The California Bureau of Health Care’s Affordability Council begins regular meetings this year – State of the Fix
From now through June, the California State Office of Health Care’s (OHCA) Health Care Affordability Council will begin meeting regularly, appoint the Health Care Cost Advisory Committee, and begin the Emergency Regulations process to collect data on total health care expenditures from taxpayers.
California Health Care Quality and Affordability Act, OR Assembly Bill 1130, to reduce the rate of cost growth across the state’s health sector. the 2022 California Health Care Corporation Health Policy Survey It found that 83% of Californians surveyed identified health care affordability as a very important issue. AB 1130 authorized the creation of an OHCA within the Health Care Access and Information Administration (HCAI), which Governor Newsom designated $30 million from its 2022-2023 budget.
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Three primary focuses of the OHCA include analyzing the healthcare market for cost trends and spending drivers, enforcing healthcare cost targets, and conducting cost and market impact reviews of proposed healthcare integration. The Healthcare Affordability Council will consist of eight members to advise on key activities of the OHCA and to approve specific aspects of the initiatives, such as the methodology for setting cost targets. The advisory committee will also make recommendations and represent hospitals, organized labor and healthcare professionals, medical groups and buyers.
the California Hospital Association (CHA) spoke in September on the formation of the OHCA, where they explained how the association played an important role in ensuring that all key parts of the healthcare system are accountable for reducing the rate of cost growth.
“Already, CHA is building a team that will interact with the new office and while some are beginning to consider the impact the office might have on hospital operations, the number one goal of cost growth, which is a goal of Not enforceable“It won’t be decided until 2025,” said President and CEO Carmela Coyle. “Engaging with not only the regulators who work in the office, but the advisory committee tasked with providing input and recommendations on data reporting requirements and cost targets will be a priority for CHA in the years to come.”
Health care spending in California was $10,299 per person and $405 billion overall in 2020, up 30% from 2015, according to HCAI. Additionally, Californians with employment-based health insurance coverage face greater out-of-pocket costs: The share of workers with a high deductible ($1,000 or more) increased from 6% in 2006 to 54% in 2020.
The OHCA is responsible for setting total cost growth targets at the state level, and specific targets for different segments of the healthcare industry. The Healthcare Affordability Council will set a total health care cost growth target for individual spending and set goals defined by the health care sector, including integrated delivery systems, geographic regions, and individual health care entities.
OHCA’s first public report on total health spending data will be the basis for the health care spending report and will cover calendar years 2022-2023. Payers, including health plans, health insurers, and fully integrated delivery systems, will provide data on total health care expenditures by September 1, 2024.
Prior to the data submission deadline, OHCA will obtain input from stakeholders through regulations, develop data specifications and guidelines for data providers, and present key findings of the Primary Healthcare Spending Report at a public meeting of the Board. The baseline report will be released on June 1, 2025. Taxpayers and fully integrated delivery systems are then expected to submit data for total health care expenditures on an annual basis.
Cost growth targets will initially be set at the state level. The Board will set cost increase targets for each year taking into account multi-year targets to support long-term planning. The target percentage cost will take into account economic indicators, including the state’s gross product, household income, and consumer price index. The Board may also develop cost targets that apply to specific segments, such as geographic regions, and will designate segments by October 1, 2027, and set sector-specific targets by June 1, 2028.
OHCA will also set statewide goals for the adoption of alternative payment models that promote the shift of payments from payment for service to payments that reward high-quality, cost-effective care. OHCA will measure progress and goals toward adopting APM standards. Additional responsibilities of the OHCA include monitoring and addressing health care workforce stability, and promoting and measuring quality and equity through performance reports on health plans, hospitals, and physician organizations.
While its ultimate impact remains unclear, the office may in fact be an important place where hospital leaders can help administrators understand competing pressures to lower cost growth, improve access to quality care, and strengthen services for unmet needs such as healthcare behaviors and health disparities, Coyle said.
From June through December 2023, the advisory committee will begin meeting and developing a statewide cost growth goal methodology. Emergency regulations for data collection of total health care expenditures will also be completed. The board will set the state’s first cost goal for 2025 on June 1, 2024.