S
AN ORGANIZATION THAT CIVIC
THAT- THAT DOES A LOT OF
ANALYSIS WITH THE ALL PAYER
CLAIMS DATA IN THAT STATE- HERE
AGAIN WE'RE LOOKING AT THE
DIFFERENCES- IN THE PRICES FOR
ULTRASOUND. AND YOU CAN SEE IT
AGAIN I'M ONLY SHOWING YOU A
HANDFUL OF WHAT SHOWS UP ON
THAT PAGE- THERE'S A LOT OF
VARIATION IN PRICING- WHAT'S
INTERESTING ABOUT THIS
PRESENTATION IS THEY SHOW SIDE
BY SIDE BOTH PRICE AND QUALITY
SO CONSUMERS CAN START TO. GET
EDUCATED ABOUT THE VALUE
PROPOSITION OF WHAT THEY'RE
SPENDING AND THAT THE HIGHEST
PRICE. BOB PROVIDER ISN'T
ALWAYS THE HIGHEST QUALITY
PROVIDER. IF WE MOVE ON TO THE
NEXT SLIDE. AND HERE ARE
BORROWING SOME INFORMATION
FROM- MY COLLEAGUES WHO WILL
SPEAK LATER ON IN TODAY'S
SESSION- CHRIS WHALEY. SO CHRIS
HAS DONE A LOT OF WORK AB AND I
ENCOURAGE YOU TO- FOLLOW UP
WITH HIM ABOUT THIS. COMPARING
THE RELATIVE PRICES THAT ARE
PAID. TO HOSPITALS- COMPARED TO
MEDICARE PRICES AND WHAT YOU
SEE ON THIS SLIDE. WAS THAT UP
COMMERCIAL PAYERS ARE PAYING
TWO TO TWO AND A HALF TIMES
WHAT MEDICARE PAYS FOR THE SAME
SETS OF SERVICES- AND THAT THIS
IS RAISING A LOT OF QUESTIONS
IN THE MARKETPLACE ABOUT WHAT
IS THE APPROPRIATE PAYMENT
LEVEL THAT WE SHOULD BE PAYING
FOR THE SENSE OF SERVICES AND
ARE THERE OPPORTUNITIES FOR
REDUCING SPEND IN THIS SPACE-
BY LOWERING- WHAT WE PAY
HOSPITALS- ON THE COMMERCIAL
SIDE. I RELATEDLY IF WE GO TO
THE NEXT SLIDE THIS ALSO COMES
FROM WORK THAT CHRIS WHALEY
AND- CHICKEN WHITE- AND BRAND-
DID- FOR COLORADO. USING THEIR
ALL PAYER CLAIMS DATA. SO THIS
IS SORTING BY COUNTY IN THE
STATE OF COLORADO- THE RELATIVE
PRICES PAID. FOR HOSPITAL
SERVICES AND YOU CAN SEE AT THE
TOP OF THE SLIDE. I HAD THESE
COUNTIES HAVE- COMMERCIAL
PAYMENT RATES THAT ARE THREE
TIMES- THE MEDICARE PRICES SO
AGAIN TRYING TO SPOTLIGHT
OPPORTUNITIES FOR SAVINGS- IN
DIFFERENT MARKETS AROUND THAT
STATE. IF WE GO TO THE NEXT
SLIDE- MASSACHUSETTS- HAS BEEN
VERY ACTIVE IN LEVERAGING THEIR
ALL PAYER CLAIMS DATA. AND THEY
HAVE A HOSPITAL- I'M SORRY A
HEALTH POLICY COMMISSION- THAT
WAS- FORMS THAT I'M SORT OF
LATE TWO THOUSAND TWELVE EARLY
AT TWO THOUSAND THIRTEEN. WHERE
THIS GROUP MEETS- TO DISCUSS
TRENDS THAT THEY'RE SEEING IN
THE DATA- AND TO SET BENCHMARKS
FOR WHERE THEY WOULD LIKE
SPENDING IN THE STATE TO BE-
AND THEY MONITOR PERFORMANCE
AGAINST THOSE BENCHMARKS. AND
WHAT YOU CAN SEE ON THIS SLIDE
IS THAT- AFTER FORMATION OF
THIS HEALTH POLICY COMMISSION
AND ACTIVE FOCUS ON COST
CONTAINMENT IN THAT STATE.
MASSACHUSETTS WHILE IT IS
MIRRORING NATIONAL TRENDS IT
MANAGED TO BRING IT SPENDING
BELOW THE NATIONAL TREND AND TO
KEEP IT THERE. IF WE GO ON TO
THE NEXT SLIDE SLIDE FIFTEEN.
THE NEXT FEW SLIDES I'M GOING
TO- SHOW YOU A NUMBER OF OTHER
WAYS IN WHICH THAT
MASSACHUSETTS ISSUES THEIR DATA
THAT SO IN THIS NEXT SLIDE-
WHAT THIS DOES IS IT TAKES
SPENDING YEAR OVER YEAR. AND IT
BREAKS IT INTO THE VARIOUS
COMPONENTS WHETHER IT'S THE
COMMERCIAL PORTION OF THE
MARKET PLACE MEDICARE- MASS
HEALTH IS THE PUBLIC PORTION
AND SO ON. AND WHAT THEY'RE
REALLY LOOKING TO DO IS TO
TRACK NOT ONLY OVERALL
INCREASES IN THE MARKETPLACE
BUT TO TRY TO UNDERSTAND HOW
THAT BREAKS OUT BY. TYPE OF
PAYER. IF WE GO ON TO THE NEXT
SLIDE. SO ON SLIDE SIXTEEN WHAT
YOU'RE NOW SEEING AS AT THE
DATA ARE NOW BROKEN OUT BY TYPE
OF SPENDING AREA WHETHER THAT'S
INPATIENT HOSPITAL CARE.
HOSPITAL OUTPATIENT CARE
PHARMACY PHYSICIAN SERVICES AND
SO ONAND AGAIN TRACKING WHERE
SOME OF THE BIGGEST CHANGES
HAVE BANNED AND IN THIS CASE
PHARMACY- WAS A BIG- YOU'RE
OVER YEAR INCREASE AREA. IF WE
GO ON TO THE NEXT SLIDE. SLIDE
SEVENTEEN- HERE AS THEY ARE
BREAKING OUT COSTS BASED ON-
SEGMENTS OF THE MARKET AB IN
THIS CASE LARGE GROUP
INSURANCE. OF VERSES THE SELF
INSURED- SO AS I MENTIONED
EARLIER THIS PRESENTATION AT
THE HEALTH CARE MARKET PLACE IS
VERY FRAGMENTED IN TERMS OF-
ALL THESE DIFFERENT PRODUCTS
THE WAY THEY'RE STRUCTURED THE
TYPES OF INCENTIVES THAT ARE
BUILT INTO THEM AND SO ON. AND
SO THIS IS AN OPPORTUNITY TO
TRY TO BOTH UNDERSTAND THE
LARGER PICTURE AND AGGREGATED
WAY BUT ALSO TO BREAK IT OUT
AND UNDERSTAND WHAT'S HAPPENING
IN EACH OF THESE DIFFERENT
SEGMENTS. IF WE GO TO THE NEXT
SLIDE. SO I MENTIONED THAT-
PAYERS ARE EXPERIMENTING WITH
ALTERNATIVE PAYMENT MODELS SO
ONE OF THESE- TYPES OF MODELS-
IS REFERRED TO AS ACCOUNTABLE
CARE ORGANIZATIONS WHERE
PROVIDERS WHO ENTER INTO THESE
CONTRACTS WITH INSURERS ARE
ACCOUNTABLE FOR DELIVERING
QUALITY CARE BUT ALSO HOLDING
SPENDING DOWN. AND WHAT
MASSACHUSETTS WAS TRYING TO
BETTER UNDERSTAND IS WHAT WAS
THE ADOPTION OF THESE
DIFFERENT- ALTERNATIVE PAYMENT
MODELS FIVE MARKET SEGMENT- AND
WHAT YOU CAN SEE ON THIS SLIDE
IS THAT IN THE COMMERCIAL. SIDE
OF THE BUSINESS- IT'S BEEN
RELATIVELY STABLE IN TERMS OF
THE ADOPTION OF THOSE MODELS
AND WHERE IT HAS REALLY TAKEN
OFF IS IF YOU LOOK IN THE
MIDDLE PART OF THE SLIDE- UNDER
MASS- M. CO A CEO. IS THE-
PUBLIC- THAT PAYMENT SYSTEM HAS
REALLY SHIFTED TO ADOPTING
THESE ALTERNATIVE PAYMENT
MODELS. NEXT SLIDE SO THAT
GIVES YOU A SNAPSHOT OF SOME OF
THE- USE CASES- THERE ARE MANY
MANY MORE- AND I'D BE HAPPY TO
TALK TO ANY OF YOU- ABOUT OTHER
TYPES OF USE CASES BUT LET ME
JUST BEFORE I CLOSE OUT
MENTIONED SOME KEY ASPECTS.
THAT ARE IMPORTANT FOR
CALIFORNIA ALL PAYER CLAIMS
DATABASE. SO THE WAY IN WHICH
THESE DATABASES ARE TYPICALLY
BUILT ARE BASED ON CLAIMS
INSURANCE CLAIMS FOR FEE FOR
SERVICE TYPE CLAIMS- OR PER
DIEM IS FOR HOSPITALS. BUT IN
CALIFORNIA WE KNOW THAT WE'VE
HAD A VERY STRONG PRESENCE OF
CAPITATED MODELS- AND
INCREASINGLY WITH THESE
ALTERNATIVE PAYMENT MODELS
OTHER FORMS OF PAYMENTS THAT
ARE MOVING FROM INSURERS TO
PROVIDERS. AND OUR ALL PAYER
CLAIMS DATABASE IT IS ESSENTIAL
THAT WE CAPTURED THIS FULL
PICTURE OF SPENDING SO WE WANT
TO KNOW- WHAT THESE PROVIDERS
EARNED IN SHARED SAVINGS WE
WANT TO KNOW WHAT THEY EARNED
AND PAY FOR PERFORMANCE
INCENTIVES- AND WE WANT TO
UNDERSTAND WHAT THEY'RE
RECEIVING IN THE FORM OF
CAPITATED PAYMENTS. SAIDTHIS
IS A CRITICAL ASPECT OF THE
DATABASE AS IT GETS BUILT AND
LOOKING TO FIND WAYS TO INCLUDE
THESE DATA. IF WE GO TO THE
NEXT SLIDE. AS I MENTIONED-
THIS IS A BIG PART OF THE
CALIFORNIA PICTURE IN TERMS OF
THESE ALTERNATIVE PAYMENT
MODELS- BUT OTHER STATES HAVE
FOUND WAYS TO COLLECT THESE AND
WE NEED TO LEARN FROM THEM HOW
THEY'VE DONE IT. BUT ALSO I
WOULD AGAIN REMIND PEOPLE THAT
HERE IN THE STATE OF CALIFORNIA
THE INTEGRATED HEALTHCARE
ASSOCIATION HAS BEEN WORKING TO
DO THIS FOR YEARS AND THERE'S
MUCH TO LEARN FROM THAT
ORGANIZATION TO ENSURE THAT WE
CAPTURE THOSE DATA. SO ON TO
THE KEY ISSUES FOR THE
CALIFORNIA APCD DATA IN
ADDITION TO THESE ALTERNATIVE
PAYMENTS- IT'S ESSENTIAL THAT
WE INCLUDE THE MEDIC CAL DATA-
BECAUSE A THIRD OF CALIFORNIANS
ARE COVERED UNDER THIS
INSURANCE MECHANISM. WE ALSO
NEED TO MAKE SURE THAT WE
CONTRACT HAITIANS- WITH UNIQUE
PATIENT IDENTIFIERS BECAUSE WE
KNOW THAT THERE'S CHURNING IN
THE INSURANCE MARKET AND
PATIENTS WILL SHIFT. IN AND OUT
OF MEDICAID OR IN AN OFFICE IN
AND OUT OF THE ACT CALIFORNIA
HEALTH INSURANCE EXCHANGE. SO
IT'S A CRITICAL THAT WE FIND
WAYS TO MAKE SURE THAT WE
UNDERSTAND WHETHER. PATIENTS
ARE CONTINUOUSLY COVERED- AND
WHAT TYPES OF INSURANCE-
THEY'VE HAD OVER TIME. AT THE
OTHER- PIECE OF THIS IS HAVING
UNIQUE PROVIDER IDENTIFIERS-
THAT CAN BE MAPPED TO-
PHYSICIAN ORGANIZATIONS AND TO
HEALTH SYSTEMS. BECAUSE WE
RECOGNIZE THAT INDIVIDUAL
PROVIDERS TYPICALLY WORK IN
LARGER ORGANIZATIONS AND THOSE
LARGER ORGANIZATIONS BRING
THINGS TO THE TABLE THAT CAN
EITHER HELP IMPROVE THE QUALITY
OF CARE OR ADD COSTS. AND SO
TRYING TO UNDERSTAND THE
CONNECTEDNESS OF ALL THESE
DIFFERENT PLAYERS INTO THESE
ORGANIZATIONS WHETHER IT'S
MEDICAL GROUPS HOSPITALS OR
HEALTH SYSTEMS IS VITALLY
IMPORTANT FOR THE STATUS AT I
SHOULD ALSO NOTE THAT- WHILE
THE STATE HAS RESOURCES TO
LEVERAGE. INFORMATION COMING
OUT OF THE STATE ASIDE- IT IS
GOING TO BE VITALLY IMPORTANT
THAT THE DATA BECOME AVAILABLE
TO THE RESEARCH COMMUNITY WHO
CAN REALLY HELP CALIFORNIA
LEVERAGE THE INFORMATION OUT TO
ADDRESS THE CRITICAL QUESTIONS
THAT ARE BEING ASKED ABOUT. HOW
DO WE TRY TO IMPROVE THE
AFFORDABILITY OF HEALTH CARE.
SO LET ME JUST CLOSE OUT- IF WE
GO TO SLIDE TWENTY TWO SO AS I
MENTIONED AT THE START- THE
HEALTH CARE PAYMENT DATABASE-
REVIEW COMMITTEE- TIED TO AB
EIGHTEEN TEN. MATT OVER- TWENTY
NINETEEN AND INTO EARLY TWENTY
TWENTY JUST RIGHT BEFORE THE
END OF- ARE THE START OF CODED.
THIS GROUP WAS A MULTI
STAKEHOLDER GROUPS THAT MADE
THIRTY SIX UNANIMOUS
RECOMMENDATIONS- IT WAS A
HIGHLY FUNCTIONING GROUP
WORKING WITH- YOU KNOW REALLY
TALENTED PEOPLE OVER IT ALL SHE
COULD. TO COME UP WITH THE
BASIC STRUCTURE OF THE PLAN FOR
MOVING FORWARD. AND THIS
INFORMATION WAS- PULL TOGETHER
IN A LEGISLATIVE REPORT THAT
WAS SUPPLIED TO THE LEGISLATURE
IN JULY. OF TWENTY TWENTY. I'M
NOW WE MOVE ON TO THE LAST
SLIDE. WE ARE NOW IN THE NEXT
PHASE- ANDTHERE IS A PROGRAM
ADVISORY COMMITTEE AGAIN FULL
DISCLOSURE- I AM ON THAT
COMMITTEE- THIS IS ONCE AGAIN A
MULTI STAKEHOLDER GROUP THAT
REPRESENTS CONSUMERS PROVIDERS
PURCHASERS INSURERS ORGANIZED
LABOR- THE HEALTH CARE SERVICE
PLANS THE SELF INSURED PLANS-
AS WELL AS THE RESEARCH
COMMUNITY. AND THIS GROUP OF
PEOPLE ARE REALLY COMMITTED TO
MAKING SURE THAT THIS IS THE
SIXTH SUCCESSFUL ENDEAVOR AND
THAT IT DELIVERS ON THE PROMISE
OF PROVIDING INFORMATION THAT
CAN HELP BUILD POLICY
SOLUTIONS. AND THIS GROUP IS
WORKING WITH OFSTED TO ADVISE
THEM- IN THE DEVELOPMENT AND
IMPLEMENTATION OF THIS PROGRAM
BECAUSE AS I THINK YOU CAN
APPRECIATE THERE ARE MANY
DECISIONS- ALONG THIS PATH TO
IMPLEMENTATION- AND HAVING THIS
BROAD REPRESENTATION- IT IS
IMPORTANT FOR ENSURING THAT.
ALL STAKEHOLDER VOICES ARE
HEARD- AND CONSIDERED IN THIS
PROCESS- AND THAT WE CAN WORK
TO BUILD A REALLY STRONG
RESOURCES THAT WILL BE USEFUL
NOT ONLY TO THE STATE OF
CALIFORNIA- BUT ALL OF THE
STAKEHOLDERS WHO REALLY KIND OF
MAKE THE CALIFORNIA. ENGINE
WORK. SO WITH THAT I WILL CLOSE
AND I'M HAPPY TO TAKE QUESTIONS.
THANK YOU- WE'D LIKE TO GO
THROUGH THE ENTIRE PANEL AND
COME BACK TO YOU IF THAT'S IF
THAT'S OKAY NOW THAT I KNOW
YOU'RE- YOUR- MIGHT KEEP YOU
AROUND FOR AWHILE BUT- I THINK
IT IF IT WILL HELP US TO FRAME
OR FRAME OUR THOUGHTS AROUND
THAT BUT I WANT TO THANK YOU
VERY MUCH- THIS PROJECT NEAR
AND DEAR TO MY HEART. IN OFFICE
ENGINE WITH DISCLOSURE THERE IS
I THINK THAT THE VALUE OF THE
DATA IS REALLY REALLY CRITICAL
TO US BEING ABLE TO GET TO A
POINT WHERE WE CAN REALLY
UNDERSTAND HOW WE'RE SPENDING
MONEY AND WHAT WE'RE GETTING
FOR IT QUITE FRANKLY SO THANK
YOU FOR YOUR WORK ON THAT MUCH
APPRECIATED IN YOUR FUTURE WORK
AS WELL. I HOPE THAT FIRST
MEETING WENT WELL LAST WEEK
AND- AND- LOOK FORWARD TO THE
PROGRESS ON THE SOUTH THANK YOU
SO MUCH THINKPROGRESS. THANK
YOU THANK YOU SO MUCH WE'RE
GONNA MOVE ON TO. MICHAEL
MICHAEL VAL OR VAL VALET BY IT
MIGHT YOU CAN CORRECT ME
MICHAEL HERE IN THE CAPITAL
SOMEWHERE. MICHAEL IS OUR CHIEF
INFORMATION OFFICER AND DEPUTY
DIRECTOR FOR INFORMATION
SERVICES. AFTER THE CALIFORNIA
OFFICE OF STATEWIDE HEALTH
PLANNING AND DEVELOPMENT THAT'S
POSH BED. AND HE'S GONNA BE
SPEAKING ON TO PA TO TWO TOPICS
ONE ON THE HEALTH PAYMENTS
DATABASE SYSTEM AS AN UPDATE.
AND ALSO HEALTH FACILITIES DATA
SO MICHAEL ARE YOU OUT THERE. I
AM A GOOD AFTERNOON- MISTER
CHAIR AND MEMBERS CAN YOU HEAR
ME OK WE CAN THANK YOU WE CAN
SEEWONDERFUL. WONDERFUL THAT'S
GREAT AND ALSO WITH ME IS- ERIC
REDLOCK ACTING CHIEF DEPUTY
DIRECTOR. OF A LOT OF SPEED- AS
MENTIONED ALL PLAN TO BEGIN
WITH THE MY PREPARED REMARKS
RELATED TO THIS HEALTHCARE.
STATED UP TO. US SO WE CAN
ADVANCE TO SLIDE TO. THANK YOU.
OFFICE IS ON AND MAKING
PROGRESS TO SUBSTANTIALLY
COMPLETE THE HEALTHCARE
PAYMENTS DATABASE OR H. B. D.
CALIFORNIA'S ALL PAYER CLAIMS
DATABASE BY JULY ONE TWENTY
TWENTY THREE AS AS MENTIONED BY
DR GAMBHIR GOT THAT SUBMITTED
REPORT TO LEGISLATURE THAT
INCLUDED THIRTY SIX UNANIMOUSLY
RATIFIED STAKEHOLDER
RECOMMENDATIONS FOR HOW TO
DESIGN AND IMPLEMENT H. P.
PROGRAM- INCLUDING PROPOSED
ADDITIONAL ENABLING LEGISLATION
NEEDED TO AUTHORIZE OPTED TO
DEVELOP THE DATABASE I WANT TO
THANK OUR DOCTOR WOULD AND
COMMITTEE ON HEALTH MEMBERS AND
YOUR STAFF FOR YOUR HELP ON
DEVELOPING THE TRAILER BILL
ASSEMBLY BILL EIGHTY. WHICH
ASSIGNED ALOHA JUNE THIRTIETH
AND PROVIDED THE ADDITIONAL
ENABLING LEGISLATION THAT
EXTENDED THE AUTHORITY
PROSTITUTED WOMEN OF AGE PT AS
MENTIONED I JUST THIS PAST
THURSDAY OFF COULD CONVENE THE
FIRST MEETING OF THE NEW
ADVISORY COMMITTEE OF
STAKEHOLDERS THAT BUYS OFF ON
ONGOING PROGRAM THE
ADMINISTRATION AND WE'RE VERY
APPRECIATIVE OF THE COLLECTIVE
EXPERIENCE AND EXPERTISE THE
MEMBERS INCLUDING DR DAMPER
THAT AGREED TO SERVE. ON THIS
IMPORTANT STAKEHOLDER COMMITTEE.
IT IS ALSO MADE. ON SOME OF
IMPORT EMPLOYMENT ACTIVITIES
HOSPITALS THE FIRST TWO STAGES
OF THE CALIFORNIA DEPARTMENT OF
TECHNOLOGY IT PROJECT APPROVAL
LIFECYCLE AND WE'RE WORKING
WITH COLLEAGUES AT TECHNOLOGY
TO COMPLETE THE FINAL TWO
STAGES TO AUTHORIZE DEVELOPMENT
OF THE IT SYSTEM. OFFICE
WORKING CLOSELY WITH THE
DEPARTMENT OF HEALTH CARE
SERVICES TO PREPARE A REQUEST
FOR FEDERAL MEDICAID MATCHING
FUND REIMBURSEMENT. TO COVER A
PORTION OF HPD SYSTEM COST. AN
AUSPICIOUS BEGIN THE PROCESS TO
REQUEST AND OBTAIN A RESEARCH
DATASET FROM THE FEDERAL
CENTERS FOR MEDICARE AND
MEDICAID SERVICES TO ACQUIRE
THE MEDICARE FEE FOR SERVICE
DATA. FOR THE SYSTEM. IT ALSO
HAS SOME IMPORTANT AHEAD. IN
TWENTY TWENTY ONE HOSPITAL
BEGIN CONTRACTING FOR THE
DATABASE TECHNOLOGY
INFRASTRUCTURE. AUSTIN ALSO
PROMULGATE EMERGENCY
REGULATIONS FOR DATA COLLECTION
THAT WILL REGULATE MANDATORY
DATA SUBMITTERS AND WHICH WILL
BE EFFECTIVE BY DECEMBER THIRTY
FIRST TWENTY TWENTY ONE. AFTER
THE GUN THE RESEARCH AND
ANALYSIS TO SUPPORT REGULATIONS
DEVELOPMENT AND IS WORKING WITH
STAKEHOLDERS. THE REGULATIONS
WILL INCLUDE THE DATA CONTENT
AND FILE FORMAT. PLAN SIMILAR
SIZE THRESHOLDS THE
COORDINATION OF DATA SUBMISSION
THE REQUIRED LINES OF BUSINESS
PATIENT AND PROVIDER
IDENTIFIERS AND THE FREQUENCY
OF DATA SUBMISSION. THE
REGULATIONS WILL ALSO INCLUDE
DATA QUALITY. AND IMPROVEMENT
PROCESSES. I'M EXPECTS TO BEGIN
INITIAL DATA COLLECTION FROM
GOVERNMENT ENTITIES IN TWENTY
TWENTY ONE. AND OVER AGAIN
COLLECTION FROM COMMERCIAL
HEALTH PLANS HEALTH INSURERS
AND PUBLIC SELF INSURED PLANS
IN TWENTY TWENTY TO. OBSTACLE
PERFORM DATA QUALITY AND
EVALUATION ACTIVITIES AS IT
RECEIVES ITS DATA. BY MARCH
FIRST TWENTY TWENTY THREE
OFFICE WILL SUBMIT A REPORT TO
THE LEDGE LEGISLATURE WITH
FUNDING OPTIONS TO SUPPORT THE
ONGOING OPERATIONS AT THE AGE
OF THE SYSTEM. BY MARCH FIRST
TWENTY TWENTY FOUR POSSIBLE
SUBMIT A REPORT LEGISLATION
THAT INCLUDES THE COVERAGE OF
THE DATA REPORTED BY BOTH
MANDATORY AND VOLUNTARY
SUBMITTERS. AND BY JULY FIRST
TWENTY TWENTY FOUR THE
STAKEHOLDER ADVISORY COMMITTEE
WILL MAKE RECOMMENDATIONS TO
AUSTIN ON HOW EXISTING STATE
PUBLIC HEALTH DATA FUNCTIONS
MAY BE INTEGRATED INTO THE
SYSTEM. AFTER THE DATABASE IS
COMPLETELY OFF IT WILL DEVELOP
AND IT'S AN ANNUAL ANALYSIS
FROM THE DATA. OFTEN LOOKS
FORWARD TO WORKING WITH ALL
STAKEHOLDERS TO SUCCESSFULLY
IMPLEMENT H. P. SYSTEM AND
BEGIN DEVELOPING ANALYTICAL
REPORTS THAT CAN SUPPORT PUBLIC
POLICY DECISIONS. FOR
HEALTHCARE AFFORDABILITY COST
CONTAINMENT- HEALTH DISPARITIES
AND MORE. THE INTENT IS FOR THE
DATA TO BE USED BY STATE
AGENCIES RESEARCHERS HEALTHCARE
ENTITIES AND OTHERS. THE DATA
SHOULD BE USED TO PROVIDE A
PUBLIC BENEFIT FOR CALIFORNIANS
FOR TRANSPARENCY AND SUPPORT
INNOVATIVE APPROACHES THAT CAN
IMPROVE THE DELIVERY OF CARE.
POSSIBLE DEVELOP POLICIES AND
PROCEDURES TO ENSURE THE
PRIVACY SECURITY AND
CONFIDENTIALITY OF CONSUMERS
INDIVIDUALLY IDENTIFIABLE
HEALTH INFORMATION AS PROTECTED.
THAT MY PREPARED REMARKS FOR
THE H. P. UPDATE- I'M HAPPY TO
MOVE TO THE SUMMARY OVERVIEW OF
AUSTIN FACILITY LEVEL DATA
REPORTING THAT BE GREAT THANK
YOU PLEASE GO AHEAD. RIGHT I AM
PLEASED THAT ENHANCE A SLIGHT
SLIGHT THREE THANK YOU SO MUCH-
AS DEMONSTRATED IN. THE
PRESENTATIONS TODAY OFTEN HAS A
LONG HISTORY OF SERVING AS A
CENTRAL CLEARINGHOUSE FOR
HEALTHCARE DATA COLLECTION
TRANSPARENCY AND PUBLIC
REPORTING. ARTICLE IT'S
HEALTHCARE DATA FROM THOUSANDS
OF HEALTHCARE FACILITIES
LICENSED BY THE DEPARTMENT OF
PUBLIC HEALTH. AND OFTEN MAKES
DATA AVAILABLE TO THE PUBLIC
RESEARCHERS POLICY MAKERS THE
MEDIA. ANDOTHERS. IT ALSO
PRODUCES ANALYSES AND REPORTS
ON HEALTHCARE OUTCOMES QUALITY
COSTS AND OTHER RELATED HEALTH
TOPICS. WE HAVE SEVERAL
DIFFERENT FACILITY LEVEL DATA
REPORTING PROGRAMS. THE PATIENT
UTILIZATION DATA REPORTING
PROGRAM INCLUDES INPATIENT
DISCHARGES. EMERGENCY
DEPARTMENT VISITS ENABLE
TOWARDS SURGERY VISITS. ALL
CALIFORNIA LICENSE HOSPITALS
EXCLUDING STATE HOSPITALS ARE
QUITE AFFORD THESE DATA ALONG
WITH THE TABLE TOWARDS SURGERY
CENTERS. THE IN PATIENT DATA
CALLED BEGAN IN NINETEEN EIGHTY
THREE AND THE REPORTING OF
EMERGENCY DEPARTMENT ENABLE
TOWARDS SURGERY DATA BEGAN IN
TWO THOUSAND FIVE. ON A SEMI
ANNUAL BASIS FOR INPATIENT
DISCHARGES AND QUARTERLY FOR
THE OTHER PROGRAMS FACILITY
SUBMIT ABSTRACTED
ADMINISTRATIVE DATA FROM
INDIVIDUAL PATIENT RECORDS
WHICH INCLUDE DATA ON A
PATIENT'S ZIP CODE. RICINUS
CITY SEX BIRTH DATE PREFERRED
LANGUAGE DIAGNOSES TREATMENTS
AND PROCEDURES. AS WELL AS THE
TOTAL CHARGES EXPECTED SOURCE
OF PAYMENT. IN TWO THOUSAND
NINETEEN CLICK TO THREE POINT
EIGHT MILLION INPATIENT
DISCHARGES FORM FROM FOUR
HUNDRED FORTY FIVE HOSPITALS.
TWELVE POINT EIGHT MILLION
EMERGENCY DEPARTMENT VISITS.
FROM THREE HUNDRED FIFTEEN
HOSPITALS WITH EMERGENCY
DEPARTMENTS AND TWO POINT ONE
MILLION AMATORY SURGERY VISITS
FROM THREE HUNDRED FIFTY.
HOSPITALS A DIFFICULT TO
APPROXIMATELY NINETY FOUR
THOUSAND AMATORY SURGERY VISITS
FROM FREESTANDING AMATORY
SURGERY CENTER. TO PROTECT THE
INDIVIDUAL PATIENT
CONFIDENTIALITY ANY REPORTING A
RECORD LEVEL DATA IS AGGREGATED
AND DE IDENTIFIED. RECORD LEVEL
DATA IS ALSO AVAILABLE FOR
QUALIFIED ENTITIES SUCH AS
CALIFORNIA LICENSE HOSPITALS
AND LOCAL HEALTH DEPARTMENTS
THE DEPARTMENT PUBLIC HEALTH
DEPARTMENT OF HEALTH CARE
SERVICES. AND QUALIFIED
RESEARCH ENTITIES. THESE DATA
ARE USED TO UNDERSTAND
HEALTHCARE VOLUME UTILIZATION
AND OUTCOMES ACROSS CALIFORNIA.
CALIFORNIA HOSPITALS AND OTHERS
USE THESE DATA TO BETTER
UNDERSTAND POSSIBLE MARKET
SHARE THE CASE MIX WITHIN THE
HOSPITAL MARKET AND SURROUNDING
MARKETS. AND SERVICE BY
MINERALIZATION BY EXPECTED
SOURCE OF PAYMENT SENT TO
NEIGHBORING FACILITIES. IT ALSO
PRODUCES ONLINE VISUALISATIONS
AND REPORTS THAT DISPLAY THIS
INFORMATION TO THE PUBLIC. THE
AWKWARD COLLECTS IMAGERY
SURGERY VISITS FOR AMBULATORY
SURGERY ENCOUNTERS IN THE
HOSPITAL SETTING MANY
FREESTANDING AMATORY SURGERY
CENTERS OPERATE UNDER POSITIONS
MEDICAL LICENSE BROTHER
HOSPITALIZED SINCE THERE FOR
THOSE SURGERY CENTERS ARE NOT
REQUIRED TO REPORT IT TO US BUT-
TWO OTHER PATIENT LEVEL DATA
REPORTING PROGRAMS ARE THE
CORONARY. ARTERY BYPASS GRAFT
SURGERY OR CABBAGE AND ELECTIVE
PERCUTANEOUS CORONARY
INTERVENTION OR PCI PROGRAMS.
BOTH PROGRAMS BY ANNUAL
PERFORMANCE REPORTS OF THE
HOSPITAL AND A CERTAIN LEVEL BI
ANNUALLY FOR CASH. THE MOST
RECENT CABINET REPORTS INCLUDED
RATINGS FOR ONE HUNDRED TWENTY
FOUR HOSPITALS AND TWO HUNDRED
EIGHTY THREE SERVICE. MOST
RECENT ELECTIVE PCI REPORT
INCLUDED RATINGS FOR ELEVEN
HOSPITALS CERTIFIED BY THE
DEPARTMENT PUBLIC HEALTH TO
PERFORM THE PROCEDURE WITHOUT
ON SITE FOR TO GO BACK. AND ADD
CITY PH CONTINUES TO CERTIFY
NEW HOSPITALS REPORTS WILL
REFLECT THIS GROWTH. THE
PRIMARY COMPONENTS MEASURES ON
WHICH OFTEN REPORTS OUR
MENTALITY STROKE. AND EMERGENCY
CABBAGE FOR THE ELECTIVE PCI
PROGRAM. ADDITIONALLY THESE
DATA ARE USED TO UNDERSTAND
TRENDS IN UTILIZATION INCLUDING
THE IMPACT OF NEWLY EMERGENT
CARDIAC PROCEDURES SUCH AS
TAVR. AND ASSOCIATIONS BETWEEN
PROCEDURAL. AND PATIENT
OUTCOMES. XIN OUTCOME BY
EXPECTED PAYER TYPE AND- IN
OUTCOMES BY THE TOTAL OF CARE.
OR CAPTURED. THE PLACE THE
ADVANCED LIFE. THANK YOU. BUT
ALSO BECAUSE FINE AND YOU DATA
FROM HEALTHCARE FACILITIES ALL
LICENSE COPY HOSPITAL AND LONG
TERM CARE FACILITIES ARE
REQUIRED TO SUBMIT ANNUAL
FINANCIAL REPORTS ALSO IT'LL
ALSO SUBMIT QUARTERLY FINANCIAL
REPORTS THE ANNUAL PORTS ARE
MORE DETAILED AND REQUIRED
REPORTED WITHIN SEVEN MONTHS
FOLLOWING THE CONCLUSION OF
FACILITIES FISCAL YEAR.
ADDITIONALLY THOSE FACILITIES
MUST ALSO SUBMIT AN ANNUAL
UTILIZATION REPORT OFFICE.
EVERY FEBRUARY FIFTEENTH FOR
THE PRIOR CALENDAR YEARS DATA.
FOR TWENTY NINETEEN AUSTIN
COLLECTED OVER EIGHTEEN HUNDRED
DETAILED FINANCIAL REPORTS NOT
COLLECTING THESE REPORTS FROM
HOSPITAL SINCE NINETEEN SEVENTY
FIVE. EXAMPLES OF INFORMATION
COLLECTED INCLUDE TYPE OF
OWNERSHIP MEDICAL STAFF
SPECIALTIES HOSPITAL SERVICES
NUMBER OF BIDS UTILIZATION DATA
BY PAYER BALANCE SHEETS AND
STATEMENTS OF CHANGES IN EQUITY
INCOME STATEMENTS STATEMENTS OF
CAPELO REVENUES BY PAYER AND
COST ALLOCATION CALCULATIONS.
THE DATA ARE USED BY A NUMBER
OF DIFFERENT GROUPS. TO
UNDERSTAND SAUDI PAYER MIX.
UTILIZATION BY PATIENT DAYS.
REVENUE CHARITY CARE AND OTHER
FINANCIAL MARGINS FOR THE
PURPOSES OF HEALTHCARE
ADMINISTRATION AND POLICY
MAKING ADDITIONALLY THE LONG
TERM CARE IN A REPORT ALSO
SERVES AS THE MEDICARE COST
REPORT AND THAT DATA SHARED
WITH UPS TO ESTABLISH FACILITY
SPECIFIC MEDICARE REIMBURSEMENT
RATES. ALL OF THIS INFORMATION
IS PUBLICLY AVAILABLE AND HELPS
HEALTHCARE ADMINISTRATORS AND
POLICYMAKERS UNDERSTAND
HOSPITAL AND LONG TERM CARE
MARKET IN CALIFORNIA. THE PANTS
TO SLIDE. FIVE CAN FINALLY
ACOSTA COLLECTS HOSPITAL CHARGE
MASTERS FAIR PRICING POLICIES
AND COMMUNITY BENEFIT PLANS
EACH HOSPITAL IS ANY OF THE
REQUIRED TO SUBMIT A COPY OF
ITS CHARGEMASTER A LIST OF
AVERAGE CHARGES FOR TWENTY FIVE
COMMON OUTPATIENT PROCEDURES
AND THE ESTIMATED PERCENTAGE
CHANGE IN GROSS REVENUE DUE TO
PRICE CHANGES. THE HOSPITAL
CHARGE MASTERS OR THE LIST
PRICE FOR HEALTH CARE SERVICES
AND SUPPLIES. SOME HEALTHCARE
SERVICE ENTITIES USE THE
CHARGEMASTER AS A BASELINE FOR
SETTING REIMBURSEMENT RATES AND
ALLOWED AMOUNTS. OTHER
INTERESTED PARTIES SUCH AS
CONSUMER ADVOCATES AND HEALTH
CARE PURCHASERS USE THE
CHARGEMASTER TO UNDERSTAND
VARIATION IN CHARGES BY
FACILITY. AUSTIN ALSO COLLECTS
FAIR PRICING POLICIES FROM
HOSPITALS. HOSPITALS RECORDED
LIKE EACH HOSPITAL FROM THE
HOSPITAL CHECK A COPY OF ITS
CHARITY CARE POLICY. DISCOUNT
PAYMENT POLICY. ELIGIBILITY
PROCEDURES FOR THOSE POLICIES
THE REVIEW PROCESS AND THE
APPLICATION FORM THE PURPOSE OF
THIS PROGRAM IS TO MAKE THIS
INFORMATION AVAILABLE FOR
PUBLIC TRANSPARENCY. AND
FINALLY THE HOSPITAL COMMUNITY
COMMUNITY BENEFIT PLANS ARE
ANOTHER REPORT REQUIRED TO BE
SUBMITTED TO IT. EACH NON WORLD
PRIVATE NONPROFIT HOSPITALS
REQUIRED TO CONDUCT COMMUNITY
NEEDS ASSESSMENT EVERY THREE
YEARS AND TO ANNUALLY SUBMIT
IT'S COMMUNITY BENEFIT PLAN TO
OFFICE. REPORTS INCLUDE WAYS
HOSPITALS ARE ADDRESSING
PRIORITY HEALTH NEEDS IN
COLLABORATION WITH THE
COMMUNITY. IN TWO THOUSAND
NINETEEN TWO HUNDRED TWENTY
HOSPITAL SUBMITTED PLANS TO
WATCH BUT- PREVIOUSLY THERE WAS
NO STANDARDIZED CALCULATION OF
THE ECONOMIC VALUE OR
STANDARDIZED REPORTING A
DEFINED CATEGORIES OF COMMUNITY
BENEFITS. THIS RESULTED IN
DIFFICULTY COMPARING WHAT
DIFFERENT HOSPITAL SPEND OR
SUMMARIZING WHAT IT'S BEEN
OVERALL FOR CERTAIN TYPES OF
COMMUNITY BENEFITS. INTO THE.
FOUR AUTHORED BY CHAIRMAN WOULD
WHICH REQUIRES PRODUCT NON
NONPROFIT ACUTE CARE HOSPITALS
FOLLOW SPECIFIED METHODOLOGY
VALUING CARE IF TO THEIR
COMMUNITIES. OVER THAT AMOUNT
TO BE. WITH CHAIRED COSTS AS
FOR A DOCTOR. THE FIRST
COMMUNITIES BENEFIT REPORTS
WITH AB TWO CORK ARE BEING
COLLECTED NOW I ALSO. FOLLOWING
EACH HOSPITALS TO TWENTY YEAR
END. ALL TWENTY BETTER REPORTS
WILL BE MADE PUBLIC. IN. TWENTY
TWENTY. SUMMARY OF THE OFF
CLOSED. DATA HEALTHCARE
PAYMENTS DATA WILL FILL GAPS
THE CARE CONTINUUM. WITH MORE
DETAIL DATE. INCLUDING THE
ACTUAL. REMARKS THANK YOU VERY
MUCH- MUCH APPRECIATED AND-
LOOK FORWARD TO THE INFORMATION
AS IT COMES FORWARD IN THE
PROGRESS AND CONTINUED PROGRESS
ON THE ON THE DATABASE SO THANK
YOU VERY MUCH APPRECIATED GONNA
MOVE ONTO OUR NEXT PANELIST-
MARRYING A WATANABE- THE ACTING
DIRECTOR OF THE DEPARTMENT OF
MANAGED HEALTH CARE AND I
BELIEVE SHE'S GOING TO BE
JOINING US BY PHONE SO. MARY IF
YOU'RE OUT THERE PLEASE. GO
AHEAD. GOOD AFTERNOON CAN YOU
HEAR ME OK YES. GREAT OKAY- SO
I AGAIN I'M VERY WATCH LOBBY ON
THE ACTING DIRECTOR OF THE
CALIFORNIA DEPARTMENT OF
MANAGED HEALTH CARE I AM JOINED
BY IT'S PRETTY GOOD THAT OUR
DEPUTY DIRECTOR OF OUR IOP WITH
THE FINANCIAL RUBIO. BOB DID
YOU MAKE THE MISSION IS TO
PROTECT CONSUMERS HEALTH CARE
RIGHT SINCE YOU'RE A STABLE
HEALTHCARE DELIVERY SYSTEM FOR
THE STATE AGENCY RESPONSIBLE
FOR LICENSING AND REGULATING A
HUNDRED AND THIRTY ONE HEALTH
CARE SERVICE PLANS THAT PROVIDE
HEALTH COVERAGE TO MORE THAN.
TWENTY SIX MILLION CONSUMERS IN
CALIFORNIA. WE REGULATE MORE
THAN 96% OF THE COMMERCIAL AND
GOVERNMENT HEALTH PLAN
ENROLLMENT IN THE STATE. WERE
INVITED HERE TODAY TO PROVIDE
INFORMATION REGARDING OUR
REPEAL HEALTH PLAN PREMIUM-
AND- ALSO TALKED BRIEFLY ABOUT
THE IMPACT OF PRESCRIPTION DRUG
COSTS IN HEALTH CARE PREMIUMS.
I'LL START WITH THE GENERAL
OUTLINE OF THE THREE MAJOR
CATEGORIES OF GREAT INFORMATION
THAT WE COLLECT. THE FIRST IS A
GREAT PILING FOR HEALTH PLANS
SUBMIT THE RATES THEY INTEND TO
CHARGE FOR THEIR SPECIFIC
PRODUCT. FOR HEALTH PLAN
PRODUCTS OFFERED IN THE
INDIVIDUAL AND SMALL GROUP
MARKETS WE RECEIVE RATE FILINGS
AT LEAST A HUNDRED TWENTY DAYS
PRIOR TO THE HELP ON
IMPLEMENTING A GREAT CHANGE.
THESE FILINGS INCLUDE THE
FINANCIAL DATA THE PLAN TO USE
TO DETERMINE JUST BY THEIR
PROPOSED STRAIGHT. ALL OF WHICH
IS REVIEWED BY THE DEPARTMENT.
BUT A LARGE GROUP MARKET WE
COLLECT SPECIFIC RATE FOR EACH
OF THE HEALTH PLANS MARCH WERE.
BUT RATHER WE COLLECT THE
METHODOLOGY FACTORS AND
ASSUMPTIONS THE PLANT YOU CAN
DEVELOP AT THE RATE. OF ALSO
WERE COLLECTED ANNUALLY AND HAD
AND ONE HUNDRED TWENTY DAYS
BEFORE THE PLANNED EMPLOYMENT
CHANGE. THE SECOND CATEGORY IS
AGGREGATED DATA WHAT IS DATA
THAT IS AVERAGED ACROSS PRODUCT
OR GROUP. HEALTH PLANS OFFERING
PRODUCTS IN A LARGE GROUP
MARKET ARE. ALSO REQUIRED TO
SUBMIT THEIR AGGREGATE RATE
INFORMATION AND LIKE TO THE
DELIGHT. THE STARTING OCTOBER
FOR OF TWO TWO ONE HEALTH PLAN
OF THE IN. AND SMALL MARK FOR
ALL BE REQUIRED TO LET YOU KNOW
I COULD GET RID OF. TO
DEPARTMENT. AND ALLOW CATEGORY
OF PRE RELATED DATA WEEK.
PRESCRIPTION DRUG COSTS ENOUGH
COMMERCIAL HEALTH PLANS. WHICH
IS RECORDED ANNUALLY AS
REQUIRED BY SB SEVENTEEN WHICH
WOULD ACT ENACTED IN TWENTY
SEVENTEEN. NOW WILL PROVIDE
MORE DETAIL- REVIEW OF EACH OF
THESE CATEGORIES STARTING WITH
OUR RATE REVIEW PROGRAM. WHAT
DO YOU MAKE A GREAT REVIEW
PROGRAM IS AN IMPORTANT
COMPONENT OF OUR OVERSIGHT OF
HEALTH PLAN FINANCES THIS
OVERSIGHT NOT ONLY ENSURES THAT
HEALTH PLAN BURKE FINANCIALLY
SOLVENT BUT ALSO MONITORS HOW
THEIR EXPENSES RELATE TO THE
AMOUNT THEY CHARGE CONSUMERS A
PREMIUM. AND THOUSAND AND TEN
THE AFFORD CARE ACT REQUIRED
STATES TO ESTABLISH A PROCESS
FOR THE REVIEW OF HEALTH
INSURANCE PREMIUMS TO PROTECT
CONSUMERS. FROM UNREASONABLE
RATE INCREASES. IN RESPONSE TO
THE ACA RATE REVIEW PROGRAM
CALIFORNIA PASSED SENATE BILL
S. B. ELEVEN SIXTY THREE. WHICH
REQUIRES HEALTH PLANS TO SUBMIT
PREMIUM RATE INFORMATION AND
REQUIRES THE DMH BE TO REVIEW
THESE BREAK BY LEADS AND
DETERMINE IF ANY PROPOSED RATE
INCREASE THAT ARE FOUND TO BE
ANGRY. ALL HELLO PLAN TO
REQUIRE TO FOR THE THEIR RATE
CHANGE WITH THE MAKES THE A
HUNDRED DAYS PRIOR TO
IMPLEMENTING A RATE CHANGE WITH
INDIVIDUAL MARKET. PRODUCT THE
DEPARTMENT REVIEWS PROPOSED
PREMIUM RATE CHANGES AND THE
SUPPORTING DATA INCLUDING
UNDERLYING MEDICAL COST TRENDS.
AND THE INFORMATION USED IN THE
DEVELOPMENT OF THE RATES TO
DETERMINE IF PROPOSED RATE
CHANGES ARE UNREASONABLE OR
OBJECTIFIED. YEAH THE HEALTH
PLAN PROVIDES DATA AND
INFORMATION SUPPORTING THE RATE
OF FILING A CLOSE TO COMPLETE.
IT THE RATE IS NOT SUPPORTED ON
HEALTH PLAN REFUSES TO ADJUST
REACHED THE DM MAKES THE FIND
THE FILING AND REASONABLE. IN
THAT SITUATION THE HEALTH PLAN
MUST NOTIFY MEMBERS OF THE
OTHER REASONABLE. FIGHT DURING
THE REGULAR PROCESS THE MAKES
QUESTION PLAN AND WHETHER PER.
AND NEGOTIATE WITH ON THE-
DURING IN ORDER TO AVOID
ANDREAS FINE. TWO THOUSAND
ELEVEN THE DAMAGE PREMIUM RATE
REVIEW BOB PROGRAM HAS
CONNECTED TO AND SIX MILLION.
AT THE END OF IT MARKET MARKET.
NOW MOVING ON TO A AVERAGE RATE
READ INTO THAT WE RECEIVE.
UNDER IN THE INTERNET AND SMALL
GROUP RATE REVIEW PROGRAM DO
YOU MAKE SHE DOES NOT REVIEW
EVERY SPECIFIC CONTRACT HOLDER
RIGHT THE LARGE GROUP MARKET.
SB FIVE FORTY SIX WHICH WAS
ACTED TWENTY FIFTY FIFTEEN
INITIATED LARGE GROUP AGGREGATE
REPORTING. BUT DO YOU MAKE THE
BEGAN COLLECTING LOT OF VARIETY
OF AGGREGATED DATA A LARGE
GROUP PREMIUMS IN TWENTY
SIXTEEN. AND PRESENTED THE DATA
AT ITS FIRST PUBLIC MEETING ON
MARCH GROUP AGGREGATE RATE TO
TWENTY SEVENTEEN. WE HAD OUR
FOURTH MEETING EARLIER THIS
YEAR PRIOR TO THE PANDEMIC
STRUCK. THE PUBLIC MEETINGS ARE
ACCOMPANIED BY A REPORT SHOWING
THE LARGE GROUP RATE DATA
BROKEN DOWN THE ROAD FOR IDEA
OF WAYS THAT SHOWING EUROPE FOR
YOUR TRIP. AMONG THE DATA GROUP
REPORTER PLANTS THE GREAT
INFORMATION BRING IN FIVE BY
VARIOUS INVOLVEMENT GROUP
MEDICAL EXPENSIVE. EXPENSIVE
AND IT'S MINISTRY TO COST AS A
PERCENTAGE OF THE PREMIUM. AND
DATA BY DIFFERENT BREEDING
METHODS USED TO MARCH FOR
COVERAGE. OBSERVATIONS FROM THE
STATE OVER THE PAST FEW YEARS
INCLUDES THAT THERE IS FAR LESS
VARIATION IN RATE CHANGES
ACROSS THE LARGE GROUP MARKET.
THAN IN THE INDIVIDUAL MARKET.
OVER 90% OF THE LARGE GROUP IN
RALEIGH THIRTY COVERAGE WITH AN
ACTUARIAL VALUE OF 80% OR
HIGHER. WHICH MEANS THAT ON
AVERAGE THE HEALTH PLAN COVERS.
80% OF HEALTHCARE COSTS. THE
PUBLIC MEETINGS HAVE ALSO
SERVED THE USE FOR A FOR PA
COMMENT CAN. AB GROUP OTHER.
FOR THE DAY AND DO YOU HAVE
BEEN TO RECEIVE BACK IN. FROM
AND I'LL BE OF THE IT'S A GROUP.
SLASH YEAR THE LEGISLATURE AB
SEVENTY ONE NUMBER. THE HELP
OPERATE CONTRACT CALLED IN A
LARGE GROUP MARK TO FILE
SPECIFIED BREAK INTO. BUT DO
YOU MAKE BEGAN YELLING. AT AT
LEAST A HUNDRED DAYS BEFORE IT.
A RATE CHANGE. THE DMA IT WILL
DETERMINE WHETHER THE METHOD.
FACTORS IN SOME. USED DEVELOP A
NEW THREE ARE. OR NOT JUST A-
IN THE GROUP MARKET GROUP WORKS
THE HELP FOR TO BUY GREAT AND
IN TWENTY NINE THERE ARE THIRTY
DOLLARS SIX RENO BURKE. CALGARY
OVERSTEP AND A HALF MILLION AND-
SO IT INDIVIDUAL. A REVIEW OF
THE RATE FOR EACH CONTRA WOULD
BE IN. REVIEWING THE
METHODOLOGY FACTOR IN AT SOME
YOU BY THESE THE BILL IN THE
RIGHT OF THE BENEFIT TO ALL
LARGE COUNTRY HOLDERS BECAUSE
THAT WE GIVE THEM PREVIOUS
UNAVAILABLE. THAT THE MATH OF
THE PLAN FOR YOU THEN THE RATES
ARE REASONABLE. ADDITIONALLY
JULY FIRST OF NEXT YEAR TWENTY
TWENTY ONE A LARGE GROUP
CONTRACT HOLDER THAT HAS
EXPERIENCE RATED A BLENDED
COVERAGE AND MEET SPECIFIED
CRITERIA CAN APPLY TO THE DM
MAKES THE WITHIN SIXTY DAYS OF
RECEIVING NOTICE OF A RATE
CHANGE. ASKING US TO REVIEW A
RATE CHANGE INDETERMINATE THE
THREE UNREASONABLE ARE NOT
JUSTIFIED. AB SEVEN THIRTY ONE
REQUIRES THE DEPARTMENT TO USE
REASONABLE EFFORTS TO COMPLETE
THE REVIEW WITHIN SIXTY DAYS OF
RECEIVING ALL THE INFORMATION
REQUIRED TO MAKE A
DETERMINATION. IN ADDITION THIS
YEAR THE GOVERNOR SIGNED A B.
TWENTY ONE EIGHTEEN LITTLE
REQUIRED MUCH OF THE SAME
AGGREGATE REPORTING FOR HELP
PLANT PRODUCTS AND INDIVIDUAL
SMALL GROUP MARKET. SO IN
FUTURE YEARS THE PUBLIC
MEETINGS REPORTS WILL INCLUDE
FOR MORE AGGREGATED DATA
TRANSFER SMALL INDIVIDUAL
MARKET. WE CAN ALL. NOW I'D
LIKE TO END UP MY REMARK BUT
THAT CAT. WERE THE- OF OUR ROLE
IN. ANOTHER BRIEF IN OUR AND-
LAW AT SEVENTEEN. SB SEVENTEEN
TRYING TO LAW IN TWENTY FIVE.
WITH THE GOAL INCREASING TREND.
AND PER THE- WITH. ABOUT THE-
OF PRESCRIPTION DRUG COSTS ON
HEALTHCARE. SB REQUIRES HEALTH
PLANS THAT FALL RATE
INFORMATION WITH THE D. IT
MAKES THE ANNUAL REPORT WITH
THE FEC DATA RELATED TO THE
COST OF COVERED PRESCRIPTION
DRUGS. THE BILL ALSO REQUIRES
THE DAY MAKES YOU TO PREPARE AN
ANNUAL REPORT SUMMARIZING THE
DATA AND THE IMPACT
PRESCRIPTION DRUG COSTS AND
HEALTH CARE PREMIUM. ANNUALLY
COMMERCIAL HEALTH HEALTH PLANS
MUST REPORT THE TWENTY FIVE
MOST FREQUENTLY PRESCRIBED
DRUGS. THE TWENTY FIVE MOST
COSTLY DRUG BY TOTAL ANNUAL
SPENDING. THE TWENTY FIVE DRUGS
WITH THE HIGHEST YEAR OVER
INCREASE IN TOTAL ANNUAL
SPENDING BY CATEGORY IS A
GENERIC BRAND OF SPECIALTY
DRUGS. AND THEY ALSO HAVE TO
REPORT INFORMATION ON THE
OVERALL OVERALL IMPACT OF DRUG
COSTS AND HEALTH CARE PREMIUMS.
TO DATE DATE MIGHT FEEL
RELEASED REAP. THAT THE FILM
COMING BUT THE MOST RECENT
REPORT RELEASED IN JANUARY OF
THIS YEAR. IN DEVELOPING THE
REPORTS THE DAMAGE TO CONSIDER
THE TOTAL VOLUME OF
PRESCRIPTION DRUGS PRESCRIBED
IN THE TOTAL COSTS BY HEALTH
PLANS FOR THE STRUGGLING BOTH
IN AGGREGATE SPENDING MOBILE.
AND A PER MEMBER PER MONTH
BASIS. ADDITIONALLY THE
DEPARTMENT ANALYZES HOW THE
TWENTY FIVE MOST FREQUENTLY
PRESCRIBED DRUGS ACROSS THE
DRUGS AND THOSE WITH THE
HIGHEST YEAR OVER YEAR INCREASE
IN TOTAL ANNUAL SPENDING.
IMPACTED HEALTH PLAN PREMIUM. I
WILL JUST HERE TO NOTE THAT THE
DATA REPORT DO YOU REPORTS DO
NOT INCLUDE COSTS PRESCRIPTION
DRUGS ADMINISTERED IN THE HALL
FOR A DOCTOR'S OFFICE. OR
OTHERWISE PAID FOR THROUGH A
CAPITATED ARRANGEMENT AND ONLY
INCLUDE COSTS FOR PRESCRIPTION
DRUGS THE FENCE OF RETAIL OR
MAIL PHARMACY. HAVING SAID THAT
THE INFORMATION WE'VE COLLECTED
SO FAR SHOWS THE IMPACT OF
PRESCRIPTION DRUG COVERAGE
PREMIUMS THE SIGNIFICANT. AND A
DEAL MAKES HIS MOST RECENT
REPORT HEALTH PLANS REPORTED
PAID NEARLY NINE POINT ONE
BILLION DOLLARS FOR SIXTY ONE.
DOLLARS AND SIXTEEN CENTS PER
MEMBER PER MONTH PER
PRESCRIPTION DRUGS IN TWENTY
EIGHTEEN. TO TWELVE POINT 7% OF
THE TOTAL HEALTH PLAN PREMIUM
AND AN INCREASE OF. FOUR
HUNDRED MILLION FOR TWENTY
SEVENTEEN. YES THE SENATE
REPORT OF A OF DAY THAT DOUBLES
HOW COST OF THE TWENTY MOST
FREQUENTLY PRESCRIBED DRUGS
RELATE TO DIFFERENT ASPECTS OF
HEALTH. SPENDING PREMIUM. WE
HAVE TWO YEARS OF AVAILABLE
DATA IN THE REPORTS ARE BILL
THE TIPSTER TRANSPORT PROVE IN
FUTURE YEARS. THE SB SEVENTEEN
REPORTS ARE ALSO DISCUSSED THE
MADE AVAILABLE PART OF OUR
ANNUAL PUBLIC MEETING ON MARCH
COULD AGGREGATE RATE- ALL NOTE
THAT THE DEER MAKES HIS WEBSITE
CONTAINS DETAILED DATA ON THE
RATE FILING ALONG WITH TOOLS TO
THORTON GRAPH FOR VARIOUS STATE
APPOINTED NEARLY TRENDS.
THERE'S ALSO AN OPPORTUNITY FOR
PUBLIC COMMENT ON THE GREAT.
PILOTS ARE POSTED ON OUR
WEBSITE. IT IMPORTANT UNDER OF
THAT WILL BE IN THE STATE A-
REPORTING OF THE SIGNIFICANT
TOOL OUR INFORMATION DOES NOT
EXTEND TO OTHER TYPES OF
COVERAGE SUCH AS SELF INSURED
GROUPS THAT ARE NOT UNDER OUR
JURISDICTION. DO YOU NEED. TO
MAKE THESE ROLE WITH RESPECT TO
PREMIUM RATE THE DATA
COLLECTION IS JUST ONE ASPECT
OF OUR OVERSIGHT OF HEALTH PLAN
FINANCES. WHICH ALSO INCLUDES
MODERATE FINANCIAL STABILITY
AND THE REGULATION OF MEDICAL
ASSURE ABOUT LOSS RATIO OR MLR
REQUIREMENTS. YOU GET FOR THE
OPPORTUNITY TO PROVIDE THE
COMMITTEE WITH THIS INFORMATION
THAT COULD BUT REMARKS. THANK
YOU VERY MUCH MUCH APPRECIATED
AND A LOT OF GREAT INFORMATION
THERE AND- I THINK IT ONCE THE
PANEL CONCLUDES WE MAY COME
BACK TO YOU WITH SOME QUESTIONS
SO. THANK YOU AGAIN FOR THE
INFORMATION- LIKE TO GO WE'RE
GOING BACK TO DOCTOR MELNICK
NOW I WAS GOING TO TALK TO US
ABOUT- COST GROWTH TARGETS. AND
WHENEVER YOU'RE READY DOCTOR
MELNICK. HI GREETINGS FROM LA
SO LET'S SEE ON MY SLIDE DECK-
SLIDE NUMBER ONE. IS THAT UP.
YOUR IT WAS YOUR TITLE SIDE I
GUESS AND ACTUALLY SITE NUMBER
TWO PERFECT WE GOT WE'RE ON THE
SAME DATE. THEN THAT'S IT OKAY.
SO YOU HEALTHCARE SPENDING IS
REACHING LEVELS THAT ARE
INCREASINGLY UNAFFORDABLE.
WE'VE WE'VE BEEN COVERING THAT
TOPIC AT. MANY OF THE SPEAKERS
TODAY CALIFORNIA COULD LEARN
FROM OTHER STATES IN DEVELOPING
A COMMISSION TO MONITOR. AND
SET SPENDING TARGETS. AND THIS
COULD PROVIDE POLICY MAKERS A
MECHANISM TO PROVIDE RELIEF TO
RISING HEALTH SPENDING HERE IN
CALIFORNIA NEXT SLIDE PLEASE.
CALIFORNIA'S OVERWHELMINGLY
WANT POLICY MAKERS TO ENGAGE ON
HEALTHCARE COSTS ISSUES THIS C.
H. CF SURVEY FROM EARLY TWENTY
TWENTY SHOWS THAT MORE THAN 80%
OF THOSE SURVEYED STRONGLY
SUPPORT. POLICY MAKERS TO
ENGAGE ON HEALTHCARE COSTS
ISSUES SO THIS IS REALLY
IMPORTANT- TO CALIFORNIANS NEXT
SLIDE PLEASE. ONE OF THE
REASONS SO IMPORTANT THAT
HEALTH SPENDING CONTINUES TO
RISE THIS SLIDE SHOWS DATA ON
HEALTHCARE SPENDING PER CAPITA
OVERTIME IN THE U. S. AS YOU
CAN SEE THAT LINE JUST GOES UP
AND UP AND UP AND UP. VERY
RARELY IF EVER ANY RELIEF AND
NOW WE'RE WELL WE'RE ABOVE TEN
THOUSAND DOLLARS PER PERSON PER
YEAR AND HEALTH CARE SPENDING.
NEXT SLIDE PLEASE. HEALTHCARE
HELP HEALTH INSURANCE PREMIUMS-
ALSO CONTINUE TO RISE. WITH
WORKERS PAYING MORE TOWARDS
THEIR FAMILY PREMIUMS THIS IS
A- THIS THIS LINE IS WITH C.
PROBABLY BEEN SHOWN EARLIER
TODAY. IN TWENTY TWENTY TOTAL
PREMIUM REACHED TWENTY ONE
THOUSAND DOLLARS A YEAR. FOR A
FAMILY WITH THE WORKERS SHARE.
ABOVE FIFTY FIVE HUNDRED
DOLLARS A YEAR. THAT'S BEFORE
ANY OF OUR OUT OF POCKET.
PAYMENTS FOR SERVICES THAT
WOULD BE USED SO AS YOU CAN SEE
FROM THIS SLIDE. HEALTH
INSURANCE HAVE BEEN GOING UP
THE CONTRIBUTION FROM THE
WORKERS GOING UP AND MORE MORE
PLANTS ARE DEMANDING. THE
INSURED PERSON OR FAMILY TO PAY
MORE OUT OF POCKET AGAIN JUST
DATA THAT SHOWS. WE'RE
INCREASINGLY BECOMING
UNAFFORDABLE EVEN IF YOU HAVE
HEALTH INSURANCE. NEXT ONE
PLEASE. THREE YOU KNOW THIS ONE
SHOWS THAT CO SPENDING GROWTH
IS NOT SUSTAINABLE IT
HEALTHCARE SPENDING IS
OUTPACING EARNINGSAND
UNDERLYING INFLATION THE TWO
TOP LINES REPRESENT HEALTHCARE
SPENDING THE TOOTH BUT SLOWER
GROWING LINES ARE MORE BASIC
ECONOMIC INDICATORS EARNINGS
AND UNDERLYING INFLATION SO
CLEARLY HEALTH SPENDING IS
OUTPACING BOTH AGAIN
CONTRIBUTING TO THE- ON
SUSTAINABILITY OF THIS TREND.
NEXT SLIDE PLEASE. THIS IS
CAUSING MORE AND MORE
CALIFORNIANS EVEN THOSE WITH
INSURANCE TO WORRY ABOUT COSTS
MORE THAN HALF OF THOSE WITH
INSURANCE REPORTED THAT THEY'RE
WORRIED ABOUT COSTS. EVEN
THOUGH THEY HAVE INSURANCE. AND
OBVIOUSLY THOSE WITHOUT
INSURANCE ALMOST A 100% ARE
WORRIED ABOUT COSTS IN
CALIFORNIA NEXT SLIDE PLEASE.
THESE HIGH HEALTH COSTS THAT
POSE HEALTH RISKS AS WELL HALF
OF THOSE SURVEYED WITH
INSURANCE SAID THAT THEY
ACTUALLY REDUCE THEIR USE OF
CARE DUE TO COST CONCERNS EVEN
THOUGH THEY HAVE INSURANCE AND
HALF OF THAT GROUP. REPORTED
NEGATIVE HEALTH EFFECTS NOW WE
SEE THAT THESE RISING COSTS ARE
GENERATING NOT ONLY A COST
PROBLEM AN ECONOMIC PROBLEM
POTENTIALLY A PUBLIC HEALTH
PROBLEM BECAUSE THAT HALF OF
THOSE REPORTING DELAYING WORK
OR MISSING CARE AND HAVING
NEGATIVE HEALTH EFFECTS. NEXT
SLIDE PLEASE. THE CALIFORNIA
COMMISSION COULD HELP POLICY
MAKERS IN PRO PROVIDE THE
PUBLIC WITH THE DATA TO
UNDERSTAND THESE ISSUES AND
DEVELOP POLICIES TO PROVIDE
MANY BENEFITS THE DAVID NEEDED
ARE GOING TO BE COMPLEX. AND
IT. IT BECAUSE OUR SYSTEM IS SO
COMPLEX AND WE'RE GONNA NEED A
WHOLE SERIES OF POLICY CHANGES
IF WE'RE GOING TO TRY TO FIX
THE SYSTEM AND WE SUPPORT
COMPETITION. AT NEXT SLIDE
PLEASE. SEVERAL STATES HAVE
DEVELOPED COMMISSIONS ALREADY A
C. H. CF STUDY THAT I WORKED ON
THE STUDY FOR STATES IN DETAIL
THERE'S A REPORT ON THE- THE
CHC WEBSITE AT THE STATE'S. ARE
WELL DEVELOPED AND VERY IN A
NUMBER OF DIFFERENT WAYS I CAN
RUN THROUGH A FEW THAT THE
DIFFERENCES QUICKLY NEXT SLIDE
PLEASE. MARYLAND IS THE OLDEST
THE- COMMISSION IN THE COUNTRY
BREAK DATES BACK TO THE
NINETEEN SEVENTIES. IT'S
EVOLVED OVER TIME. ONE
IMPORTANT FEATURE OF THE
MARYLAND PROGRAM EVEN TODAY IS
A FUN TARGETS ONLY HOSPITAL
SPENDING. NOW IT COVERS
HOSPITAL SPENDING FOR ALL
PAYERS INCLUDING MEDICARE
BECAUSE IT HAS A SPECIAL WAIVER
FROM MEDICARE TO INCLUDED IN
THIS PROGRAM. THEY STARTED OUT
BY SETTING JUST IMPATIENT RATES
PRICES FOR IN PATIENT CARE THEY
EXPANDED THAT TO INCLUDE
OUTPATIENT SERVICES AT
HOSPITALS AND THAT ULTIMATELY
NOW HAVE A TOTAL GLOBAL BUDGET
SYSTEM FOR HOSPITALS. THIS
ALLOWS THEM TO TAKE INTO
ACCOUNT NOT ONLY PRICES BUT
UTILIZATION AND FACTORS THAT
AFFECT BOTH OF THOSE THINGS
OVER TIME. THERE IS EXPLORING
WAYS TO ADD IN PHYSICIAN
SPENDING. UNDER THEIR MODEL IN
MARYLAND NEXT SLIDE PLEASE.
OREGON THE- TARGETS MEDICAID
SPENDING AND HEALTH PLAN RATES
FOR PUBLIC EMPLOYEES ONLY SO
AGAIN HERE'S AN EXAMPLE OF A
COMMISSION THAT HAS LIMITED
PURVIEW LET'S CALL IT. ALL
RIGHT AND SO THEY THEY HAVE THE
AUTHORITY TO REGULATE MEDICAID
SPENDING AND ALSO THE AUTHORITY
TO IMPACT HEALTH PLAN RATES FOR
UP. HEALTH PLANS THAT COVER THE
PUBLIC EMPLOYEES BECAUSE THOSE
TWO POPULATIONS ARE PRETTY BIG
IN OREGON COVERS ABOUT 30% OF
THE OF THE COMMERCIALLY
INSURED- NON MEDICARE
POPULATION. INTERESTINGLY AS
PART OF THE REGULATIONS THEY'RE
ABLE TO ACTUALLY IMPOSE RATE
CAPS. UP WITHIN THE HOSPITAL
CONTRACTS SETTING PRICE LIMITS
OF 2100% OF MEDICARE FOR THOSE
PLANS THAT SERVE A PUBLIC
EMPLOYEES SO IT'S A COMBINATION
OF HEALTH INSURANCE PLUS RATE
REGULATION. NEXT SLIDE PLEASE.
RHODE ISLAND'S INSURANCE
PREMIUM REGULATION MODEL IT
COVERS THE COMMERCIALLY
COMMERCIAL PLANS FOR THE FULLY
INSURED POPULATION ONLY DOES
NOT COVER A RISA PLANTS THE
HEALTH INSURANCE COMMISSIONER-
REVIEWS IN ADVANCE FOR THE
UPCOMING YEAR PROPOSED RATE
INCREASES AND BENEFIT PACKAGES
AND HAS THE AUTHORITY TO.
REQUIREBOTH CHANGES IN IN IN
RATES AS WELL AS COMPONENTS OF
THE HEALTH BENEFITS SO FOR
EXAMPLE- THE HEALTH
COMMISSIONER RECENTLY REQUIRED
PLANTS TO INCLUDE SMOKING
CESSATION AS ONE OF THE
BENEFITS THAT WOULD BE COVERED
IN THAT HELP PLANTS SO AGAIN
IT'S A PREMIUM- HEALTH PLAN
REGULATION MODEL. LIMITED JUST
TO COMMERCIALLY INSURED FULLY
INSURED POPULATION. NEXT SLIDE
PLEASE. THE MASSACHUSETTS
MASSACHUSETTS IS THE MOST
COMPREHENSIVE AND WELL
DEVELOPED UP BOTH PROGRAM AND
DATA AND REPORTING SYSTEM IN
THE COUNTRY ALL RIGHT AND
THEY'RE ORGANIZED IS BASICALLY
TO AGENCIES THE MASSACHUSETTS
HEALTH POLICY COMMISSION AND
THEN- WHAT'S CALLED CHEER
CENTER FOR HEALTH INFORMATION
THESE ARE TWO SEPARATE
GOVERNMENT AGENCIES THAT WORK
TOGETHER THE DATA AGENCIES
RESPONSIBLE FOR ALL THE DATA
COLLECTION PREPARING THE DATA
THAT'S THEN ANALYSED. BY THE
POLICY COMMISSION THE HEALTH
POLICY COMMISSION IS AN
INDEPENDENT ALTHOUGH IT'S A
GOVERNMENT AGENCY IT'S GOT
INDEPENDENT MEMBERS- AND THEY
SET SPENDING TARGETS FOR THE
ENTIRE POPULATION- TOTAL
SPENDING FOR ALL SERVICES FOR
THE ENTIRE POPULATION EXCEPT
FOR THE UNINSURED. THEY HAVE
EXPLICIT BENCHMARKS THEY HAVE
EXTENSIVE AUTHORITY TO COLLECT
COMPREHENSIVE DATA AS I
MENTIONED THEY HAVE THIS
INDEPENDENT AUTHORITY PLUS THEY
HAVE A VERY FAIRLY ELABORATE A
STAKEHOLDER- STRUCTURE THAT
INCLUDES STAKEHOLDERS AT
VARIOUS ASPECTS. WHICH THEY-
KILL ME MAKES THE WHOLE PROCESS
MORE EFFICIENT THEY DON'T
DEVELOP DATA COLLECTION PLANS
THAT ARE INEFFICIENT FOR
EXAMPLE BY INCLUDING
STAKEHOLDERS THEY'RE ABLE TO
UNDERSTAND EARLY ON OKAY THIS
FIELD IS JUST WAY TOO EXPENSIVE
TO ADD TO OUR DATA COLLECTION.
THIS YEAR WE NEED TO PUT THAT
OFF TO YOUR TO OUR TWO YEAR
THREE THINGS LIKE THAT SO
THEY'VE LEARNED ABOUT. HOW TO
DO THAT. A OR A AND THE COOK
THAT THEY ALSO HAVE THE
AUTHORITY TO MONITOR SPENDING.
OF WHAT'S CALLED HEALTH CARE
ENTITIES WHICH COULD BE MEDICAL
GROUPS HOSPITALS INSURANCE
PLANS ED IF THE GROWTH RATES
ARE IT EXCESS OF THE TARGETS
THAT THEY SET EACH YEAR. THEY
HAVE THE AUTHORITY TO DIG IN.
AND DEMAND- REMEDIAL PLANS FROM
EACH OF THESE ENTITIES THEY
ALSO HAVE THE AUTHORITY TO
REVIEW TRANSACTIONS. AND IF
THEY THINK THOSE TRANSACTIONS
ARE ANTI COMPETITIVE REFER THEM
TO THE STATE ATTORNEY GENERAL.
NEXT SLIDE PLEASE. SO THIS SITE
SUMMARIZES THOSE FOUR STATES
SOME OF THE KEY FEATURES AS I
MENTIONED THEY VERY IN THEIR
SCOPE OF THE TYPES OF-
ENFORCEMENT MECHANISMS AND
THINGS LIKE THAT ALL OF THE
STATE'S SET EXPLICIT BENCHMARKS
FOR GROWTH IN HEALTHCARE
SPENDING AND IT'S TIED IN SOME
WAY TO PROJECTED STATE GDP SO
THAT'S HOW THEY'RE KIND OF-
TIDYING HEALTHCARE SPENDING TO
AFFORDABILITY IF OUR ECONOMY
GROWS AT A CERTAIN RATE WE
SHOULD BE ABLE TO AFFORD TO
SPEND MORE ON HEALTHCARE BUT
NOT MORE. THAN WERE- INCREASING
IN TERMS OF OUR ECONOMIC OUTPUT.
ALL RIGHT NEXT SLIDE PLEASE.
ABOUT ONE MORE HERE WE GO SO
CALIFORNIA MY CONSIDER SOME OF
THE IMPORTANT FEATURES IN THESE
PROGRAMS THE VALUE OF EXPLICIT
BENCHMARKS THE AUTHORITY TO
COLLECT COMPREHENSIVE DATA.
GOVERNMENT STRUCTURE THAT
INCLUDES STAKEHOLDER
COLLABORATION AND THEN SOME OF
THE ENFORCEMENT MECHANISMS THAT
ARE PRESENT IN THE STATE'S
MIGHT BE HELPFUL IN A
CALIFORNIA TYPE MODEL. NEXT
SLIDE PLEASE. NO MATTER WHICH
DIRECTION CALIFORNIA GOES I
HIGHLY ENCOURAGE CALIFORNIA TO
MOVE QUICKLY. TO ESTABLISH A
SOME KIND OF AN OFFICE FOR
AFFORDABILITY. AND COST
MONITORING RATE MARILYN I THINK
IS A REALLY WORTHWHILE MODEL
BECAUSE IT'S THE MOST
COMPREHENSIVE THEY'VE BEEN
DOING IT FOR MANY YEARS THEY'VE
KIND OF LEARNED THE HARD WAY
WHAT DATA WE CAN GET EASILY
WHAT DATASETS RELIABLE THINGS
LIKE THAT. THEY'VE OFFERED TO
WORK WITH CALIFORNIA'S STAFF
AND ANY KIND OF A TASK FORCE
THAT YOU BUY FOR. TO GIVE US
THEIR THE LESSONS LEARNED AND
HOW WE MIGHT FACE IN DATA
COLLECTION- SO I THINK IT'S A
WORTHWHILE MODEL TO EXPLORE-
YOU KNOW AS I SAID BEFORE I
RECOMMEND THAT WE MOVE QUICKLY.
I THINK CALIFORNIA ESPECIALLY
IF WE IF WE GET GOING WITH THE
COMMISSION. HAS THE OPPORTUNITY
A UNIQUE OPPORTUNITY SPENDING
IS ACTUALLY GOING DOWN NOW FOR
THE FIRST TIME. SINCE I'VE BEEN
STUDYING HEALTH CARE. WHICH IS
A LONG TIME AND THEN THE
QUESTION IS CAN WE LEVERAGE
THIS. YEAR UNFORTUNATE PANDEMIC
WHICH IS REDUCING SPENDING TO
SET A NEW LOWER COST BASE AND
THEN MAYBE SAID GETS. THE DON'T
ALLOW US TO REBOUND BACK TO
WHERE WE WERE. ALL RIGHT SO WE
HAVE A UNIQUE OPPORTUNITY BUT I
DO THINK WE HAVE TO MOVE
QUICKLY BUT AGAIN I THINK THE
DATA- COULD BE MADE AVAILABLE
QUICKLY. OF MARYLAND IN
ADDITION TO HAVING AT ALL PAYER
CLAIMS DATABASE LIKE THE ONE
THAT CALIFORNIA'S GONNA HAVE.
ALSO HAS THE AUTHORITY AND HAS
DEVELOPED A MUCH MORE EXTENSIVE
REPORTING SYSTEM. WHERE THEY
DIFFER WHERE THEY REQUIRE
AGGREGATE REPORTS FROM ENTITIES
WITHIN THE STATE. THAT ARE MUCH
MORE FEASIBLE AND ARE NOT
SUBJECT TO THE ARREST OF
CONSTRAINTS SO AGAIN I HIGHLY
ENCOURAGE CALIFORNIA. TO TALK
TO THE FOLKS THAT MEASURE IN
MASSACHUSETTS FIGURE OUT WHAT
THEY'VE GOT WHAT THOSE REPORTS
LOOK LIKE- THAT WOULD SAVE US
SOME TIME TO GET GOING QUICKLY.
ALL RIGHT NEXT SLIDE PLEASE.
LET'S SEE SO FEEL FINALLY I AS
I MENTIONED IMMEDIATE ACTION-
BECAUSE COSTS AND PRICES ARE
GOING UP AS WE SPEAK. I
MENTIONED EARLIER THE IDEA OF
BUILDING ON THE RECENT ATTORNEY
GENERAL SETTLEMENT AND THE
TREMENDOUS RECORD THAT WAS
BUILT THAT LAWSUIT STARTED IN
TWENTY FOURTEEN. IT SHOWS YOU
HOW OFTEN WE CANNOT RELY ON
PRIVATE LAWSUITS TO BRING BACK
COMPETITION TO THE MARKET WE
NEED POLICYMAKERS TO ACT. WE'VE
GOT A TREMENDOUS AMOUNT OF
INFORMATION THAT WAS MADE
PUBLIC THAT PREVIOUSLY WAS
PRIVATE. THAT WE COULD STUDY
AND WE COULD SEE FROM THAT
SETTLEMENT. ELEMENTS THAT WOULD
HELP TO RESTORE COMPETITION TO
THE MARKET LIMITING ALL IN NON
CONTRACTED WHICH IS ONLY GONNA
GET WORSE NOW WITH THE PANDEMIC
MORE THE SYSTEM FOR BUYING UP
STRUGGLING HOSPITAL STRUGGLING
MEDICAL GROUPS. WE'RE GETTING
MORE AND MORE CONCENTRATED IT
HEY THAT'S GOING TO GIVE THEM
MORE POCKET POWER AND IF WE
DON'T O SOMETHING TO PROTECT
CONSUMERS THEY'RE GONNA COME
BACK WITH BIG PRICE INCREASES.
IN THE IS SUES THEIR CONTRACTS
RUN OUT- SO. OUR RESEARCH THAT
JUST THESE TWO POLICY CHANGES
COULD LITERALLY SAVE BILLIONS
FOR CALIFORNIA CONSUMERS
RELATIVELY QUICKLY MAYBE
ESTABLISHED A NEW BENCHMARK OF
SPENDING. UP AND GET OUR
CONSUMER SOME SAVINGS AND A
SLOWER GROWTH RATE. THANK YOU
VERY MUCH. WELL THANK YOU VERY
MUCH MELNICK. WE ARE WE'RE
RUNNING UP AGAINST A LITTLE BIT
OF A TIME CRUNCH HERE AND- I
YOU KNOW NOT AND WE'VE SOME ARE
MEMBERS OF A HAD TO MOVE ON BUT
I SO I MAY FOLLOW UP
INDIVIDUALLY WITH QUESTIONS- ON
SOME OF THESE ISSUES BUT BUT I
WANT TO JUST HIGHLIGHT ON- YOU
KNOW WHAT WE'VE WHAT WE'VE
HEARD HERE WE'VE GOT AN UPDATE
ON THE ON THE DATABASE WE'VE
GOT WE KNOW THE- THE VALUE OF
THE DATABASE WHICH IS. THE
FOUNDATION FOR US OF
UNDERSTANDING HOW WE'RE
SPENDING OUR MONEY HERE WE
HEARD ABOUT SOME OF THE DATA
WE'VE HEARD HOW THE DEPARTMENT
MANAGED HEALTHCARE OPERATES AND
WE'RE GETTING SOME EARLIER
EARLY DATA ON ON- DRUG PRICE
TRANSPARENCY. AND THOSE AND THE
WAY I UNDERSTOOD THAT THOSE
NUMBERS ARE ACTUALLY COMING IN
HIGHER PERCENTAGE THAN WHAT
WE'VE HEARD IN THE PAST WITH-
THROUGH OTHER OTHER ESTIMATES
WHICH MAKES THAT DRUG SPEND TO
BE EVEN A HIGHER PERCENTAGE OF
THE OVERALL HEALTH CARE SPEND.
SO THE VALUE OF TARGETS. AND
LOOKING TO MARYLAND AS A
PARTNER AS A PARTNER AS WE MOVE
FORWARD ON SOME OF THESE THINGS
LOOKING TO GO GLOBAL BUDGETING
AND- WHEN YOU LOOK AT THAT WITH
YOU LOOKING AT THOSE TARGETS
THOSE TARGETS- ARE OBVIOUSLY
LOWER THAN WHAT WE'RE SPENDING
CURRENTLY IN CALIFORNIA. I MEAN
IF WE'RE AT THREE IN THE 3%
RANGE. ON THOSE TARGETS WHETHER
IT'S MARYLAND OR MASSACHUSETTS.
OR I CAN'T REMEMBER THE OTHER
STATE THERE BUT- YOU HAD TO
GET- RHODE ISLAND AND OREGON
THEY'RE ALL IN THE THREE
PERCENTAGE RANGE AND WE'RE
HIGHER THAN THAT IN CALIFORNIA
SO OBVIOUSLY- THEY'RE DOING
SOMETHING RIGHT AND WE'RE WE'RE
AND WE'RE BEHIND THE ONE
QUESTION I WOULD LIKE TO ASK
YOU AND THEN AND THEN I'VE GOT
OF SHIFT THE ORDER A LITTLE BIT
I'M GONNA HAVE TO APOLOGIZE TO
OUR SPEAKERS BUT- IS THE SKY
FALLING. WITH WITH THE STAFF
THESE. BY WE- YOU KNOW HOW IT
DOESN'T IF THESE BEEN GOING ON
FOR A WHILE NOW IN THE STATES.
AND I THINK THE PUSH BACK WE
WOULD POTENTIALLY GET IN
CALIFORNIA'S. OH MY GOODNESS WE
COULD NEVER DO THAT IN
CALIFORNIA. SO IS THE
HEALTHCARE DELIVERY SYSTEM.
FUNCTIONAL VIABLE IN THOSE
STATES OR ARE THESE TARGETS WE
EIGHTEEN- UNINTENDED
CONSEQUENCES FOR ACCESS OF FOR
AND QUALITY OF CARE. THAT'S FOR
YOU DOCTOR MELNICK'S. QUESTION
I THINK IT AS PART OF OUR
RESEARCH FOR THE CALIFORNIA
HEALTH CARE FOUNDATION WE DID
INTERVIEW LOTS OF FOLKS IN THE
STATES. NONE OF THEM REPORTED
HEROES DOWN. YEAH TO- SETTING
TARGETS AND ACHIEVING THEIR
TARGETS SO AT THE END FORGET
WE'RE STARTING FROM AN ENORMOUS
COST BASE. AND SO AND THE THESE
THE TARGETS THEY CENTER NOT
DRACONIAN BY ANY MEANS- AND SO.
THEY DIDN'T REPORT- YOU KNOW
ANY SUBSTANTIAL NEGATIVE
IMPACTS ON THE DELIVERY SYSTEM
OUTCOMES QUALITY AVAILABILITY
ABILITY THOSE KINDS OF THINGS
BUT CERTAINLY THOSE ARE THINGS
THAT YOU WANT TO BUILD IN AND
MONITOR. IN A COMPREHENSIVE
DATA SYSTEM FOR THE STATE RIGHT
THANK YOU VERY MUCH AND I WANT
TO THANK THE ENTIRE PANEL FOR
THE DISCUSSION AND I FOR ONE
WILL GO BACK AND RE WATCH THIS
BECAUSE I WANT TO PICK UP SOME
MORE INFORMATION SO. MY
APOLOGIES TO THE NEXT TWO
SPEAKERS WE HAVE TO CHANGE THE
ORDER- AND WE NEED TO ASK THE
DOCTOR WHALEY SPEAK- APPARENTLY
IN SAN FRANCISCO THEY'RE GOING
TO CLOSE THE BUILDING WHERE HE
IS AT FIVE O'CLOCK WHICH MEANS
THAT IF WE DON'T CHANGE THE
ORDER OF OUR PRESENTATIONS. WE
WILL GET TO HEAR MISTER WHALEY
AND I OUR DOCTOR WEEKLY AND I
THINK IT'S IMPORTANT THAT WE
HEAR THIS- HIS HIS COMMENTS ARE
BOTH IMPORTANT AND I SO I
APOLOGIZE TO MR GREENY- I HOPE
YOU CAN STICK WITH US- AND
BECAUSE I KNOW YOUR YOUR
PORTION IS REALLY IMPORTANT TO
US AS WELL- AND I HOPE THAT
YOUR BILL IS NOT GOING TO GET
CLOSED BUT WE DO KNOW IN SAN
FRANCISCO THEY'RE GOING TO
CLOSE THE BUILDING AT FIVE
O'CLOCK SO. SO I'D LIKE TO
HAVE- DR WHALEY IF YOU ARE
AVAILABLE TO- SPEAK TO US-
PLEASE. SIR PLEASE JUMP IN. THE
DOCTOR THE DOCTOR WAY THESE IN
SAN FRANCISCO TO THOSE. AHA.
GREAT MOSTLY WE ADJUST THE
CAMERA CARE HERE TALLER THAN
SORRY THERE WE GO. THANK YOU
AND PLEASE PLEASE A PLEASE GO
AHEAD DOCTOR WHALEY IS A POLICY
RESEARCHER AND PROFESSOR.
PARDEE RAND GRADUATE SCHOOL AND
HE'S GOING TO BE TALKING TO US
ABOUT OPTIONS. FOR CONTROLLING
COSTS OF DOCTOR WINNING. GO
AHEAD LOOK THANK YOU FOR HAVING
ME AND I'M EXCITED TO TALK
ABOUT HEALTHCARE AFFORDABILITY
IN CALIFORNIA CAN YOU PULL THE
MICROPHONE CLOSER TO YOU OR
SPEAK UP YOU PULL THE
MICROPHONE CLOSER TO YOU OR
SPEAK AT. OKAY THE LAST IS THAT
YEAH IT'S A LITTLE BIT. HARD TO
MASK. AND SO I TRY TO SPEAK UP.
IF A GHOST OR SOMETHING MOVING
YOUR MICROPHONE UNDER RECORD
NEXT. NEXT SLIDE PLEASE. ONE OF
THE THINGS THAT THAT IS A
DRIVING ISSUE OF MANY THINGS
AND TALK ABOUT TODAY IS JUST
THE GROWING CONCERN FOR HEALTH
CARE AFFORDABILITY FOR MANY
CALIFORNIANS IN A RECENT SURVEY
CONDUCTED BY THE KAISER FAMILY
FOUNDATION OF A CALIFORNIANS
45% OF THOSE SURVEYED IN
CALIFORNIA LISTED HEALTHCARE
COSTS IS A GROWING CONCERN
HEALTHCARE AFFORDABILITY. WHEN
ASKED ABOUT SPECIFIC AREAS OF
HEALTHCARE COSTS THEIR
CONCERNS. ARE FIT THINGS LIKE
MENTAL HEALTH CARE INCREASE
ACCESS TO PROVIDERS AND AT
LOWER COSTS FOR HEALTHCARE
WE'RE SPECIFIC AREAS OF ACCESS
AND AFFORDABILITY. THAT OUR
CONCERNS FOR CALIFORNIANS. THE
CLIPPERS. IN LIGHT WITH THE
AFFORDABILITY THAT THAT MANY
CALIFORNIA- EXPRESSING IT'S
IMPORTANT TO THINKABOUT MAYBE
THE COST PRESSURES THAT ARE
BEING PLACED ON CALIFORNIANS
FOR HEALTH CARE THESE ARE
NUMBERS THAT ARE SIMILAR TO
THOSE THEY WERE PRESENTED BY BY
MANY THE PREVIOUS PANELISTS AND
SO I THINK THERE'S A GROWING
CONSENSUS AMONG RESEARCHERS
THAT THE ISSUES AROUND
AFFORDABILITY ARE IMPORTANT FOR
POLICY MAKERS AND FOR
CALIFORNIANS. IN CALIFORNIA THE
AVERAGE EMPLOYER PLAN OR THE
RIGHT AVERAGE PREMIUM RATHER
FOR EMPLOYER SPONSORED PLAN. IS
NOW OVER TWENTY THOUSAND
DOLLARS WHICH AN INCREASE OF A
133% SINCE TWO THOUSAND TWO.
DEDUCTIBLES FOR CALIFORNIANS
HAVE INCREASED OVER 210060% AND
NOW THE TYPICAL DEDUCTIBLE FOR
CALIFORNIA FAMILY PLANNING FOR
THOSE WITH EMPLOYER SPONSORED
INSURANCE IS OVER ONE THOUSAND
SEVEN HUNDRED DOLLARS. LOOKING
AT THE CURRENT COVER CALIFORNIA
MARKET FOR THOSE WHO RECEIVE
INSURANCE THROUGH THE
CALIFORNIA EXPERIENCE SINCE
CHANGE. AVERAGE PREMIUMS NOW
AVERAGE AROUND FIVE THOUSAND
DOLLARS. THANKS I PLEASE. I
THINK THIS IS THE SAME CHART
WHAT WAS PRESENTED IN THE
PROFESSOR BALLOTS PRESENTATION
BUT THERE'S ALSO IT IN LIGHT OF
THE GROWING COST A CONCERN THAT
THAT WE ARE CENTRALLY PAYING
FOR HEALTH CARE COSTS AND
RISING HEALTH CARE COSTS AND
WAGES AND OTHER TYPES OF
BENEFITS. JUST AN EXAMPLE OF
THIS THIS USES DATA FROM FROM A
NATIONWIDE SURVEY OF EMPLOYER
PLANS. AND IF WE LOOK AT THE
AVERAGE COST GROWTH FOR
EMPLOYERS. DEDUCTIBLES HAVE
INCREASED BY A 162% OVER THE
LAST DECADE AT THE SAME TIME
PREMIUMS INCREASE INCREASE BY
ABOUT FIFTY PERCENT. WHICH IS
MUCH FASTER THAN WAGES AND AT
AND IT JUST OVERALL GENERAL
PUSH. THE CLIPPERS. TO HELP
LOOK AT SOME OF THE ISSUES
AROUND HEALTH CARE
AFFORDABILITY. MY COLLEAGUES AT
RAND AND I LOOKED AT THAT
HOSPITAL PRICES AND HOW THEY
VARY ACROSS THE COUNTRY. TO DO
SO WE USED A LARGE COLLECTION
OF INSURANCE DATA FROM BOTH
EMPLOYER PLANS AND ALSO AIR ALL
PAYER CLAIMS DATABASE IS. WHAT
WE FOUND IS THAT ACROSS THE
COUNTRY. EMPLOYERS IN AND
PRIVATE INSURANCE PLAN TO
PAYING PRICES THERE WERE ABOUT
TWO HUNDRED AND 47% MEDICARE.
IN CALIFORNIA THE PRICE WAS A
LITTLE BIT HIGHER. THE RELATIVE
TO MEDICARE THE AVERAGE PRICE
FOR INSURANCE PLANS IN THE
STATE WAS ABOUT TWO HUNDRED AND
69% MEDICARE. SO CROSS THE
BOARD CALIFORNIA. ROGEN'S PLANS
AND INDIVIDUALS WITH INSURANCE
COVERAGE IN CALIFORNIA ARE
PAYING ABOUT TWICE WHAT
MEDICARE WOULD PAY FOR HOSPITAL
SERVICES. NEXT I PLEASE. WE
ALSO LOOK TO BE RANGING
HOSPITAL PRICES AND IT'S NOT SO
WE FOUND THAT WHILE THE AVERAGE
WAS ABOUT TWO HUNDRED AND 60%
THE PRICE FOR HOSPICE SERVICES
RANGE QUITE DRASTICALLY SO WE
HAVE SOME HOSPITALS THE LOWER
END THAT ARE PRICED AT ABOUT
110060% MEDICARE. IN OTHER
HOSPITALS THAT ARE OVER TWICE
AS HIGH AND ABOVE 4100%
MEDICARE. AND SO THE STORY OF A
HOSPITAL PRICES IN CALIFORNIA
IS NOT THAT THERE'S A SINGLE
PRICE THAT'S HIGHER LOWER BUT
RATHER THAT THERE'S A WIDE
RANGE DISTRIBUTION OF PRICES.
NEXT SLIDE PLEASE. AT THE SAME
TIME WHILE PRICES VARY WIDELY
QUALITY OF SERVERS AS WELL. AND
ONE OF THE REASONS THAT WE DID
THE STUDY AND HOW ONE OF THE
GOALS THAT WE HOPE EMPLOYERS
POLICYMAKERS AND OTHERS WILL
USE OF THE STATE UP IS ACTUALLY
TO COMBINE INDIVIDUAL OVER
PRICE DATA WITH WITH HOSPITALS-
CHOIR OR QUALITY DATA RATHER.
TO LOOK AT THE HIGH QUALITY AND
LOW PRICE HOSPITALS WHICH YOU
CAN THINK OF IN TERMS OF VALUE
PERSPECTIVE REPRESENT THE HIGH
VALUE HOSPITALS IN THE STATE OF
CALIFORNIA. SO HERE THE THESE
HOSPITALS ARE ARE HIGHLIGHTED
AT THE BOTTOM CORNER IT BLEW.
THE NEEDS OF THE HOSPITALS THAT
HAVE BELOW AVERAGE PRICES. AND
QUALITY THAT IS ABOVE AVERAGE
FOR THE STATE OF CALIFORNIA. AS
YOU CAN SEE THERE THERE ARE
MANY WELL KNOWN HOSPITALS- THAT
THAT WE'VE HIGHLIGHTED AND SO
IT'S THERE THERE ARE HOSPITALS
THAT ARE WELL KNOWN BECAUSE
THIS TO CALIFORNIA. AND HELP OF
LOW PRICES AND HIGH QUALITY.
NEXT SLIDE PLEASE. AND WHEN WE
LOOK A BIT DEEPER THE RANGE OF
PRICES THAT THE VARIATION
PRICES IN ACROSS THE STATE OF
CALIFORNIA IS REALLY DRIVEN BY
RELEASED WHAT ONE CONTRIBUTING
FACTOR THAT WE NOTICE RIGHT
AWAY IS THAT IF WE LOOK AT
HOSPITAL PRICES THERE MANY
HOSPITAL PRICES IN IN NORTHERN
CALIFORNIA THAT TEND TO BE MORE
EXPENSIVE. COMPARED TO
HOSPITALS IN SOUTHERN
CALIFORNIA. AND SO ACTUALLY IF
WE IF WE LOOK AT OUR DATA. AND
DISTINGUISHED USING BB
AFFORDABLE- THAT THE COVER
CALIFORNIA RATING AREAS. AND
SPLIT THE OUR OUR SAMPLE IN
USING SOME OTHER DATA LOOKING
AT IT HOSPITAL RATING REGIONS.
AND LOOK AT HOSPITALS IN
NORTHERN CALIFORNIA AND
SOUTHERN CALIFORNIA. WE FIND
THAT HOSPITALS IN NORTHERN
CALIFORNIA. ABOUT THIRTY
THOUSAND DOLLARS MORE EXPENSIVE
FOR INPATIENT MISSION. WHERE
AVERAGE COST FOR NORTHERN
CALIFORNIA INCREASED MISSION IS
ABOUT THIRTY THOUSAND DOLLARS
COMPARED ABOUT TWENTY THREE
THOUSAND DOLLARS IN SOUTHERN
CALIFORNIA. IF WE LOOK AT THE
SAME PRICE RELATIVE TO MEDICARE
FOR A HOSPITAL'S OVERALL. WE
FIND THAT NORTHERN CALIFORNIA
HOSPITALS ARE ABOUT 23% MORE
EXPENSIVE THAN OTHER CALIFORNIA
HOSPITALS. AT 210080% MEDICARE-
RELATIVE TO ABOUT 210030%
MEDICARE. AND THEN IF WE USE
OUR ADDITIONALLY A MARKET
CONSTRUCTION MEASURES DEVELOPED
BY BY FEDERAL AND STATE
REGULATORS. TO THINK ABOUT
WHAT'S A HEALTH. ARE OUR
COMPETITORS. AS MEASURED BY
BODY MEASUREMENT CALLED THE HER
FOR DAHLE TO TRY WHERE A HIGHER
IF YOU TRY TO DO INDICATES A
LESS COMPETITIVE AND MORE COST
FREE MARKET. IN THE LOWER
EIGHTY CHINA INDICATES A- A
MORE COMPETITIVE MARKET. WE
FIND THAT POTENTIALLY A LT OF
THE VARIATION THE REFINED OR
DIFFERENCE OF PRICES RATHER
GOOD FIGHT BETWEEN NORTHERN AND
SOUTHERN CALIFORNIA. IS
ACTUALLY EXPLAINED. BY BY
DIFFERENCES IN MARKET STRUCTURE.
SO NORTH CALIFORNIA WE FIND
THAT THE HOSPITAL A TO TRY.
THIS JUST UNDER THREE THOUSAND
THE FTC AND DEPARTMENT OF
JUSTICE CONSIDER IT A MARKET
THAT IS VERY CONCENTRATED USING
OTHER INDUSTRY DEFINITIONS AND
OTHER INDUSTRIES AND IN A TO A
TYPE OF TWO THOUSAND FIVE
HUNDRED. AND SO APPLYING THAT
SAME MARKET DEFINITION OR
MARKET CONSTRUCTION MEASURE TO
HOSPITALS IN NORTHERN
CALIFORNIA SUGGESTED THE
NORTHERN CALIFORNIA HOSPITAL
MARKET IS NOT COMPETITIVE-
USING BEAUTY METRICS THAT HAVE
BEEN APPLIED BY BY FEDERAL
REGULATORS. IN CONTRAST THE
EIGHTY GIANT CALIFORNIA IS
ABOUT 60% OF BAD NORTHERN
CALIFORNIA AT ABOUT. EIGHTEEN
HUNDRED. AND IF WE LOOK AT IT
PREMIUMS ON THE ACA. RECOVER
CALIFORNIA RATHER OUR PREMIUMS
IN IN NORTHERN CALIFORNIA FOR A
SILVER THE SECOND MOST
EXPENSIVE SILVER PLAN. FOR A
FIFTY FIVE YEAR OLD. ARE ABOUT
40% MORE EXPENSIVE IN NORTHERN
CALIFORNIA VERSUS OTHER
CALIFORNIA. ABOUT ONE POTENTIAL
EXPLANATION IS THAT IT'S JUST
CAUGHT MORE COSTLY TO DO
BUSINESS IN NORTHERN CALIFORNIA
FOR SOUTHERN CALIFORNIA. OR
POTENTIALLY- WAGES ARE HIRED IN
NORTHERN VERSUS SOUTHERN
CALIFORNIANS SO THEY COST MORE
TO PROVIDE HEALTH CARE BECAUSE
YOU HAVE TO PAY DOCTORS AND
NURSES MORE. BUT IF WE ACTUALLY
LOOK AT JUST TO KIND OF METRICS
OF JUST OVERALL MARKET
DIFFERENCES OUTSIDE OF
HEALTHCARE. WE ACTUALLY FIND IT
THROUGH THE STORY MAY NOT BE
EXPLAINED BY THOSE TYPES OF
DIFFERENCES. SO FOR EXAMPLE IF
WE LOOK AT OVERALL WAGES WAGES
IN NORTHERN CALIFORNIA. ARE
JUST 4% HIGHER THAN THAN IN
SOUTHERN CALIFORNIA. AND IF WE
LOOK AT HOUSING COSTS. WHICH WE
MEASURED HERE TO THE AVERAGE
HOME VALUE. HOUSING COSTS IN
NORTHERN CALIFORNIA ARE
ACTUALLY LESS EXPENSIVE THAN IN
SOUTHERN CALIFORNIA INTO THIS
MIGHT BE ONE POTENTIAL
BAROMETER OF OUR COST OF LIVING.
ANSWERS IS WE'RE WE'RE
COMPARING PRICES AND MARKET
STRUCTURE ACROSS CALIFORNIA.
THERE ARE NOTICEABLE
DIFFERENCES IN PRICES. BETWEEN
NORTHERN AND SOUTHERN
CALIFORNIA. THESE PRICES DON'T
SEEM TO BE EXPLAINED BY
DIFFERENCES IN JUST THE COST OF
DOING BUSINESS IN NORTHERN
VERSUS SOUTHERN CALIFORNIA. BUT
THE STRUCTURE OF THE HOSPITAL
INDUSTRY IN HOSPITAL MARKETS
ARE DRASTICALLY DIFFERENT
BETWEEN NORTHERN AND SOUTHERN
CALIFORNIA. NEXT SLIDE PLEASE.
M. IN A RELATED STUDY
COLLEAGUES AT THE UNIVERSITY
CALIFORNIA BERKELEY AND I HAVE
LOOKED AT THAT THE STRUCTURE OF
MARKETS ACROSS CALIFORNIA AND
HOW THEY'VE EVOLVED OVER THE
LAST COUPLE YEARS. WE DID THIS
STUDY IS WE CREATED AN INDEX OF
HOSPITAL MARKET CONCENTRATION
HERE SCALE GOES FROM ZERO SO
THAT THE COMPETITIVE MARKET.
WITH WHAT THE COMPETITION. TO
OUR HIGHEST MEASURE OF SIX
WHICH IS A MANAGER MARKET WITH
LITTLE COMPETITION AND LOTS OF
VERTIGO CONCENTRATED MARKET.
WHAT WE FIND IS THAT OVERALL
BETWEEN THE TWO THOUSAND TEN TO
TWENTY SIXTEEN PERIOD. MARKETS
AND IN CALIFORNIA DID BECOME
MORE CONCENTRATED. HOWEVER THE
CONCENTRATION OF THE LARGEST
GROWTH MARKET CONCENTRATION
REALLY OCCURRED IN NORTHERN
CALIFORNIA. IN A PARTICULAR IN
IN THE FAR KIND OF REACHES
NORTHERN CALIFORNIA AND ALSO IN
IN THE SIERRA FOOTHILLS. AND SO
WHAT WE ARE. HAPPY TALKED ABOUT
DIFFERENCES BETWEEN PRICES IN
OTHER MARKETS STRUCTURE IN
NORTHERN VERSUS SOUTHERN
CALIFORNIA THIS CHART
ILLUSTRATES WHERE A LOT ABOUT
CHANGING MARKET CONCENTRATION
IS ACTUALLY OCCURRING. NEXT
SLIDE PLEASE. ANOTHER RECENT
TREND THAT IS ALSO HAPPENING IN
CALIFORNIA IS ALSO THE IS THAT
THE TREND OF VERTICAL
INTEGRATION WHERE PHYSICIANS
ARE EMPLOYED BY HOSPITALS OR
HEALTH SYSTEMS KATE TOUCHED ON
SOME OF THE AFFECTS OF VERTICAL
INTEGRATION BUT HERE I JUST
WANT TO ILLUSTRATE WHAT'S
HAPPENING IN TERMS OF THE RISE
IN BROOKLYN GRATION. IN
CALIFORNIA. IN THE SAME STUDY
THAT THAT HIGHLIGHTED EARLIER.
WE DOCUMENTED TRANS IN VERTICAL
INTEGRATION OF CALIFORNIA
PHYSICIANS USING DATA ON BOTH
PRIMARY CARE PHYSICIANS WHICH
IS- INDICATED BLUE HERE.
PRIMARY CARE PHYSICIANS
INCREASED FROM ABOUT- 26% OF
PHYSICIANS BEING VERTICALLY
INTEGRATED TO JUST UNDER 40% IN
IN TWENTY SIXTEEN. FOR
SPECIALIST POSITIONS INDICATED
READ THE GROWTH WAS PRETTY RUDE
TO THIS MUCH MORE DRAMATIC
INCREASING FROM ABOUT 20% IN
2010254% IN TWENTY SIXTEEN.
SEVEN ADDITION TO CHANGING
MARKET STRUCTURE MORE AND MORE
PHYSICIANS ARE NOW POISED BY A
HOSPITAL OR HEALTH SYSTEM AND
THERE ARE FEWER INDEPENDENT
PHYSICIANS. A LOT OF- A DOCTOR
UNDER FROM COLLEAGUES WORK
SUGGESTS THAT THEY'RE BOTH
PRICE COMPETITION AND QUALITY
EFFECTS OF VERTICAL INTEGRATION
INTO THIS TYPE OF TREND IS
SOMETHING THAT. THAT REGULATORS
IN CALIFORNIA SHOULD BE AWARE
OF. EXIDE THE BILL. MOST OF OUR
WOULD HAVE TALKED ABOUT TODAY
WERE ALL OVER TALK ABOUT THE
RATHER HAS FOCUSED ON ON
HOSPITAL COSTS BUT I THINK IT'S
ALSO IMPORTANT TO KNOWLEDGE
THAT PRESCRIPTION DRUG COSTS
ACCOUNT FOR GROWING SHARE OF
SPENDING. IF WE LOOK ACROSS THE
LAST THREE YEARS PRESCRIPTION
DRUG COSTS ACTUALLY SHOW THAT
THE LARGEST INCREASE IN
SPENDING AND NOW COUNT FOR
ABOUT 21% OF HEALTHCARE COSTS
IN CALIFORNIA. NEXT SLIDE
PLEASE. ADDITIONALLY ANOTHER
POLICY CONCERN FOR MANY
CALIFORNIA'S OUT OF NETWORK
BILLS WERE SURPRISED BILLS. IN
A SURVEY CONDUCTED BY THE
KAISER FAMILY FOUNDATION ABOUT
A THIRD OF CALIFORNIA'S
REPORTED THEY HAD RECEIVED AN
UNEXPECTED OR A SURPRISE BILL
IN THE LAST YEAR. UNEXPECTED
AND SURPRISE BILLS- THAT THAT
HAPPENED WITH WIND A PATIENT
GOES OUT OF NETWORK FOR A
SERVICE WHERE THEY THEY ARE NOT
ANTICIPATING. RECEIVING OUT OF
NETWORK BILLING BELIEVE THAT
EVERYTHING IS IN NETWORK. OR
BOTH SOMETHING THAT BECAUSE
LOTS OF DISTRESS TO PATIENTS
WITH IT IN ADDITION OR
SOMETHING THAT THEY CAN ALSO
LEAD TO HIGHER PRICES FOR IN
NETWORK CARE. NEXT I PLEASE.
FINALLY WHO WOULD HAVE
DISCUSSED SO FAR HAS REALLY
FOCUSED ON ON THE POPULATION
THAT RECEIVES INSURANCE THIRD
EMPLOYER OTHER TYPES OF PRIVATE
INSURANCE INCLUDING THROUGH
COVERED CALIFORNIA. IT'S
IMPORTANT TO ALSO RECOGNIZE
THAT THERE MANY PATIENTS WHO
WHO RECEIVE CARE OUTSIDE OF THE
EMPLOYER SPONSORED OR PRIVATE
INSURANCE SYSTEM. IN PARTICULAR
THERE THERE ARE ABOUT A HUNDRED
SEVENTY FIVE FEDERAL QUALIFIED
HEALTH CARE CENTERS IN THE
STATE OF CALIFORNIA. TO PROVIDE
CARE FOR OVER FOUR MILLION
CALIFORNIANS WHO ARE
PREDOMINANTLY LOW INCOME. IN
ADDITION THERE ARE THIRTY SIX
CRITICAL ACCESS HOSPITALS. THAT
PROVIDE CARE FOR RURAL
CALIFORNIANS. AND CALIFORNIA IS
ALSO HOME TO OVER TEN MILLION
MEDICAID ENROLLEES AND- ALMOST
THREE MILLION PEOPLE WITHOUT
INSURANCE. AND THOSE WERE
THINKING ABOUT POLICIES TO
ADDRESS THE HEALTH CARE SYSTEM
IT'S REALLY IMPORTANT TO
KNOWLEDGE THAT THE PRICE ISSUES
THAT THE MARKET COMPETITION
ISSUES THAT HIGHLIGHTED EARLIER.
EMILY TARGET TO PRIVATELY
INSURED POPULATION AND THEIR
OTHER POPULATIONS WHERE WE NEED
TO ENSURE WE HAVE ADEQUATE
ACCESS TO CARE. NEXT I PLEASE.
AND SO THAT THAT'S KIND OF THE
LANDSCAPE POLICE AS I SEE THE
PRIMARY ISSUES AFFORDABILITY
CALIFORNIA. AND AS WE'RE
THINKING ABOUT POLICIES TO
ADDRESS AFFORDABILITY AND TO
ENSURE ACCESS TO AFFORDABILITY
I THINK THAT THE LEAST THE WAY
I THINK OF IT IS THROUGH THERE
IS A CONTINUUM OF POLICY
OPTIONS. WITH INCREASING
EFFORTS AND INCREASING
CHALLENGES TO IMPLEMENTING ITS
POLICY BUT THE SAME TIME
INCREASING REWARDS. AND SO IT
JUST EXAMPLE- CALIFORNIA HAS
MADE GREAT STRIDES RECENTLY TO
ADOPT PRICE TRANSPARENCY. AD I
THINK THIS IS A POLICY OPTION
THAT CAN. BE TO FURTHER CHANGES
BUT WE HAVE TO BE REALISTIC
THAT PRICE TRANSPARENCY BY
ITSELF ISN'T SOMETHING THAT'S
GOING TO WHOLESALE CHANGE THAT
THE MARKET CALIFORNIA. GIVEN
THE EFFORT THAT THE
CALIFORNIA'S INVESTED IN IN
PROMOTING PRICE TRANSPARENCY I
THINK THERE ARE WAYS TO THINK
ABOUT LEVERAGING A LOT OF THAT
WORK TO BUILD ON ON ON PRICE
TRANSPARENCY FOR FURTHER
POLICIES. SO FOR EXAMPLE MANY
EMPLOYERS IN CALIFORNIA I AM
GONNA HIGHLIGHT SOME SPECIFIC
SPECIFIC EXAMPLES ARE REALLY
DOING REALLY INNOVATIVE WORK
AROUND INSURANCE BENEFIT
DESIGN. WHERE THEY'RE USING
PRICE TRANSPARENCY INFORMATION
TO INFORM HOW THE STRATEGICALLY
SET BENEFITS FOR THE WORKERS.
AND THEN FINALLY FOR THINKING
ABOUT ADDRESSING MARKET
COMPETITION AND ADDRESSING
PRICES FOR FROM MORE OF A
REGULATORY STANDPOINT THAT'S
SOMETHING THAT CAN BUILD ON ON
ON PRICE TRANSPARENCY. BUT IT
MIGHT BE SOMETHING THAT
REQUIRES MORE EFFORT FOR BRENDA
LATERS AND POLICY MAKERS BUT IT
MIGHT BE SOMETHING THAT COULD
HAVE A BROADER IMPACT ON
AFFORDABILITY FOR CALIFORNIANS.
NEXT I PLEASE. IT TOO IF WE
THINK ABOUT WAYS TO ADDRESS
PRICE TRANSPARENCY I THINK THE
ALL PAYER CLAIMS DATABASE THAT
THE MY COLLEAGUE CHERYL DEBRA
MENTIONED IS A REALLY GREAT
START FOR CALIFORNIA AND AN
EXCELLENT WAY TO PROMOTE PRICE
TRANSPARENCY. ONE OF THE
CHALLENGES OF PRICE
TRANSPARENCY NOT JUST IN
CALIFORNIA BUT IN IN EVERY
OTHER STATE IS THAT THE THROUGH
THE RECENT SUPREME COURT
DECISION TWENTY FOURTEEN. OF
KOBE VERSES OF THE METRIC
MUTUAL LIMITS THE ABILITY OF
CALVET OR IF OF STATE UP HERE
CLAIMS DATABASES. TO COLLECT
DATA FROM FROM SELF FUNDED
INSURANCE PLANS WHICH PRIMARILY
COVER THE LARGE GROUP INSURANCE
MARKET THAT'S REGULATED THROUGH
ARRESTED BY THE FEDERAL
GOVERNMENT. THIS IS A KEY. A
SHORTCOMING OF MANY ARE ALL
PAYER CLAIMS DATABASE IS. WHAT
POTENTIAL OPTIONS WERE THESE
POLICY THAT THE CALIFORNIA
COULD COULD EXPLORE AND HAS
BEEN- DISCUSSED IN OTHER STATES
IS TYING A PARTICIPATION OTHER
INSURANCE PRODUCTS IN
CALIFORNIA TO SUBMISSION TO THE
PCT FOR SELF FUNDED PLANS. FOR
EXAMPLE. THE STATE OF
CALIFORNIA COULD THINK ABOUT
WAYS TO REQUIRE THAT FIRMS WHO
WHO OFFERED INSURANCE THROUGH
COVERED CALIFORNIA ALSO SUBMIT
THEIR SELF FUNDED DATA TO A
CALIFORNIA APCD. OTHER FOR
STATE TO HAVE ADOPTED MODELS
WERE INSURANCE PLANS TO PROVIDE
BENEFITS TO THE STATE PLAY
HEALTH PLAN. I HAVE TO PROVIDE
INSURANCE FOR THEIR HIRD NON
STATE PLAY HEALTH PLAN TO THE
STATE APC APCD AS A
PARTICIPATION FOR UP FOR
ADMINISTERING THE EMPLOYEE
HEALTH PLAN DATA. AND THAT'S A
POTENTIAL POLICY THAT THE
CALIFORNIA COULD CONSIDER AS
WELL. NEXT SLIDE PLEASE. THIS
IS EXAMPLE OF HOW HOW
CALIFORNIA PUBLIC PURCHASERS
HAVE ABUSED DRUG PRICE
TRANSPARENCY I THINK REALLY
COME FROM THE CALIFORNIA PUBLIC
EMPLOYEES RETIREMENT SYSTEM OR
CALPERS ONE OF THE THINGS THAT
THE CALPERS NOTICE SEVERAL
YEARS AGO THAT PRICES FOR MANY
COMMON SERVICES VARY PRETTY
WIDELY. THE CALPERS THAT HAVE
ACCESS TO AN ALL PAYER CLAIMS
DATABASE BUT IS DEVELOPED OVER-THE LAST OF YEARS A PRETTY
SOPHISTICATED APPROACH FOR
THINKING ABOUT PRICES WITHIN
THEIR THEIR OWN EMPLOYEE
POPULATION. JUST EXAMPLES OF
THE PRICE RANGE THAT THE
CALPERS FACED THIS SLIDE SHOWS
THE RANGE IN PRICES FOR COST
PLEASE ON THE LEFT. ONE OF
THINGS THAT THE CALPERS
NOTICED. THAT PRICES FOR CORNOS
BEES LIKE MANY OTHER SERVICES
RANGE PRETTY DRASTICALLY SO
HERE PRICES RANGE FROM A LOW OF
ABOUT FIVE HUNDRED DOLLARS. ALL
THE WAY UP TO TEN THOUSAND
DOLLARS. THE OTHER THING THAT
CALPERS NOTICED. IS THAT THERE
ARE MANY DID PROVIDER DELIVERY
ORGANIZATIONS THAT DELIVER
COMMENTS SERVICES BUT CHARGE
DRASTICALLY DIFFERENT PRICES.
ONE OF THINGS THAT THE CALPERS
NOTICE FOR COST PLEASE IS THAT
HOSPITAL OUTPATIENT DEPARTMENTS
OF OUTPATIENT FACILITY-
OPERATION UNIT AFFILIATED WITH
A HOSPITAL. TEND TO CHARGE
PRICES THAT ABOUT TWICE THE
PRICE AS OF AMADOR SURGICAL
CENTERS WHICH TEND TO BE
INDEPENDENT AND FREESTANDING
CENTERS. CALPERS IMPLEMENTED A
REFERENCE BASED PRICING PROGRAM
WHERE THEY THE- THRESHOLD ADD
TO THAT- FROM ONE THOUSAND FIVE
HUNDRED DOLLARS RATHER.
INDICATED BY THE BLACK LINE
HERE. AND SHIFTED PATIENTS TO
LOWER PRICE PROVIDERS USING
FINANCIAL INCENTIVES. IN A
STUDY PUBLISHED BY- OUR
COLLEAGUES AT THE UNIVERSITY OF
CALIFORNIA BERKELEY HIGH WE
DOCUMENTED THAT ONCE CALPERS
IMPLEMENTED THIS PROGRAM.
PATIENTS SHIFTED PRETTY
DRASTICALLY TOWARDS LOWER PRICE
PROVIDERS. AND SO ON THE RIGHT
FIGURE WE SHOW THE INCREASE
ADOPTION OF LOWER PRICED
PROVIDERS FOLLOWING
IMPLEMENTATION THE PROGRAM
CALPERS THE REDLINE RELATIVE TO
COMPARISON GROUP RATHER
CALIFORNIA PURCHASERS THE BLUE
LINE. AND TO THESE TYPES OF
PROGRAMS LEVERAGE OF PRICE
TRANSPARENCY. WHICH IS SIMILAR
TO THE DATA BEING COLLECTED
THROUGH AN ALL PAYER CLAIMS
DATABASE BUT THE PAIR WITH
BENEFIT DOT DESIGN INFORMATION
AND FINANCIAL INCENTIVES. TO
ENCOURAGE THE USE OF LOWER
PRICE PROVIDERS. THE CLIPPERS.
AND SO IS THE STATE OF
CALIFORNIA IS THINKING IT ABOUT
LEVERAGING SOME OF THE
INFORMATION COLLECTED THROUGH
PRICE TRANSPARENCY I THINK
THERE'S AN IMPORTANT ROLE- THAT
THE CALIFORNIA CAN CONSIDER IN
TERMS OF PROMOTING SOME OF THE
WORK THAT THE CALPERS IS DONE.
FROM MY VIEWPOINT CALPERS IS
ONE OF THE MOST INNOVATIVE
PURCHASERS OF HEALTH CARE
SERVICES THE UNITED STATES.
THEY'VE PIONEERED PROGRAMS SUCH
AS REFERENCE PRICING AND MORRIS.
AND THEY'VE ADDRESSED PRIVATE
POLICIES TO ADDRESS PRICE
VARIATION OF HIGH PRICES FOR A
VARIETY OF SERVICES INCLUDING
OUTPATIENT SERVICES INPATIENT
SERVICES. AND ALSO
PHARMACEUTICAL SERVICES. AND SO
I THINK A TERM AMOUNT OF. FOR
THE STATE OF TO HIRE SOME OF
THE WORKERS IS DOING TO
IMPLEMENT INNOVATIVE BENEFITS.
AND TO POTENTIALLY ALLOW OTHER
EMPLOYERS TO LEARN FROM SOME OF
THE WORK CALPERS IS DOING AND
IN SOME SENSE ADOPTED BEING
DONE IN THEIR OWN BACKYARD.
NEXT SLIDE PLEASE. THE CLUB IS.
AND SO IT IS WERE AWESOME THINK
ABOUT PREVIOUS LIKELY. AT OTHER
POLICIES. I THINK IT'S A PER TO
THINK TO KEEP IN MY- JUST THE
ROLE OF ENSURE ACT TO. MARKET
TO GET. AND WE CAN'T.
AFFORDABLE HEALTH CARE. IF
PROVIDE MARKETS ARE NOT. AND IF
PATIENTS TO HAVE AND TO LOWER
COST PER. AS I HIGHLIGHTED.
THERE MAY NORTH CALIFORNIA
MARKET. WHERE THE HEALTH TO
SYSTEM FRANKLY IS NOT
COMPETITIVE. AND SO THERE MAY
NEED TO BE OVERSIGHT OF MARKETS
OR POLICIES THAT THE PLATE PUT
IN PLACE PRICE LIMITS FOR
MARKETS THAT BUT FRANKLY ARE
NOT COMPETITIVE. SECOND WE KNOW
THAT CONSOLIDATION IS DRIVEN BY
BY PRICING DIFFERENTIALS. AND
SO REGULATORS MAY WANT TO
CONSIDER SOME OF THESE
UNDERLYING PRICE DIFFERENCES
THAT PROVIDE THE- THE
GROUNDWORK FOR CONSOLIDATION
AND PROVIDE INCENTIVES FOR
CONSOLIDATION THAT WE SEE
HAPPENING CALIFORNIA. ONE ONE
POTENTIAL EXAMPLE WOULD BE TO
THINK ABOUT POLICIES THAT LIMIT
FACILITY FEES FOR SERVICES THAT
DON'T HAPPEN IN IN- FACILITY
SERVICES ARE HAPPENING NON
FACILITY AS A SET OF CARE. THIS
IS A SYSTEM OR A OF PRICING MAR
THAT SCRIPT OFTEN INTEGRATION
FOR BECAUSE- AND ABOUT WAYS TO
ADDRESS THAT DR OF INTEGRATION.
MORE DIRECTLY BE SOME THAT
MIGHT A POTENTIAL. REDUCING THE
OF FOR INTEGRATION. AND THEN
FOR I ABOUT I OF NETWORK
EARLIER. I DON'T BILLS OR
SOMETHING LEAD TO LOTS OF
FINANCE DISTRESS FOR CAO. AND
OTHERS WHO RECEIVE A NETWORK.
BUT THEY ARE PLAY IMPORTANT
ROLE IN LEADING TO HIGHER
NEGOTIATED FOR IN NETWORK
SERVICES. IN A RECENT. BY BY IN
A UNIVERSE OF THE CALL DUFFY
AND I DOCUMENTED HOW MUCH CAL.
ANOTHER COULD SAVE IF ADDED
THAT POLICY WERE WORD. AN
ESSENTIAL IF WE THOUGHT ABOUT
POLICY THAT LIMIT HOW MUCH
PATIENTS A WRIST. FOR OUT OF
NETWORK CARE. IN OUR PAPER WILL
BE FOR. WHAT WE- WAS THAT IF.
WAS TO THINK ABOUT A THAT WOULD
CAP. AT A NETWORK BILL AT 2%
MEDICARE. INTO A FEW KEY A OUT
OF NETWORK BILL. THE MAXIMUM
AMOUNT THAT YOU IS A PATIENT
FOR IS 2% MEDIC. THE BATTLE
PLACE DOWNWARD PRESSURE ON HOW
ENDEAVOR PRICES ARE OR GOING TO
GO SHADED AND COULD LEAD
SAVINGS OF 30% OVER FOR IN
PRICE. AT THE SAME TIME THE
ALTERNATIVE APPROACH OF INSTEAD
OF CAPPING RELATIVE TO
MEDICARE. AND INSTEAD TYING TO
THE AVERAGE PRICE IN
CALIFORNIA. WOULD RELEASE TWO
WOULD RESULT IN. SIMILAR
SAVINGS OF A TWO SEVEN PER.
NEXT I PLEASE. AND THIRD
DISAGREED THE CAL HEALTH CARE
LANDSCAPE VARIOUS. AS I'VE
DISCUSSED A FEW TIME. HI PRICES
IN NORTHERN. OUR TRIP BY MARKET
CUTS. AND THE BEEN SEVERAL THE
DOCUMENTED THE MARKET STRUCTURE
FOR PROVIDER DELIVERY SYSTEM
NORTHERN CALIFORNIA IS IT NOT A
LIAR COMPARED THE REST COUNTRY.
K. CAN CAN USE BOTH PRICE
TRENDS. AND MARKET OVER TO
PROMOTE. IN TWO TO MAKE HEALTH
CARE MORE FOR MORE FOR BECAUSE-
BUT WHILE DOING SO WE NEED TO.
THE VOTING PATIENTS IN THE POOR
THAT SERVE THE PATIENTS STILL
HAVE ADEQUATE ACCESS TO PROVIDE.
THANK YOU FOR HAVING ME AND
HAPPY TO ANSWERING OTHER
QUESTION. HOW YOU VERY MUCH
DOCTOR IT'S A YOU GIVE US A LOT
OF VALUE AND- WE'VE NOW FOR
QUITE A WHILE THAT PRICES
NORFOLK. ARE DEAF HIGHER THAN
SOUTHERN. I GUESS- WITH YOUR
CHART YOUR BY IS A IS A TRIP IT
WAS. OF THAT AND- YOU KNOW I
GUESS PART OF ME WONDERS YOU
KNOW HAVE BEEN SOMEONE WHO
LIVES IN NORTHERN CALIFORNIA
WHEN YOU- THE YOU LOOK AT THAT
AND THE STARK DIFFERENCE THERE
DO WONDER IF THIS IS. I HAVE A
HARD TIME BELIEVING THAT THE
COST OF THE LIVER CARE IS THAT
MUCH HIGHER RIGHT THIS FEELS
LIKE MAYBE IT'S HIGHER BECAUSE
IT CAN BE HIGHER- AND- I THINK
WE MIGHT HEAR SOME OF ABOUT A
LITTLE BIT MORE ABOUT THAT AND
THERE YEAH BUT YOU KNOW WITH.
GARCIA CONSOLIDATION BUT I DO
AS YOU LOOK AT THAT TOO IT IS
IT IS IT REALLY IS A DOUBLE
WHAMMY WHEN YOU LOOK AT THE
TABLE TO CALIFORNIA'S THERE
BECAUSE- NOT ONLY ARE YOU
PAYING YOU KNOW A THIRTY ONE
PERCENT. INCREASE IN THE
HOSPITAL INPATIENT HOSPITAL
PRICES- YOU'RE ALSO. PAIN IN OF
FOR THREE PER HIGHER. SO THOSE.
HAVE TO BE CONNECTED IN SOME SO
YOU'RE GETTING YOUR GETTING A
DOUBLE WHAMMY THERE. THAT MORE
THAN OFFSETS THE 4% DIFFERENCE
IN IN SALARIES. AND YET YOUR
PRICE A HOME MIGHT BE LOWER
BUT- BUT IF YOU GET A BIG NASTY
HEALTH CARE BILL- THAT DOESN'T
FEEL SO GOOD AND IT REALLY
PROBABLY DOES MAKE MUCH
DIFFERENCE IN YOUR OVERALL
QUALITY OF LIFE SO. SO I WANT
TO THANK YOU VERY MUCH FOR THE
INFORMATION I SUSPECT WILL HAVE
SOME ADDITIONAL. OF FOLLOW UP
QUESTIONS WE AT SOME POINT. BUT
I ALSO RECOGNIZE THAT YOUR
BUILDINGS GOING TO CLOSE IN ONE
MINUTE. AND UNLESS YOU WANT TO
SPEND THE NIGHT THERE YOU KNOW.
YOU KNOW WE MAY NEED TO MOVE ON
TO OUR NEXT BIGGER. THANK YOU
SO MUCH FOR YOUR PRESENTATION I
REALLY APPRECIATE IT SO. AND IT
IS NOT IS MR. SO INTERVIEW. TO
STOP. MISTER NAZARIAN. THEIR
PHONE. IF HE IS I WANT TO GO ME
A SHOT. AT REAL QUICK IF. MAY
MAYBE NOT AT THIS. SO OKAY. WE
WILL GO AHEAD AND MOVE ON TO
OUR FINAL SPEAKER I WANT TO.
AND APOLOGY THANK YOU MISTER
GRAINY GRAINY. FOR YOUR
PATIENCE I APOLOGIZE FOR
CHANGING THE ORDER NUMBER WE
HEARD YOUR BUILDING DOESN'T
CLOSE UNTIL FIVE THIRTY SO MY
APOLOGIES SINCERE APOLOGIES.
THE MR GREEN IS THE A VISITING
OF LAW AT THE UC LED HASTINGS
LAW SCHOOL AND HE'S GOING TO
TALK TO US ABOUT HEALTHCARE
INDUSTRY CONSOLIDATION SO
PLEASE WHENEVER YOU'RE READY
SIR AND THANK YOU SO MUCH FOR
YOUR PATIENCE REALLY APPRECIATE
IT. GERMAN WOULDN'T THANK YOU
FOR THE COMMITTEE FOR THE
INVITATION- IT'S REALLY- A
PLEASURE TO TALK ABOUT THIS
IMPORTANT SUBJECT. YOU KNOW AS
ACADEMICS WE DEFINE AN
IMPORTANT SUBJECT IS SOMETHING
WE'VE BEEN WRITING ABOUT. AND
I'VE BEEN SPENDING MOST OF MY
CAREER FIRST AS A- A TRIAL
LAWYER AND- SUPERVISOR IN THE
JUSTICE DEPARTMENT IN
WASHINGTON. GOVERNING
HEALTHCARE ANTI TRUST MATTERS
AND IN THE LAST THIRTY YEARS AS
A TEACHER AND A- A WRITER AND
AN OCCASIONAL KITS ARE ABOUT
HEALTHCARE POLICY. I'M SO I'M
GONNA GO QUICKLY OVER SOME OF
THE ECONOMICS DATA THAT YOU'VE
YOU'VE TALKED ABOUT. A MORE TO
SET UP WHAT I WANT TO TALK
ABOUT WHICH IS LAW AND WE
HAVEN'T TALKED THAT MUCH ABOUT
LAW AND REGULATION. AND YOU
KNOW THAT I THINK IS THE
CRITICAL JUNCTURE WE'RE AT NOW
WITH SO MUCH CONCENTRATION. HE
HAD SO MUCH ATTENTION BEING
PAID TO HEALTH CARE SO IF.
YOU'LL GO TO THE FIRST SLIDE
PLEASE. OKAY THIS IS TO A NIFTY
IF YOU'LL AT THE RIGHT HAND
THAT THAT WOULD BE A 100%
TREATY CALIFORNIA- OF THE
UNITED STATES RATHER. AS A
HUNDRED PERCENT. CAN YOU SEE
ALL THOSE DOTS SCATTERED AROUND
THOSE ARE DOTS OF OTHER
COUNTRIES FOR EACH OF THOSE
PROCEDURES EVERYTHING FROM HIP
REPLACEMENTS AND ANGIOPLASTY TO
CARDIAC CATHETERIZATION AND SO
FORTH. AND YOU SEE THERE JUST A
FRACTION OF THE UNITED STATES
CHARGES. AND IF YOU HIT THE
SLIDE ONE MORE TIME YOU'LL SEE
A POP UP- GOING ON. AND THE
ANSWER THE IS THAT PRICE ARE
PRIMARY REASON THE U. S. SPENDS
MORE THE WONDERFUL ARTICLE WAS
WRITTEN YEARS AGO BY A-
TERRIFIC ECONOMIST WITH A
REINHARDT. AT ANY IT IT'S THE
PRICE STUPID AND I WAS TRYING
TO CONVINCE. POLICY MIGHT.
MAKERS THIS WAS FIFTY YEARS AGO
THAT YOU DON'T PAY A TO PRICES
THAT'S THE REAL DRIVER OF
HEALTH HEALTH CARE AND I THINK
THAT'S REAL FOCUS THE FOCUS HAS
TO BE- COULD ENCOURAGE. A
NUMBER OF YOU SPEAKERS SAID
IT'S NOT DIVERT. IT'S NOT
UTILIZATION IT'S AND IT'S
CERTAINLY NOT QUALITY OR
OUTCOMES WE ARE A LITTLE WE ARE
LAGGING THE WORLD AND IN THE
END QUALITY. CRAFTED OKAY NEXT
COULD SLOW. COULD YOU PUT THE
MICRO CLOSE TO YOU AND SO CAN
HEAR YOU BETTER. SURE. AT SURE.
THE THING YOU. THE UP. IF YOU
COULD HIT THE NEXT SLIDE THE-
THIS IS THAT IT REVEALED BY
THIS IN THE DATA YOU HEARD ORAL
TODAY HOSPITAL BECAUSE IN
CALIFORNIA ARE EX. AND WHAT
THIS LAW ILLUSTRATES IS THAT. A
BIG OF LAW INCREASES OUR
HOSPITAL SYSTEMS THAT IS
ENTITIES THAT OWN THREE OR MORE
HOSPITALS- AND MULTI HOSPITAL
SYSTEMS ARE REALLY THE LARGEST
DRIVER OF COST THEY WERE THE
TARGET OF THE SUTTER CASE THAT
I'M GONNA TALK ABOUT IN A
LITTLE LITTLE WHILE BUT IT'S
IMPORTANT TO REMEMBER THAT
CONCENTRATION REALLY DOES DRIVE
COSTS HERE. WHEN HIT THE NEXT
SLIDE PLEASE. THIS JUST REPEAT
WHAT YOU JUST HEARD FROM THE
PREVIOUS SPEAKER AND IT'S JUST
A SNAPSHOT OF THE NORTH SOUTH
DIVIDE IN CALIFORNIA WITH THIS.
SHOWING A 30% DIFF IN IN NORTH
FOR SOUTH. OF IT WHAT'S THE X.
FOR ALL THIS WELL. CERTAINLY
CONCENTRATE IS I THINK MOST OF.
AGREE THE REASON THE BOTTOM DRY
OF HI COSTS AND DO WE MEAN BY
CA. YOU COULD ACCOUNTS. AS A
SHORE. FOR LACK OF COMPETITION
TOO FEW COMPETITORS HAVE WITH
THEIR TOO FEW COMPETITORS JUST
A COUPLE OF GAS STATIONS ACROSS
THE STREET FROM EACH OTHER.
THEY'RE GOING TO HAVE NO
INCENTIVE TO DRIVE PRICES DOWN
AND THAT'S THE STORY THROUGHOUT
ECONOMIC HISTORY AND IT'S
CERTAINLY THE STORY IN
HEALTHCARE JUST TONS OF
ECONOMIC STUDIES. SHOWING JUST
THAT WHEN I GO TO THE NEXT
SLIDE. SO THIS IS THIS CHART IS
A IT A NOTABLE ONE. UP IN A MAY
BE A LITTLE HARD TO READ. BUT
IT IT DISPLAYS THE DIFFERENT
LEVELS OF. CONCENTRATION IN
CALIFORNIA. NOW THE WAY TO
THINK ABOUT CONCENTRATION IS
THERE'S A LEVEL AT WHICH THE
LAW THE ECONOMISTS AND OTHERS
SAY IS HIGHLY CONCENTRATED. AND
THAT LEVEL IS AROUND BETWEEN
TWO THOUSAND AND THREE THOUSAND
ON THIS H. H. I. INDEX. SO IF
YOU LOOK IF YOU TO AN IMAGINARY
LINE RIGHT BETWEEN TWO THOUSAND
AND THREE THOUSAND AT TWENTY
FIVE HUNDRED THAT'S WHERE WE
REALLY START TO WORRY ABOUT
CONCENTRATION. AND WE'RE GOING
TO SEE YOU SEE THAT THE BOTTOM
LEVEL THE LEVEL THAT'S PRIMARY
CARE IT'S BELOW THAT LEVEL SO
MOST PRIMARY CARE PRACTICES ARE
NOT HIGHLY CONCENTRATED. BUT AS
YOU MOVE UP YOU SEE THE
INSURANCE THE NEXT LINE UP THE
SCALE THE INSURANCE MARKET IS.
SOMEWHAT HIGHLY CONCENTRATED
CERTAINLY ABOVE TWENTY FIVE
HUNDRED. AND AS YOU GO FURTHER
UP THE NUMBERS BECOME
ASTRONOMICAL- SPECIALTY
PHYSICIANS AT FORTY. ONE
HUNDRED S. LEVEL AN HOSPITALS
AT FIVE THOUSAND SIX HUNDRED
NINETY FIVE IN CALIFORNIA JUST
TO GIVE YOU WHAT THE SNAPSHOT
OF WHAT THAT MEANS. THAT HIGH
CONCENTRATION RATE AT THE
HOSPITAL LEVEL THIS MEANS IT'S
A ONE HOSPITAL TOWN STE THE
HOSPITAL HAS SEVENTY MAYBE 75%
OF THE OF THE PATIENT
ADMISSIONS. AND MAYBE ANOTHER
HOSPITAL HAS TENER OR FIFTEEN.
SO THAT'S THAT'S WHERE WE ARE
IN CALIFORNIA HIGH
CONCENTRATION ACROSS. THE BOARD
NEXT SLIDE PLEASE. WHAT I JUST
TALKING ABOUT IS HOW. COMPTON
COUNTS. FEW COMPETITORS FOR
EACH HOSPITAL IN THEIR MARKET
VIEW COMPETITORS FOR EACH
SPECIALTY PHYSICIAN IN THEIR
MARKET. NOW I'M TURNING TO
VERTICAL CONCENTRATION AND BY
VERTICAL AS A COUPLE SPEAKERS
HAVE MENTIONED VERTICAL
CONCENTRATION HAS TO DO WITH
HOSPITALS ACQUIRING PHYSICIANS-
END. DID ECONOMICS WE SAY YOU
REQUIRE AN IMP TORQUE. TO YOUR
SIR. IN CAN SEE IS DE INCREASE
IN THE OF HIGH. PRACTICES THAT
HAVE BEEN ACQUIRED BY ODDS
FISTS GIVE PHYSICIAN PRACTICE
THE HAVE BEEN ACQUIRED BY
HOSPITAL. SPECIALTY. PRACTICES
ARE NOW UP 252% OWNED BY. OR
COULD BY HOW. AND FORTY TWO PER
FOR PRIMARY. OKAY SO LET'S JUMP
TO THE NEXT SLIDE SO WHAT IS
THIS ALL WE US WELL. THE TAKE
AWAY HERE IS. THIS IS THE L.
THAT INCREASE CONCENTRATE.
LEADS TO HIGHER PROVIDE
PROVIDER PRICES SO HIGHER.
CONCENTRATION MEANS THEY CAN
BARGAIN FOR HIGHER PRICES AND
HIGHER PRICES LEAD TO HIGHER
PREMIUMS THAT'S THE SCENARIO
THAT I THINK THE OVERWHELMING
NUMBER OF STUDIES AND ECONOMIST
AGREE ON I WON'T GO INTO ANY AT
THE DATA THAT MUCH THE FIRST
THE FIRST. BULLET POINT SHOWS
YOU THAT EVEN NIGHT WITH A
MODEST INCREASE OF
CONCENTRATION- YOU SEE IN A
THOUSAND DOLLAR A YEAR INCREASE
IN IN PRICES- STUDIES HAVE
SHOWN INCREASES OF 2240% AFTER
MERGERS OF CLOSELY. RELATED
HOSPITALS IN LOCAL MARKETS. SO
TO WITH PHYSICIAN.
CONCENTRATION CRITIC POSITION
CRISIS CONCENTRATION RES IN
HIGH PRICE. TO GO DOWN TO THE
THIRD LOW WHAT IS HAVE TO DO
WITH WITH COST. ACAP ARE A GOOD
MATCH. AND IT TURNS OUT THAT
FOR TO AND IS A- WITH HIGHER
PRICES THESE THREE STUDIES OUR
ROLE FROM THE PETROUS. GROUP AT
THE BERKELEY AND THEY'VE DONE
JUST REMARKABLE STUDIES AND
THEY SOME OF THEIR STUDIES WERE
INSTEAD. IN GETTING TO HELP
BRING THE- THE SUTTER CASE AND
FINALLY THE LAST ONE'S REALLY
INTERESTING BECAUSE NOW THERE'S
A STUDY COMING OUT OF STANFORD-
BY LAWRENCE BAKER SHOWING THAT.
WHEN SPECIALIST INTEGRATE WITH
GENERALIST WITH PRIMARY CARE
THE PRICES OF BOTH GO UP
WITHOUT NOTABLE INCREASES IN
QUALITY SO. THE POTENTIAL FOR
HIGHER PRICES OCCURS ACROSS THE
BOARD WHEN THERE'S
CONCENTRATION. WE COULD GET
FLIPPED TO THE NEXT SLIDE. THIS
THIS NEXT. FOCUS ON THE
CULPRITS WHO ARE THEY AND HOW
TO WE GET HERE THAT FOR COOPER
AND I SHOULD MENTION I NINE
YEARS AS AN IN WITH THE JUST TO
AND EACH DIVISION AND THERE HAS
BEEN UNDER ENFORCEMENT OF
ANTITRUST MERGER LAW A PERIOD
OF SEVEN YEARS ELAPSED IN THE
LATE NINETIES UP WHEN NO CASES
WERE BROUGHT AND THAT. GAVE A
BRIGHT GREEN LIGHT TO MERGERS
CONSOLIDATION WENT ON A PACE
AND WE SAW A HUGE INCREASE IN
MERGERS RESULTING AND
CONCENTRATION- THIS IS BEEN
REVERSED EXTENT BUT THERE HAVE
BEEN A SERIES OF A RONI IS. BY
THE COURTS NOW AS A LAW
PROFESSOR LIKE DECLINE THE
COURTS NO DON'T KNOW WHAT
THEY'RE DOING BUT IN THE CASE
THE DATA ACTUALLY IT. STAY OF
RETROSPECTIVE STUDIES HOSPITAL
MERGERS THAT WERE ALLOWED TO GO
THROUGH. THEY WENT TO TRIAL AT
A COURT APPROVED THEM THESE
RETROSPECTIVE STUDIES- THE
PRICES DID IN FACT INCREASE AS
WAS PREDICTED BY THE
GOVERNMENT. SO THOSE CASES PLUS
THE GREEN LIGHT OF UNDER
ENFORCEMENT REALLY LEAD TO
CONCENTRATION. WHAT ELSE IS OUT
THERE WELL AS YOU'VE JUST
HEARD. FROM FOR MR WILEY THE-
THERE WERE GAPS IN BREAK. AND
IN FACT SOME RAKE. ACTUALLY
ENCOURAGE MERGERS YOU HEARD HIM
TALK ABOUT PAYMENTS. THAT WE
PHYSICIAN AT. OF SOAK SIDE OF
SERVICE. AND THERE'RE A NUMBER
OF OTHERS I'VE WRITTEN A COUPLE
PAPERS THAT TRY TO. WHERE THE
RED BROTHER FELL BY ACTUALLY.
CONCENTRATION WITHOUT HELPING
CONSUMERS ANOTHER ANOTHER-
BECAUSE OF CONCENTRATION IS
WHAT I CALL THE ACA MAY BE DO
WHAT DEFENSE THEY SAY ALL THE
ACA WANTED EVERYBODY TO GET
TOGETHER OF WANTED INTEGRATION.
NOTHING COULD BE FURTHER FROM
THE TRUTH I SOMETIMES TELL MY
STUDENTS YOUR DOCTOR MAY TELL
YOU AND DOCTORS HAVE FOUND YOU
KNOW A GLASS OF WINE WITH
DINNER MAY BE GOOD FOR YOUR
CARDIOVASCULAR SYSTEM. BUT YOUR
DOCTOR WOULD TELL YOU DON'T
DRINK THREE BOTTLES OF WINE
WITH DINNER- THAT'S THE THAT'S
THE FALLACY THAT THAT SO OFTEN
PORTRAYED BY SOME OF THE-
MERGING PARTIES THAT THEY'RE
JUST. TO REGULATION THAT IS NOT
WHAT THE ACA WAS ABOUT AND
FINALLY WILL THIS CREATED WHAT
I CALL A GOLD RUSH MENTALITY
HOSPITALS BEGAN TO THINK BOY IF
I DON'T REQUIRE MY NEIGHBOR
SOMEONE ELSE WILL OR IF I DON'T
GRAB A POLE WITH. SO ELSE WILL.
WE GO TO THE NEXT SLIDE. SO THE
NEXT LINE I I'D I JUST AS WELL
ABOUT A TRUST LAW. WE HAVE A
HIGH TWENTY. OF IT FOR OF AN H.
LAW WE'VE- UP SOME BIG WE'VE-
STOPPED. COULD AND AREAS WHAT'S
GOING ON WELL FIRST OF ALL I
MENTIONED THE SEVEN YEARS
NEGLECT THAT. TO THESE- A LOT
OF THE CONSOLIDATION AND BY THE
WAY LET ME JUST MENTION THE
COURTS HAVE RIGHTED THE SHIP.
THE LAST FIVE OR SIX CASES
BROUGHT BY THE JUSTICE
DEPARTMENT IN FTC. HAVE REALLY
CORRECTED THE ERRORS OF THE OF
THE EARLIER CASES THERE'S A
MAJOR CASES PENDING RIGHT NOW
IN FACT THERE'S A MAJOR ONE IN
PHILADELPHIA OF JEFFERSON
HOSPITAL IN. EINSTEIN HOSPITAL
BUT I THINK I THINK IT BE SAID
THAT THE COOK THE LAW REALLY
HAS HAS CLASS. THE STANDARDS
BUT IN SOME WAYS THE HORSES OUT
OF THE BARN. WHAT ABOUT CONDUCT
CAN ANY TRUST REALLY PENAT
SHOULD DANNY TRUST REALLY
PENALIZE. BAD ACTS. ACTION BY
DA PER. WELL HERE'S THE THING
THAT A LOT OF GOOD CERTAINLY A
LOT OF LA PEOPLE TO KNOW. ANTI
TO. DOES NOT PROHIBIT MEN ARE
PRICE. THERE'S NOT IN THE LAW
THAT SAYS AMANDA. CAN CHARGE
HIGH. OLYMPIC LAW DOES. IS SAY.
ANTI THAT DOMINATE CAN'T DO
THAT MAKE. THEIR MEN ARE THAT
ARE IN. OR OBTAIN THE MONOPOLY.
SO WHICH WAS THE- AT. HOLDING
ONTO YOUR MAY NOT BY. MEANS BUT
YOU'VE GOT IT YOU CAN CHARGE
PRICE IN A- IS A PAY TIGER WITH
TO GO TO THAT. KIND OF CONDUCT.
AND FOR RELYING ON IT EACH LIVE
IS DIFFICULT BECAUSE IT'S SO
COSTLY AND THESE CASES TAKE FOR
EVER TO BE. TO BE FINISHED. AND
THE ONLY APPLIED TO ONE PARTY.
SO WHEN YOU ONE SUIT ONE WITH
OTHER WOULD PAY ATTENTION. AND
NOT DO THE SAME THING HAVE
GOTTEN GAUGE OF THE MERGER. BUT
SOMETIME IT'S WERE IT I IS THIS
I USE TO HEAR SO OF MY FRIEND
AND PRIVATE PRACTICE UNDER. THE
SAID THERE'S NO WAY THERE NO
MERGE NOT TRY. IT OKAY THROWN
IN. YOU DON'T IN A SERIOUS
TROUBLE LOSE SOME IN. BUT IT
MIGHT WORTH IT TO TRY TO GO MY-
AND FIND ANOTHER. IS THAT
THERE'S AN ADDED IN FOR. OFTEN
THE IN JUSTO KNOW WHEN TO BE
THE CASES HAVE ACCESS TO
EXPERTS AT CETERA AND THAT'S
WHY I THINK THE DISCUSSION
WE'VE BEEN HAVING ABOUT THE HPC
IS REALLY IMPORTANT. HAVING
THAT EXPERT AT THE ALREADY TO
HELP IS REALLY IMPORTANT. CAN
WE FLIP TO THE NEXT SLIDE- OKAY
I GOT A BUNCH OF MINUTES I
WOULD JUST WANT TO BRIEF
ADDRESS ABOUT CONSOLIDATION.
THE FIRST ONE I'VE WRITTEN A
COUPLE PAPERS ON THIS I CALL IT
THE SUMO WRESTLER FALLACY. AND
THE IDEA HERE IS THAT SOME
PEOPLE ASSUME IN SOME COURTS OF
ACTUALLY SORT OF ASSUMED. THAT
CONSUMERS ARE BETTER OFF WHEN
YOU HAVE A BIG INSURER HEALTH
INSURER. BUMPING ITS BELLY
AGAINST A BIG HOSPITAL SYSTEM.
THE TWO WILL JUST ORT OF DUKE
IT OUT IN THE RING AND
CONSUMERS WILL BE BETTER OFF.
AGAIN NOTHING COULD BE FURTHER
FROM THE TRUTH ECONOMIC THEORY
DOESN'T SUPPORT THAT. AND
ECONOMIC HISTORY DOESN'T
SUPPORT THAT WE HAVE A NUMBER
OF CASES WHERE THE TWO
WRESTLERS SHOOK HANDS THERE'S A
FAMOUS CASE UP IN BOSTON WITH
THE DOMINANT. INSURER IN THE
DOMINANT HOSPITAL SYSTEM.
ESSENTIALLY HAD BUT THE BOSTON
GLOBE CALLED A HANDSHAKE IN THE
SNOW. SO IT'S JUST AS EASY FOR
THEM TO TAKE CARE OF EACH OTHER
AS IT IS TO CONCLUDE. ANOTHER
METHOD X. IS THE I THAT MARK
ARE SELF CORRECT AND IN SOME
AREAS SURE ENTRY AND OTHER
FACTORS CAN CORRECT. MARKET
POWER AND DEAL WITH. A DOMINANT
FIRMS IN INNOVATION CAN CHANGE
THINGS. THAT ISN'T THE CASE IN
HEALTHCARE THEIR ENORMOUS
BARRIERS TO ENTRY AND ALTHOUGH
THERE ARE SOME IMPORTANT
INNOVATIONS THAT NEED TO BE
ENCOURAGED INCLUDING
TELEMEDICINE. THEY'RE NOT GOING
TO. REPLACE THE NEED FOR IN IN
PATIENT CARE. AND HOSPITALS
HAVE BEEN VERY SUCCESSFUL IN
MOVING TO OUTPATIENT CARE
DOMINANCE AS WELL. FINALLY
ANOTHER BIT IS THAT QUALITY
IMPROVES EXERCISE INCREASES.
AGAIN THE ECONOMIC STUDIES
DON'T SUPPORT THAT- THEIR
NUMBER OF CAUGHT THE ECONOMIC
STUDIES OUT THERE THAT SHOW AT
BEST. QUALITY REMAINS NEUTRAL
IN FACT THERE SEVERAL STUDIES
THAT SAY QUALITY WORSENS AS YOU
GET BIGGER AND BIGGER- THERE
ARE CERTAIN CIRCUMSTANCES WHERE
THERE IS A RELATIONSHIP BETWEEN
THE VOLUME OF. SERVICES
PROVIDED AND QUALITY THERE
THOSE HAVE BEEN SHOWN TO EXIST
IN THE- IN TRAUMA AND A FEW
OTHERS. BUT THERE'S CERTAINLY
NO REASON FOR IT ACROSS THE
BOARD LENIENCY. SHOULD WE THROW
GO TO THE NEXT SLIDE PLEASE.
ONE LAST MYTH THE IDEA THAT
SELL. IS INTO IT'S AN- COULD.
MEET REAL MEANS JUST BRINGING
ENTITIES. INTEGRATE REALLY MAY
DOING THE HARD OF GETTING RID
OF THE IT FOR. PROP THE SILO
EFFECTS AND ALL THE OTHER
EFFECTS THAT PLAGUE THE
HEALTHCARE SYSTEM. AND THIS
SAID ONE OF THE TOP ECONOMIST
PUT IT I THINK PRETTY WELL WHEN
HE SAID CONSOLIDATION WAS
PRIMARILY FOR THE PURPOSE OF
ENHANCING THE BARGAINING POWERS
OF THE MERGING PARTIES. VIS A
VIS THE PAYERS AND IT DIDN'T
LEAD TO REAL INTEGRATION. AND
ANOTHER POINT HE'S MADE ANOTHER
SURVEY YOU DON'T NECESSARILY
HAVE TO MERGE WITH. A RIVAL TO
GET THE BENEFITS OF INTEGRATION
YOU CAN DO THAT BY JOINT
VENTURES AND OTHER KINDS OF
ARRANGEMENTS THAT ARE SHORT OF
MERGER BECAUSE MERGERS REMEMBER
MERGERS FOR AND JOINT VENTURE
ARE LESS LESS PER MINUTE. NEXT
SLIDE PLEASE. OKAY SO LET ME
JUST CLOSE BY BY GOING THROUGH
A COUPLE OF. IMPORTANT AT.
POLICY PAPERS THAT WE'VE DONE
IT YOU HASTINGS LAW SCHOOL AND
ARE WORKING WITH THE FOLKS AT
THAT THE PETROUS CENTER AT
BERKELEY- WE'VE LOOKED AT DEB.
PARTICULARLY AT THE CONDUCT OF
DOMINANT PROVIDER AND PAYERS
AND WE'VE ISOLATED A NUMBER OF
SO CALLED ANTI COMPETITIVE
CONTRACTING CLAUSES. AND THESE
ARE CLOSE IS THE DOMINANT
HOSPITALS IN PARTICULAR UP PUT
IN PLACE THAT KEEP THEIR
MONOPOLY- MOST FAVORED NATIONS
CLAUSES ANTI STEERING ANTI
TEARING GAG CLAUSES AS TO PRICE
ALL OR NOTHING CONTRACTED
EXCLUSIVE DEALING. AND THE IDEA
HERE IS THAT EACH OF ONE OF
THESE AND- IT LOOKS LIKE I'M
NOT CONNECT TIME TO GO INTO
MUCH DETAIL BUT EACH ONE OF
THESE ARE SORT OF DEVICES TO
PRESERVE MARKET POWER JUST TAKE
ANTI STEERING FOR A MINUTE ANTI
STEERING REALLY SAYS- THE
DOMINANT HOSPITAL SAYS TO THE
INSURER. DON'T PUT ME IN A LESS
FAVORED TIER WITH YOUR
BENEFICIARIES DON'T MAKE THEM
PAY HIGHER- HIGHER COPAY. FOR
ME BECAUSE IF YOU DO I'M GOING
TO DROP. I'M GOING TO DROP OUT
OF YOUR NETWORK AND IF I DROP
OUT OF YOUR NETWORK YOU'RE NOT
GOING TO SELL ANY AND SHARON'S
THOSE KIND OF CLOSES ARE REALLY
TAILOR MADE TO HELP MONOPOLIST
MAINTAIN ITS MARKET POWER. ALL
OR NOTHING CLOSES ARE ANOTHER
ONE IN WHICH THE DOMINANT
HOSPITAL SAYS- YOU WANT MY MUST
HAVE HOSPITAL THE HOSPITAL YOU
REALLY NEEDED AND- IN- IN
OAKLAND OR OR BERKELEY HE
REALLY NEED THAT HOSPITAL WELL
YOU'RE GONNA HAVE TO PAY THAT
SAME HIGH PRICE FOR MY OTHER
HOSPITALS. WHERE I DON'T HAVE
MARKET POWER WHERE THERE IS
REAL COMPETITION THOSE ARE JUST
TWO EXAMPLES. IN THAT THESE
WERE REALLY PART OF THE BECAUSE
THE EVIDENCE THAT WAS GOING TO
BE PRESENTED IN THE CASE THE
ATTORNEY GENERAL BROUGHT
AGAINST SUTTER HEALTH AND THERE
IS ANOTHER CASE IS STILL
PENDING THE ATTORNEY GENERAL'S
CASE ALONG WITH THE OTHER HE
BROUGHT BY THE ATTORNEY GENERAL
AND A UNION. ARE IN THE PROCESS
OF BEING SETTLED WITH THE A
DECREE THAT WILL CURB THEIR
CONDUCT- BUT THERE IS A CONCERN
I HAVE HERE AT LEAST THAT. I
THINK THEY WERE THE SETTLEMENT
IS A- AND NOW. BUT IN WAYS WERE
WHACK A MOLE WITH DOMINO HOSP
THEY WILL COME UP WITH WAYS OF
AROUND SOME OF THE SOME OF THE-
SOME OF THE FIXES WE PUT IT.
OKAY LET ME JUST BRIEFLY GO
OVER A COUPLE OF THE TWO OF
POLICY PAPERS WE'VE PUT OUT
COULD I GO TO THE NEXT SLIDE
PLEASE. THE FIRST ONE REALLY
GOES BACK TO THE QUESTION OF
CAN WE IMPROVE JUST MERGER
ENFORCEMENT CAN WE REALLY GET.
AT LEAST WITH RESPECT TO
MERGERS GOING FORWARD FROM NOW
ON CAN WE GET BETTER ATTENTION
PAID TO THEM. AND HERE I THINK
THE STATE ATTORNEY GENERAL CAN
PLAY THAT ADAM PORTEN ROLE AND
CERTAINLY- THE CALIFORNIA STATE
ATTORNEY GENERAL HAS BEEN A
LEADER- IT NOT JUST THIS
ATTORNEY GENERAL PICK FOR YEARS
PAST HAS BEEN A LEADER IN IN
THIS AREA- AND WHAT DO THEY
NEED. WHAT DO THEY NEED WHAT
THEY MIGHT NEED SOME
LEGISLATIVE HELP TO IMPROVE
THEIR PERFORMANCE ONE IS THEY
SHOULD HAVE PRIOR NOTICE OF ALL
MERGERS MANY MERGERS ARE UNDER
THE RADAR SCREEN THEY OCCUR AND
ONCE A MERGER HAPPENS. IT IT'S
ALMOST IMPOSSIBLE TO CHALLENGE
BECAUSE YOU CAN'T UNSCRAMBLE
THE EGG THE PEOPLE HAVE THE
MERGING PARTIES HAVE REARRANGED
THEIR BUSINESS. THEY LAID
PEOPLE OFF SO UNLESS THEY GET
PRIOR NOTICE- IT'S VERY HARD
AND THEY'RE JUST I. DON'T HAVE
TIME TO GO INTO IT BUT THERE'S
BEEN A BIG MOVEMENT AMONG HEDGE
FUNDS TO ACQUIRE PRACTICES
AROUND THE COUNTRY AND THOSE
HAVE BEEN LARGELY INVISIBLE.
YOU MIGHT ALSO WANT PRIOR
APPROVAL BY THE ATTORNEY
GENERAL SO THE ATTORNEY GENERAL
HAS A FIRST CRACK AT IT. AND
THEN IT'S UP TO THE PARTIES TO
APPEAL. INPUT IS IMPORTANT DATA
AND WE HAVE TO MENTION BEFORE
HAVING ALL. AT ALL PAYER
DATABASE IS A- SO THE GENERAL
COULD DO A BETTER JOB- YOU
MIGHT HAVE GROW. AS SUCH
STANDARDS APPLY YOU CERTAINLY
OUGHT TO HAVE. LOOKED AT
MERGERS THAT YOU HAVE LET GO
LET GO THROUGH. TAKE A LOOK AND
SEE WHETHER. THE AND I CAN.
HARMS DID OCCUR. GO TO THE NEXT
SLIDE PLEASE. THE SECOND PAPER
WE WROTE WAS. HAD TO DO WITH
THE CON. IF I MAY EARLIER IN
SOME STATES HAVE GONE FOR IN A
BEAR ANTI COMPETITIVE. WITH
REESE TO MOST FAVORED NATIONS
IS ONE. AND IT A PORTENT DOT
POSSIBLE IS SB NINE SEVENTY
SEVEN WHICH WAS CONSIDERED BY
THE CALIFORNIA LEGISLATURE LAST
YEAR. WHICH REALLY WOULD PUT IN
PLACE AUTHORITY OF THE ATTORNEY
GENERAL. TO TAKE A HARD LOOK AT
THESE CONTRACTS RANGING FROM
THE ONES I LISTED EARLIER
INCLUDING. AS WELL EXCLUSIVE
DEALING AND TO SAY WHEN A
DOMINANT HOSPITAL PUTS THOSE IN
PLACE. THE ATTORNEY GENERAL OR
TO TAKE A HARD LOOK AT THEM AND
SEE IF THEY ARE INDEED ANTI
COMPETITIVE AND HAVE THE
BENEFIT OF ADMINISTRATIVE
REVIEW OF THEM- SO THERE IS A
STRONG ARGUMENT FOR- THE KIND
OF. AUTHORITY THAT SB NINE
SEVENTY SEVEN WOULD PUT IN
PLACE- ANTI TRUST LITIGATION AS
I DISCUSSED IS IMPORTANT IT'S
IT PLAYS A ROLE BUT AS I SAID
IT'S CERTAINLY NOT ENOUGH TO
TAKE CARE OF THE- THE PROBLEM I
LISTED SOME OF THE SUCCESSFUL
CASES THE GOVERNMENT IS
BROUGHT. THERE'S ANOTHER
POSSIBILITY IT THAT'S GIVING
THE STATE DEPARTMENT OF
INSURANCE AUTHORITY TO REVIEW
THESE PROVIDER CONTRACTS. THIS
IS A SOMEWHAT AKIN TO WHAT'S
BEING DONE IN RHODE ISLAND. THE
STATE ATTORNEY THE STATE
DEPARTMENT OF INSURANCE CAN
TAKE A LOOK AT CONTRACTS AND
SAY. YOU KNOW WE'RE NOT GONNA
APPROVE YOUR CONTRACT IF THE
PROVIDER- CLAUSES. ARE OF THE
ANTI COMPETITIVE TYPE I'D
LOOKED AT OR SIMPLY TO. YOU'RE
PAYING MUCH THIS WOULD
STRENGTHEN THE ABILITY OF THE
INSURER TO BARGAIN EFFECTIVELY-
YOU COULD GO FURTHER YOU COULD
HAVE RATE CAPS ON A DOMINANT
PROVIDERS AND THEIR OTHER.
REGULATORY TOOLS OUT THERE THAT
SOME STATES ARE FOOLING AROUND
WITH SOME OF WHICH I DON'T
THINK OUR GREAT IDEA THERE'S
ONE CALLED. THE CERTIFICATE OF
PUBLIC THE- REGULATION. WHICH
WOULD CREE ANOTHER A- LIKE A
SORE. OF NEED AGE AND I THINK
THERE PROBLEM WITH THAT. AND
FINALLY YOU COULD GO FOR EVEN
FURTHER AND HAVE PAYER RIGHT.
IT'S ARE. COMING OUT THE NEXT
LIFE. I JUST WANTED TO A WITH
THE SNAP OF WHERE ISLAND SITS
THAT THAT'S ONE THAT'S OF
INTERESTED ME AND I THERE ARE A
LOT OF POLICY PEOPLE AT IT. TO
UP IN POWER THE STATE ATTORNEY.
THAT SORRY THE STATE. OF
INSURANCE. TO DISAPPROVE PLAN
RATES. BASED ON AFFORDABILITY
AND THAT BATES CALLED THEIR
AFFORDABILITY LOSS SO IT REALLY
IS FOCUSING ON. ARE THE
CONTRACTS THAT THE- HOSPITALS
ARE ENTERING INTO WITH THE
PAYERS. ARE THEY REALLY DRIVING
THE HIGHER COSTS AS- THE
OVERWHELMING EVIDENCE SEEMS TO.
TO BE. THE CASE. AND THIS LAW
ACTUALLY- DID SEVERAL
INTERESTING THINGS BE IT
REQUIRED- IF REQUIRED INSURERS
TO INCREASE HOW MUCH WAS BEING
PAID OUT FOR PRIMARY CARE. SHE
WAS TRYING TO READ BALANCE THE-
THE PAYMENT LEVEL WITH TOO MUCH
MONEY GOING TO- TO SPECIALTY
CARE NOT ENOUGH TO PRIMARY
CARE. BECAUSE THERE IS JUST TO
PUT IT BLUNTLY MORE BANG FOR
YOUR BUCK IN PRIMARY CARE. ED
AYE AYES AYE BUT I JUST
MENTIONED HERE COULD BE. TO PUT
IN GREAT REGULATION OF CERTAIN
SO CERTAIN KIND. SUCH AS
SETTING MAXIMUM REIMBURSEMENT
RATES AS A PERCENTAGE OF
MEDICARE. AND REQUIRE VALUE
BASED PAYMENTS SO THERE ARE A
LOT OF REGULATORY OPTIONS OUT
THERE. AND I UNDERSTAND THE
COMMITTEE'S GOING TO HOLD SOME
HEARINGS- IN IN THE COMING
MONTHS ABOUT THEMSELVES. YOU
KNOW THE THOSE OF US WORKING
THIS AT THAT THAT HASTINGS HAD
BERKELEY WERE BE HAPPY TO.
PARTICIPATE. ONE MORE SLOW. SO
HE MY TAKE A THE WE HAVE HIGH
KERR. RESULTS IN HIGHER PER
PRICE THAT'S VERY WELL. THOSE
HIGHER PROVIDER RESULTING
HIGHER PREMIUMS AND THE DOCTOR
AND HAD AFFECT AT. ALL OF WHICH
RESULTS IN UNDER INSURANCE AND
ON INSURANCE- OF ANY TRUST
OVERSIGHT IS NECESSARY BUT NOT
SUFFICIENT WE OUGHT TO
ENCOURAGE AND EMPOWER THE
ATTORNEY GENERAL TO THE EXTENT
WE CAN BUT IT DOESN'T DO THAT
MUCH ABOUT EXISTING
CONCENTRATION THAT'S WHERE THE
POWER IS AND THAT'S WHERE THE
COSTS ARE BEING DRIVEN. WE HAVE
SOME LEGISLATIVE OPTIONS THAT
I'VE I'VE DISCUSSED VERY
BRIEFLY WHETHER THEY BE
PROHIBITING THE CONTRACT TERMS
ARE PUTTING IN PROVIDER RATE
CAPS PUTTING IN MAXIMUMS. OF
EMPOWERING THE INSURANCE
DEPARTMENT TO DO SOME OF THAT
OVERSIGHT OR EMPOWERING THE
ATTORNEY GENERAL TO HAVE
AUTHORITY TO TAKE A LOOK AND
BRING BRING CASES. ON ONE MORE
SLIDE PLEASE. I KNOW THERE'S
BEEN SOME DISCUSSION TODAY AND
I KNOW MEMBERS OF THIS
COMMITTEE ARE VERY INTERESTED
IN THE- IN THE- RURAL MARKETS
OF WHAT. WHAT THE SITUATION IS
FOR WORLD MARKETS. M.
CALIFORNIA IS VIA JUSTICE
WONDERFULLY I MOVED HERE THREE
YEARS AGO FROM MISSOURI AND
IT'S AND IT'S HEAVEN ON EARTH
I'LL GIVE YOU GIVE YOU THAT BUT
IT'S A VERY DIVERSE STATE. AND
YOU HAVE SO MANY DIFFERENT
KINDS OF. COMMUNE AND ECONOMIC
CONDITIONS AROUND THE STATE
LET'S GO ONE MORE SLIDE WE LOOK
AT CONCENTRATION. WE SEE A REAL
VARIETY IN. HOW MUCH
CONCENTRATION THERE IS BY
MARKET. AND THIS WAS JUST A
LIST THAT THE PEOPLE OF PETROUS
PUT TOGETHER- UP COMPARING ALL
THE DIFFERENT COUNTIES BY THE
HER FOR DAHLE INDEX. I
REMEMBER. TWENTY FIVE HUNDRED
IS HIGHLY CONCENTRATED AND WHEN
YOU GET DOWN TO THE EIGHT
THOUSAND AND EIGHTY. THREE
HUNDRED YOU'RE TALKING ABOUT
ONE HOSPITAL. COUNTIES SO. THE
ISSUE HERE IS. ARE THERE ISSUES
THAT ARE PECULIAR TO RURAL
COUNTIES THAT HAVE TO BE
SPECIFICALLY ADDRESSED BECAUSE
IN SOME CASES THEY ARE WHAT
THEY CALL THE ACTUAL MONOPOLIES
THERE ARE GOING TO BE MULTIPLE
HOSPITALS IN THOSE TOWNS AND
ARE THERE IT REGULATORY OR
OTHER MEANS TO. A FIGURE OUT
WHETHER THERE IS EXCESSIVE
PRICING BECAUSE THEY MAY HAVE
HIGHER COSTS- DIFFERENTIALS AND
SECONDLY IF THERE IF THERE ARE
THOSE MECHANISMS HOW COULD THEY
BE EFFECTIVELY DEPLOYED AND TO
GO AFTER THE PROBLEM AREAS TO
NOT HURT THOSE PERFORMING WELL
AND JUST A COUPLE THINGS I WANT
TO MENTION TO THE TO THE TO THE
COMMITTEE- YOU KNOW ONE OF THE
REALLYINTERESTING THINGS
THAT'S BEEN GOING ON OBVIOUSLY.
WITH COVE IT HAS BEEN THE
RELIEF THAT WAS THAT WAS-
PARCELED. OUT BY THE GOVERNMENT
THE CARES ACT. THIS A HUNDRED
AND SEVENTY FIVE. BILLION WITH
A B. DOLLARS TO CALIFORNIA.
HOSPITALS AND PROVIDERS- THAT'S
A LOT OF MONEY AND THE QUESTION
IS WHERE DID IT GO WELL THE
AGAIN THIS THE A STUDY DONE BY
BY THE PETROUS CENTER- RACING
REALLY SEVERE QUESTIONS ABOUT
THAT BECAUSE IT APPEARS. A LOT
OF THAT MONEY WENT TO THE- THE
HOSPITALS THAT ARE DOMINANT THE
HOSPITALS THAT HAVE. A LOT OF
MONEY IN THE BANK IN FACT- THE
WRITERS OF THAT REPORT
SUGGESTED- THE WAY THE MONEY
WAS ALLOCATED WENT. ON THE
BASIS OF PATIENT REVENUE FROM
PRIVATE INSURERS PER HOSPITAL
WELL THE BIG. HEALTHY HOSPITALS
HAVE A LOT OF MONEY FROM
PRIVATE INSURERS MANY OF THE
RURAL AND SMALLER HOSPITALS DO
NOT. IN THE MONEY WENT- IN A
HIGHER PROPORTION AND AT LEAST
THE AUTHORS OF THAT STUDY
SUGGESTS THAT THE- THE FACT
THAT HIGHLY CONCENTRATED MARKET
HOSPITALS ARE ABLE TO. EXTRACT
HIGHER PRICES AND THOSE HIGHER
PRICES TURNING TO HIRE. CARES
ACT RELIEF- IS REALLY
PROBLEMATIC SO I THINK WE OUGHT
TO TAKE A LOOK AT JUST WHERE
THE MONEY WENT TO WHETHER
WHETHER SOME OF THAT. EXCESS
RELIEF- OR TO BE RE EXAMINED-
THERE ARE A NUMBER OF
INTERESTING- ANECDOTES OUT
THERE IN THE NEW YORK TIMES RUN
ARTICLES. SHOWING THAT HOSP
WOULD LITERALLY. OF CASH IN THE
BANK. RECEIVED A LOT OF KERR'S.
SO THAT CERTAINLY SOMETHING TO
LOOK AT AS WELL AS TAKING A
HARD LOOK AT JUST WHAT THE COST
AND- EXPENSE SITUATION. IS FOR
THE RURAL HOSPITALS. WE I THINK.
I THINK OUR GOING TO CLOSE
PRETTY SOON TO BUT I A CERTAIN
APPRECIATE THE OPERA SO IF YOU
WANT TO. ASACOL BE HAPPY TO
ADDRESS THE FOUR FIVE ONE MORE
OF IN MY TO SO I SAW THAT'S IN
ON. THE NICER DARK SO THERE WE
GO. SO I JUST WANT SAFE YOU FOR
THE- AND- THE WAY YOU HAVE. DID
I IT'S REALLY VALUE TO US AS A
AS WE LOOK LOOK TO THE FUTURE.
AND OBVIOUSLY. YOU KNOW SOME OF
THE SOME WE TALKED ABOUT WE
HAVE WE HAVE BEEN LOOKING BUT
YOU KNOW THE CHALLENGE WE- IS
THAT THE- WIND WHEN YOU WERE
TRYING TO. CHANGE IN THIS IT ON
SOME OF THESE IS MET WITH HUGE
RESIST AND YOU ON YOUR UNDER.
WHY HAS HAVE A THE WE ARE BACK.
IN THE YOU'VE DONE IN THE PAST.
AND I GUESS ONE OF THE THINGS
THAT I WILL TAKE THE ONE OF THE
TAKEAWAYS. I'VE I DO. PER FROM.
AS WHO DOES READ A REAL A MOST
RURAL DE. IS THAT IN CAN'T FEEL
LIKE THE. THE WHO HAVE THE- GOT
MORE GOALS. AND THOSE WHO
DIDN'T. THINK WHO HAVE BEEN
STRUGGLING TO STORE. WILL CAN
TO STRUGGLE IN PROBABLY
STRUGGLE AND IS. THAT IS. A
HUGE FRUSTRATE. FOR ME. AND I
HOPE THAT AS WE LOOK AT IF
THERE IS ANOTHER REAL. PACK OF
SOME. THAT THAT WILL BE ADDRESS
BUT I DO IF THAT WILL BE
ADDRESSED QUITE FRANKLY-
BECAUSE THE INEQUITIES- WILL
WILL CONTINUE TO GROW AND I
FIND THAT REALLY FRUSTRATING
SO. SO I JUST WANNA SAY THANK
YOU I DO BELIEVE WE WILL HAVE
SOME FOLLOW UP QUESTIONS AT
SOME POINT- BUT NOT FROM OUR
MEMBERS TODAY. AND I- HOPE THAT
WE CAN REACH OUT TO YOU AND
CONTINUE TO ENGAGE- ENJOYED
VERY MUCH ENJOYED YOUR
PRESENTATION AND THEN THANK YOU
SO MUCH. BE DELIGHTED TO HELP
THANK YOU. THANK YOU AND ONCE
AGAIN MY APOLOGIES FOR MAKING
YOUR LAST BUT- BUT- YEAH. I
GUESS AND IF. WE GET TO A
THAT'S GOING TO THOSE NO
PROBLEM NOT MY SOX ARE NOT IN
WORLD. TODAY. I'M NEUTRAL PARTY
TO. FAIR ENOUGH. THANK YOU SO
MUCH FOR APPRECIATE IT REALLY
FOR SAID THANK A- ALL RIGHT WE
ARE TO GO TO PUBLIC COMMENT NOW.
AND THE- CLING TO THE WAY HOUR
WILL. LIMITING THAT A BIT
HOWEVER REST ASSURED WE DO WILL
TAKE. PUBLIC THROUGH RICH
PUBLIC SO FOR ALWAYS WE ARE
HAPPY TO HAPPY TO DO THAT I'M
TRYING TO FIND NOTES HERE. SEE
WHEN WE ARE WE ARE IN THE WE
ARE NOW IN THE COMMENT PORSCHE
OF THE CALL IN. WE'LL BE USING
A Mà TELEPHONE SURVEY THROUGH
ANY MEMBER THE PA AND IT
PROVIDE COMMENT. PAN OF
PANELISTS ALREADY HEARD HE
SPOKE THE CALL IN NUMBER FOR
COMMENTS FOR THIS IS EIGHT
SEVEN. SIX NINE TWO. EIGHT NINE
FIVE SEVEN AND THE ACCESS CODE
IS. ONE THREE ONE FIVE FOUR
THREE SEVEN AND YOU'LL ALSO%
FIND US ON NUMBER ON THE
ASSEMBLY HEALTH COMMITTEE'S
WEBSITE AS WELL AS ON YOUR TV
SCREEN I BELIEVE I HOPE. AND
THE OPERATOR ON THE LINE WILL
GIVE INSTRUCTIONS ON HOW TO BE
PLACED IN THE QUEUE TO PROVIDE
YOUR PUBLIC COMMENT. IF YOU'RE
CALM IF YOU ARE CALLING IN
PLEASE ELIMINATE ALL BACKGROUND
NOISE THIS INCLUDES MUTING YOUR
LIVESTREAM BROADCASTING YOUR
SMART DEVICES TO REDUCE THE
SOUND DISTORTION. ONCE PLACED
IN THE QUEUE YOU'LL BE ASKED TO
MUTE YOURSELF UNTIL YOU'RE
CALLED UPON TO SPEAK. IF YOU'RE
HAVING ANY PROBLEMS WITH THE
MODERATED PHONE SERVICE YOU CAN
CALL THE COMMITTEE AT.
916-319-2097 AND MY STAFF WILL
BE THERE TO TRY TO HELP. ALSO A
NOTE I SAID WE ARE ACCEPTING
WRITTEN PUBLIC COMMENT THROUGH
THE HEALTH COMMITTEES PUBLIC
EMAIL. WHICH IS AH. E. A. DOT
COMMITTEE ASSEMBLY DOT C. A.
DOT G. O. V. WHICH IT CAN ALSO
BE FOUND ON OUR WEBSITE WE WILL
NEED TO LIMIT HOW LONG EACH
PERSON SPEAKS WE'RE GONNA ASK
EACH PERSON TO SPEAK FOR ONE
MINUTE I DO APOLOGIZE FOR THAT
BUT WE ARE WE ABSOLUTELY DO
WANT TO HEAR FROM YOU AND WILL
ACCEPT WRITTEN COMMENTS AS WELL
I WANT TO THANK YOU FOR YOUR
PATIENCE- AND IF THERE'S
SOMEONE WE DO HAVE SOMEONE IN
THE ROOM. FIRST WE'LL START
WITH THAT GIVE THE PHONE
SERVICE TO A CHANCE TO BEGIN A
MODERATE SO WE'LL GIVE THIS OUR
WITNESS WELL ONE MINUTE PLEASE
OF PROCEED WHEN YOU'RE READY.
THANK I'M AFRAID. THAT IS NOT.
NONETHELESS I'LL SHARE WITH
SOME. ADMINISTRATION HAD MINOR
COURAGE. YOU HAVE TO GO IN YOUR
HEART. HI CAN TELL YOU ALL
REALLY CARE. NONE CONSIDERING
THE PRESENT DIFFICULTIES AND
HOW CARE COSTS AND CAL I THINK
IT'S A LOT LIKE LOOKING IN A
STING WINTER. IF YOU ARE
LISTENING FOR THE HEART I WOULD
SAY. WHAT HAPPENED TO HER. I'VE
BEEN BASICALLY TORTURED FOR
ALIGNMENT ST TWENTY FOUR SEVEN.
AND SIX MONSTER TWENTY PERCENT.
IN THE PAST FOUR MONTHS HAS
BEEN TORN. THE MY FRIENDS ARE
NOT AS IMPORTANT AS ARE NOT
MORE ANY MORE FOR ANYONE ELSE'S.
I WOULD JUST SAY TO WHOEVER IS
MIGHT BE RESPONSIBLE. FOR IT- I
WOULD SAY THAT I ADMIRE YOUR
ABILITY TO COME UP WITH GREAT
IDEAS. AND I ADMIRE I ADMIRE
YOUR CLARITY AND YOUR
KNOWLEDGE. AND HIGHER TO SHARE
IT WITH OTHERS SUFFERING. I
WISH WE COULD COME UP WITH A
WAY FOR EVERYONE TO FIND PEACE
AND COMFORT IN THE HEARTS. AND
HOW MUCH YOU KNOW THAT I'M I'M
WORKING TO MAKE SURE THAT
EVERY. FAMILY AND IN CHILD. IN
CALIFORNIA NEVER HAS TO GO
THROUGH ANYTHING LIKE I'VE GONE
THROUGH. THEM I WILL NOT
CONSIDER I'VE WON HANDILY ALL
EMERGE FROM THIS CONFLICT WITH
THEIR DIGNITY INTACT. IF I WERE
SURE. YOU RELEASE ITHOUGHT IF
YOU'RE SURE I WAS LISTENING
FROM THE HEART. I WONDER WHAT
YOU WOULD TELL ME. IF YOU.
HAVEN'T FOUND. I'M CONCERNED
ABOUT THESE MEDICATIONS AND
VACCINES I HOPE YA. KNOW THE
PERSON JUST RECOGNITION I
CERTAINLY SERVICE CERTAIN OF
THE DOCTORS ARE. ACTIVISTS WE
GOT ME INTO AND I DON'T BLAME A
SINGLE PERSON. WELL IT WAS NOT
THAT I KNOW OF AND I JUST WISH
I KNOW THAT I THINK DOCTORS ARE
GREAT AND I HOPE THAT WE CAN
HAVE A CONVERSATION. ABOUT THEM
THE SPACE THINGS AND- COME UP
WITH SOLUTIONS THAT WORK FOR
ALL OF US HOPE YOU'RE NO YOU'RE
PERFECT JUST LIKE IT. JUST LIKE
I MENTIONED WHICH YOU. THANK
YOU VERY MUCH I APPRECIATE
COMMENTS. WE WILL- GO TO PHONE
LINES AND- ASK FOR PEOPLE FOR.
WHO LIKE TO SPEAK UP PLEASE GO
AHEAD OF THAT MISSED IT WE HAVE
A MADAM OR MR OPERATOR I DON'T
REALLY KNOW. MATT ACTION I'M
HERE HELLO LADIES AND GENTLEMEN
IF YOU WISH TO PROVIDE A PUBLIC
COMMENT PRESS ONE AND THEN ZERO
AGAIN ONE BEEN TERRIBLE. WE DO
HAVE ABOUT THREE IN THE QUEUE
WELL FIRST GOTO LINE NINETEEN
PLEASE GO AHEAD. THANK YOU
KELLY BEING WITH THE CALIFORNIA
MEDICAL ASSOCIATION
REPRESENTING OVER FIFTY
THOUSAND POSITIONS ACROSS
CALIFORNIA. CNN REPORTED THAT
INCREASING AFFORDABILITY FOR
HEALTHCARE CONSUMERS INCLUDING
ADDRESSING UNDERLYING COST
DRIVERS LIKE DELIVERY TO
CONSOLIDATION. THE STATEMENT
ALL MUST ALSO DO MORE TO
PROMOTE INNOVATION AND QUALITY
REDUCE WASTE AND ALLEVIATE
ADMINISTRATIVE BURDENS ON
PHYSICIANS AND OTHER HEALTHCARE
PROVIDERS. EMF COMMITTED TO
HELPING FIND WORKABLE SOLUTIONS
THAT SERVE PATIENTS AND ENABLE
SUFFICIENT TO PROTECT THE
PUBLIC HEALTH AND EXPAND ACCESS
TO AFFORDABLE HEALTH CARE. WE
LOOK FORWARD TO PARTICIPATING
IN THE ONGOING DISCUSSIONS OVER
THE FALL THANK YOU. THANK YOU
VERY MUCH. NEXT CALLER PLEASE.
AT WHAT TIME THIRTY ONE HE
THOUGHT HAD. THANK YOU GOOD
EVENING DOCTOR WOULD DEFEAT AND
J. DS ON BEHALF OF SEIU
CALIFORNIA THANK YOU FOR
HOSTING THIS VERY POINT AND
THEN FORGED NATIONAL HEARING
AND THAT BITCOIN OF VIRUS
ENDEMIC WHICH HAS REALLY SHED
LIGHT ON RISING HEALTH CARE
COSTS AS WELL AS IMPACT ON
ACCESSING HEALTH CARE
ESPECIALLY AS MORE AND MORE OF
OUR FRONTLINE CENTRAL HEALTH
CARE WORKERS. ARE FURLOUGHED
AND LAID OFF FIRST ON
HEALTHCARE COSTS AS YOU NO
DOCTOR WOULD OVER THE LAST
COUPLE OF DECADES AT YEAH YOU
HAD PRIORITIZE AND WORK ON
VARIOUS PROPOSAL TO TACKLE HI
UNSUSTAINABLE HEALTHCARE COSTS.
SECOND CONTACT WITH THE HEALTH
CARE AS MENTIONED EARLIER
ACCESS AND PRICES OF HOT
HEALTHCARE HAVE ALREADY BEEN
IMPACTED BY HIGHLY CONSOLIDATED
HEALTH CARE MARKET THAT
PANDEMIC FURTHER COMPOUNDED
IMPACT ON ACCESS DUE TO THE
FORCE SHUTDOWN OF PROVIDER AND
HOSPITAL FACILITIES IN THE LAST
FEW MONTHS. BUT WHILE MANY
PROVIDERS HAVE BEEN IMPACTED
FINANCIALLY BY THE PANDEMIC
WHICH HAS LED TO CLOSURE
FURLOUGHS AND LAYOFFS WE WOULD
ALSO LIKE TO SHED LIGHT ON THE
OTHER PROVIDER HOSPITAL SYSTEM
THAT HAVE- LOAD AND LAID OFF
NINETY CENTRAL WORKERS. YET
HAVE REMAINED EQUALLY IF NOT
MORE PROFITABLE NOW DURING THIS
ENDEMIC AND THIS WAS EVIDENT BY
WHAT MR GREENY HAD MENTIONED
REGARDING THE ONE HUNDRED
SEVENTY FIVE BILLION DOLLARS IN
CARE ACT FUNDING GOING TO LARGE
HOSPITAL SYSTEMS THAT HAVE MORE
IN RESERVE TO HAVE MORE POWER
RATHER THAN THE FUNDING GOING
TO TRULY STRUGGLING AND SMALLER
HOSPITALS. WE LOOK FORWARD TO
WORKING WITH YOU AGAIN AND
OTHER MEMBERS IN THE
LEGISLATURE ON COMING UP WITH
MORE APPROPRIATE PROPOSAL TO
ADDRESS HI MIKE THIS AND COST
AS WELL AS THE CONSOLIDATION
THAT WE SEE IN OUR HEALTH CARE
MARKETS THANK. YOU THANK YOU
VERY MUCH. WHEN ON TO OUR NAY
CALL PLEASE. NEXTEL LINE THIRTY
THREE PLEASE GO AHEAD. THANK
YOU TO WOULD MEMBERS OF THE
COMMITTEE THAT THE CAMP WITH
THE ASSOCIATION OF HEALTH PLANS
THANK YOU AGAIN FOR HOLDING
THAT'S VERY IMPORTANT HEARING I
CALIFORNIA HEALTH PLANS ARE
COMMITTED MAKING HEALTHCAREMORE ACCESSIBLE AND AFFORDABLE
FOR ALL CALIFORNIANS. WE ARE
PLEASED TO SEE THAT THE
LEGISLATURE HEARING PLAY PLACE
A HIGH PRIORITY ON THIS ISSUE.
THIS YEAR'S RECORD LOW PREMIUM
RATE CHANGE TRENDS
UNPRECEDENTED COVER NINETY
PRICE THAT DEMONSTRATE. THE
CONTINUED STRONG PARTNERSHIP
BETWEEN GOVERNOR NEW SOME.
COVER CALIFORNIA THE LARGEST
LEGISLATURE AND HEALTH PLANS
WORKING TOGETHER TO KEEP
HEALTHCARE AFFORDABLE AND
ACCESSIBLE FOR ALL. CALIFORNIA
HEALTHLINE REPORTED RECENT
ACTIONS PROVIDE MORE STATES
THAT THE AN EMPLOYMENT
REQUIREMENT THAT CONSUMERS HAVE
HEALTHCARE COVERAGE EITHER JUST
A FEW OF THE CRUCIAL ACTION
ACTION THAT HAVE CONTRIBUTED TO
BE THE STAR OF THE LOW RATE.
HEALTH PLANS ALSO SET UP IN
EXTRAORDINARY WAYS TO HELP OUR
PROVIDER PARTNERS IMPACTED BY
THE PANDEMIC. INCLUDING
EXTENDING BILLIONS OF DOLLARS
THEY NEED FINANCIAL ASSISTANCE.
CALIFORNIA'S HEALTH LOOK
FORWARD TO CONTINUING OUR WORK
TO IMPROVE HEALTH CARE
AFFORDABILITY AND BUILD UPON
THE GAINS WE HAVE ACHIEVED IN
CALIFORNIA'S HEALTH CARE
MARKETPLACE. THANK YOU THANK
YOU VERY MUCH- MADAM MODERATOR
DO WE HAVE ANY ADDITIONAL
PEOPLE IN THE QUEUE. WE NEED TO
HAVE ABOUT FIVE MORE IN THE
QUEUE NOW OKAY NEXT NEXT COLOR
BLACK FOOTBALL. BROUGH CAROLINE
THIRTY SIX IF I HAD. GOOD
EVENING THIS IS YES MEAN PALLID
WITH HEALTH ACCESS CALIFORNIA
THANK YOU SO MUCH FOR HOLDING
THIS IMPORTANT HEARING TODAY
TODAY'S HEARING MAKES IT CLEAR
HEALTHCARE COSTS ARE OUT OF
CONTROL AND CONSUMERS CONTINUE
TO SUFFER NEEDLESSLY THANK THE
DATA SHOWS CONCLUSIVELY THAT
PRICES KEEP GOING UP EVEN
THOUGH CONSUMERS ARE USING MORE
HEALTH CARE. PUT SIMPLY THEY
ARE PAYING MORE AND GETTING
LESS AND THAT AFFECT HEALTH
OUTCOMES. THE HIGH COST OF
HEALTHCARE IMPACT CALIFORNIANS
IN MANY WAYS INCLUDING WAGE
STAGNATION WHICH HAS LONG
LASTING RIPPLE EFFECT FOR A
PERSON'S AND FAMILY'S LIFE.
WHAT THE COST OF THE HEALTHCARE
SYSTEM CONTINUES TO INCREASE
THERE ARE STEPS WE CAN TAKE THE
CONTROL COSTS. MANY OF WHICH
HAVE BEEN DISCUSSED TODAY
INCLUDING SUCCESSFULLY
IMPLEMENTING AND FUNDING THAT
HELPS PAYMENT DATABASE.
CREATING SOMETHING LIKE THE
OFFICE OF HEALTH CARE
AFFORDABILITY TO SET COST
GROWTH TARGET. STOPPING
SURPRISE MEDICAL BILLING FOR
OUT OF NETWORK ER VISITS
CONTROLLING CONSOLIDATION. AND
CONTINUING TO WORK ON REIGNING
IN THE COST OF PRESCRIPTION
DRUGS. THANK YOU AGAIN FOR
HOLDING THIS INFORMATIVE
HEARING AND WE LOOK FORWARD TO
WORKING WITH THE COMMITTEE AND
LEGISLATURE ON TACKLING THE
ISSUE OF HEALTHCARE COSTS.
ULTIMATELY IMPROVE
AFFORDABILITY FOR CONSUMERS
THANK YOU THANK YOU VERY MUCH
NEXT CALLER PLEASE. MAX OF ALL
TIME THIRTY FIVE PLEASE GO
AHEAD. THANK YOU CHAIR WOODEN
MEMBERS BARBARA GLAZER WITH A
CALIFORNIA HOSPITAL ASSOCIATION
AS THE COLOR CALIFORNIA'S
HEALTHCARE SYSTEM HOSPITAL A
CRITICAL ROLE IN MAKING HEALTH
CARE MORE AFFORDABLE FOR
CONSUMERS. A LITTLE KNOW THAT
THE SYSTEM IN ITS CURRENT FORM
CAN BE IMPROVED BILLING IS
COMPLICATED PLANTS ARE
DIFFICULT TO NAVIGATE AND THERE
ARE BARRIERS IN ACCESS TO CARE
ESPECIALLY FOR SPECIALTY
SERVICES. WHICH REQUIRING THE
SYSTEM EVERY CALIFORNIAN HAS
ACCESS TO HIGH QUALITY
AFFORDABLE CARE IS A PRIORITY
FOR HOSPITALS AND SHOULD BE A
PRIORITY FOR OUR ENTIRE.
HEALTHCARE SYSTEM. I LITTLE
SUPPORT THE CONCEPT OF IT INTO
ANALYSIS EXPERT REVIEW AND
MONITOR AND HELP CARE COSTS
TREND. RECOMMENDATIONS TO THE
LEGISLATURE SHOULD CONSIDER
METHODS TO MODERATE THE RATE OF
GROWTH IN HEALTHCARE SPENDING
AND ENCOURAGE INNOVATION. SH
THIRD DOUBLE PRACTICAL
ACHIEVABLE STEPS TAKEN DIRECTLY
REDUCE THE RATE OF GROWTH IN
HEALTHCARE SPENDING FOR
CONSUMERS INCLUDING EXPAND OUR
CURRENT EFFORTS TO REDUCE THE
NUMBER OF CALIFORNIANS WITHOUT
HEALTH INSURANCE. REDUCE THE
FINANCIAL BURDEN ABOUT FADED OR
ANOTHER VERY REGULATION. MANY
OF THE REGULATIONS FOR THE
LICENSING AND CERTIFICATION OF
HEALTH CARE FACILITIES AND
OTHER PROVIDERS NO LONGER
ALIGNED WITH TODAY'S CHANGING
HEALTH CARE ENVIRONMENT. YET
STILL ACCOUNT FOR A SIGNIFICANT
AMOUNT OF PRODUCT WITHIN THE
HEALTHCARE SYSTEM. THANK MAKE
REGULATIONS ALONE ARE ESTIMATED
TO COST MORE THAN ONE HUNDRED
BILLION AND EXPENSE THAT WILL
BE BORNE BY HEALTHCARE
CONSUMER. ENCOURAGE INNOVATION
AND FOCUS ON REFORMING THE
CURRENT HEALTHCARE
REIMBURSEMENT FRAMEWORK THE
FAILED TO HELP PROTECT COSTS
WITHIN THE HEALTHCARE SYSTEM.
THE LAST AS WE CONSIDER LET. TO
AN INDEPENDENT GOVERNMENTAL
ENTITY WE RECOMMEND EXAMINING A
FRAMEWORK SIMILAR TO THE MED
PAC STRUCTURE. TO PROVIDE
EXPERT ANALYSES OF THE
CALIFORNIA HEALTH CARE MARKET
PLACE. IN ISSUE REGULAR REPORTS
TO THE LEGISLATURE AS THE
LEGISLATURE CONSIDERS
HEALTHCARE POLICY EACH YEAR.
THANK YOU FOR THE OPPORTUNITY
DID COMMENTED THINKING THANK
YOU VERY MUCH. NEXT CALLER
PLEASE. NEXT PHOTO LINE THIRTY
PRE IF I HAD. GOOD EVENING THIS
IS JENNIFER LAWRENCE IN THE
WESTERN CENTER ALONG PROPERTY.
WE MUCH APPRECIATE YOU HOLDING
THIS IMPORTANT HEARING ON
CONTROLLING THE COST OF
HEALTHCARE IN CALIFORNIA. OUR
LEGAL SERVICES AND COMMUNITY
PARTNERS SIXTEEN FIRSTHAND WHAT
HAPPENS WHEN HEALTHCARE COSTS
DRIVE UP HEALTH CARE PREMIUMS
OUT OF POCKET COSTS IN
CALIFORNIA. IN PARTICULAR LOW
WAGE WORKERS ARE PREDOMINANTLY
WORKERS OF COLOR FIND
THEMSELVES FOR GOING HEALTH
CARE BECAUSE THEY CANNOT AFFORD
IT EVEN WHEN THEY HAVE COVERAGE
THE SKYROCKETING HEALTH CARE
COSTS ALSO THREATENED EFFORTS
TO ATTAIN UNIVERSAL HEALTHCARE
COVERAGE IN CALIFORNIA. IN
CONSIDERING THE OPTIONS WE HAVE
MOVING FORWARD WELL WE VERY
MUCH APPRECIATE AND HAVE ARE
PARTICIPATED IN EFFORTS TOWARDS
GREATER TRANSPARENCY
TRANSPARENCY. BE THE GOAL
ITSELF WE ALREADY KNOW THAT
SOME HEALTH SYSTEMS ARE FAR
MORE XPENSIVE THAN OTHERS. BUT
THERE'S A LITTLE BIT LOW INCOME
CONSUMERS CAN DO WITH THE FACT.
THAT THEY DO NOT HAVE ENOUGH
POWER INFORMATION ABOUT WHERE
TO GET CARE NOR SHOULD THEY
BEAR THE RESPONSIBILITY WHEN
THEY'RE THE PLAYERS IN THE
SYSTEM. WITH THE LEAST
INFORMATION. ANY SOLUTION MUST
ALSO INCORPORATE ACTUAL
REGULATION AND OVERSIGHT THAT
REQUIRES THE HEALTHCARE
INDUSTRY TO DO THINGS
DIFFERENTLY. FOR THIS REASON WE
HAVE SUPPORTED SOLUTION BUT THE
CREATION OF THE OFFICE OF
HEALTH CARE AFFORDABILITY AND
LEGISLATION THAT WOULD CONTROL
SURPRISE MEDICAL BILLS. AND
HOPE TO SEE MORE SOLUTIONS LIKE
THAT THAT WOULD REQUIRE REAL
INDUSTRY CHANGE AND CONTROL
HEALTHCARE PRICES. THANK YOU.
THANK YOU VERY MUCH NEXT NEXT
CALLER PLEASE. NOT LINE THIRTY
SEVEN I HAD. HI GOOD AFTERNOON
MISTER CHAIR MEMBERS- BREAKS
DOUGHERTY HERE ON BEHALF OF
CALIFORNIA ACADEMY OF FAMILY
PHYSICIANS IN CALIFORNIA INTO
THE FIRST SURGERY ASSOCIATION
IT'S BEEN WELL DOCUMENTED THAT
PRIMARY CARE PROVIDERS AND
ESPECIALLY FAMILY POSITIONS
ABOUT EXCEPTIONAL VALUE FOR THE
HEALTHCARE DOLLARS SPENT BOTTOM
LINE FAMILIES ITS STATE HEALTH
CARE COSTS AND MARKS AS SUCH
PRIMARY CARE MUST BE THE
FOUNDATION ON WHICH ANY
HEALTHCARE SYSTEM IS BUILT.
FURTHERMORE A DISCUSSION ABOUT
HEALTHCARE COSTS IN PORTABILITY
CAN'T OCCUR WITHOUT MENTIONING
THE START OF SERVICE FOR THAT
CARE FOR EXAMPLE UC BERKELEY
RESEARCH HAS SHOWN THAT EVERY
PROCEDURE PERFORMED IN AN AFC
FACE THE MEDICARE PROGRAM 40%
AND SAVE EDICARE BENEFICIARIES.
FIFTY TO SIXTY PERCENT. IN
THEIR COPAYMENTS. THANK YOU FOR
YOUR TODAY FAMILY POSITION IN A
BILL CURSOR CENTER READY TO
HELP EXACTLY COMPOSTER
COLLECTIVE OBJECTIVE OF
PROVIDING HIGH QUALITY MEDICAL
CARE IN THE MOST EFFICIENT AND
COST EFFECTIVE MANNER AS
POSSIBLE THANK YOU. THANK YOU
VERY MUCH. OUR NEXT CALLER
PLEASE. NOT ABOUT CAROLINE
THIRTY EIGHT YES GO AHEAD. GOOD
EVENING MISTER CHAIR MEMBERS
ONLY DEFENSE MARIA WITH NEXT
GEN POLICY THANK YOU SO MUCH
FOR PUTTING THIS HEARING ON THE
SYSTEMIC ISSUE OF HEALTH CARE
AFFORDABILITY- WE WOULD LIKE TO
ECHO THE SENTIMENT FOR THE
COMMENTS IN THE TESTIMONY FROM
THE PRESENTER BUT HIGHLIGHTED
LONGSTANDING SOLUTION BASED OFF
OF EXTENSION. EXTENSIVE
RESEARCH OF THE HEALTHCARE
MARKET AND ON A PERSONAL
ANECDOTE IN TWO THOUSAND EIGHT
I HAD A FAMILY MEMBER HAD AN
UNEXPECTED MEDICAL EMERGENCIES
THAT LEFT THEM WITH OVER A
HUNDRED AND FIFTY THOUSAND
DOLLARS OF MEDICAL. SPOTS FOR A
SEVENTY TREATMENT IN THE ICU
AND UNFORTUNATELY LIKE MR MAYES
HAD. HIGHLIGHTED NOT MUCH HAS
CHANGED ON THE HEALTH CARE
AFFORDABILITY FRONT. WE HOPE TO
CONTINUE AN ADVOCATE WITH THE
STATE TO MAKE SIGNIFICANT
CHANGES TO OUR CURRENT
HEALTHCARE SYSTEM TO ENSURE
EQUITABLE AFFORDABLE.
HEALTHCARE SYSTEM THAT THIRDS
PATIENTS OVER PROFITS THANK YOU
SO MUCH RIGHT THANK YOU. OUR
NEXT CALLER PLEASE. WE ACTUALLY
DON'T HAVE ANYONE ELSE IN THE
QUEUE AT THIS TIME OKAY. WELL I
WANT TO SAY THANK YOU VERY MUCH
TO EVERYONE WHO TUNED IN TODAY
AND WE WENT A LITTLE OVER TIME
BUT- I THINK IT WAS VERY
VALUABLE AND I THINK THAT THE
INFORMATION WE HAVE PICKED
TODAY WILL. LEAD TO FUTURE
HEARINGS AND- WILL BE LEAD TO.
UNDOUBTEDLY LEAD TO SOME
CONSIDERATION FOR FUTURE
LEGISLATION SO- THANK YOU ONCE
AGAIN FOR PARTICIPATING- WITH
THAT WE WILL GO AHEAD AND
ADJOURN THIS HEARING AND WE
SHALL GOOD EVENING.