[{"_1":2,"_100":-5,"_101":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6291733,"mediaKeyId","2529472-cf38baaad53fabc1462d3c8357c28732","parentId",2529472,"title","OCA recommends method to identify high‑cost hospitals; proposes lower growth targets for 11 outliers","audioSeconds",3250,"startMs",1902000,"endMs",5152000,"viewUrl","/Search/View?dp=1&key=2529472-cf38baaad53fabc1462d3c8357c28732&start=1902&end=5152","thumbnailUrl","https://assets.pipeline.soar.com/2529472-cf38baaad53fabc1462d3c8357c28732/thumbnail_1902000.jpg","articleUrl","/articles/6291733/California/OCA-recommends-method-to-identify-highcost-hospitals-proposes-lower-growth-targets-for-11-outliers","mediaUrl","https://secure.pipeline.soar.com/6291733-9dd70b156704db4ecb8553eaa07bcec2/orig.mp4?Expires=1771186631&Signature=Z8L96vGQhYHWqpOl5mpHgorGrHkSe5hj5N2BktyapXw2pZg3dFqWAvNn~ePHDzSUwa3laUSVTtFH4exvvTQ~CvNHVFLJlOG9DE1rDNA8xaXArvRkuZvl-SyLF8P1ji7JBWPg5ZPc5ePzp-Y9R9m7u1rRRUuDyIho1jAjSNifwzf9I0wo8zqEzyU2kqjxJA~0~SjCjwjhpiCFvf9bQGIH0mZdAzIF71iJ1k2uCvzwP9xK-KjHaUg5GIFte7bgVyM3vb55U2WNN~WhgOGIAM5LPGz9pKNBSxzKApCCPGZfD4p~gjNlMtsOLeXeQ--2EpW3x-xSGidXx9pqtCVGw0yzyA__&Key-Pair-Id=KUT5TJCACFTXG","author","Department of Health Care Access and Information","date","2025-03-07T23:28:40Z","article","The Office of Health Care Affordability (OCA) recommended a two‑part method for identifying hospital outliers and proposed lower annual spending growth targets for a group of 11 hospitals it found to be ‘‘repeat outliers.’","mediaType","Video","parentTitle","February 2025 | Health Care Affordability Board Meeting","oneSentenceSummary","OCA proposed identifying hospitals as disproportionately high cost if they sit above the 85th percentile for three of five years on both (1) a unit‑price measure (commercial inpatient net patient revenue per case‑mix‑adjusted discharge) and (2) a relative‑price measure (commercial‑to‑Medicare payment‑to‑cost ratio). Staff said that approach flags hospitals with ‘‘systematically higher costs’’ and that the office identified 11 repeat outliers using it.","taxTitle","Department of Health Care Access and Information, Agencies under Office of the Governor, Executive, California","taxId",16207,"location","California","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6291723,"OCA outlines straw model for behavioral‑health investment benchmark focused on outpatient and community care",2347,10028000,12375000,"/Search/View?dp=1&key=2529472-cf38baaad53fabc1462d3c8357c28732&start=10028&end=12375","https://assets.pipeline.soar.com/2529472-cf38baaad53fabc1462d3c8357c28732/thumbnail_10028000.jpg","/articles/6291723/California/OCA-outlines-straw-model-for-behavioralhealth-investment-benchmark-focused-on-outpatient-and-community-care","https://secure.pipeline.soar.com/6291723-2d772e7b29ffffea241697f52dbc9e7f/orig.mp4?Expires=1771186631&Signature=dpyMZneob6-t4wOhdzuPXvtm1I-e1xAmskn2ZJcw5B1H9RXo3k-cTeYsK87nZ4FbAIOsf01CpaiYfRmd7nmG0ByP9kaaZ~s2hUc5Qnmo-o-QkJkqWcO6DHT0G1c8wG7TcZKGyXO5ozOyRQR3uz~RnQVqL36yMyQFsRr~AS0Z251kpp2sgfaNSCBqpBbFvCuD~GMTadICJk5bfg0GGUnRViR2Qq6BOelq4-SpyIs3tswAQxx3sbrXofLnQKKLzA2IJ-Tmw-kHUwg1Yxz1GbJOrd1~-KXE144VkuBhxCXntlv~cqyS-qVCg~IP4QwxmPhwXNPUATr7buZWYXrbcW~opQ__&Key-Pair-Id=KUT5TJCACFTXG","The Office of Health Care Affordability presented a straw model for a behavioral‑health investment benchmark that separates measurement from the policy benchmark: OCA would measure total behavioral health spending broadly (claims, non‑claims, pharmacy and patient responsibility) but set a focused benchmark that counts covered in‑network outpatient and community‑based behavioral health services intended to expand timely, culturally responsive care and reduce out‑of‑pocket spending.

Staff said the benchmark would not initially include most inpatient, residential or long‑term‑care behavioral health spending but would include claims and non‑claims payments for outpatient services (telehealth, professional outpatient visits, mobile services and community programs). OCA staff said pharmaceuticals would be included in overall measurement but are under consideration for exclusion from the focused benchmark so as not to swamp changes in outpatient investment.

The office has been developing the approach with its investment and payment work group and the advisory committee. Board and work‑group members generally supported a focused benchmark but some participants urged OCA to track inpatient and residential spending separately; others urged linking benchmark performance to access and outcome metrics. The office plans to continue work‑group meetings through July and to return to the board with a recommended benchmark in July 2025.","OCA proposed a two‑track approach: (1) measure total behavioral health spending broadly (claims, non‑claims, pharmacy and patient responsibility) and (2) set an investment benchmark focused on covered, in‑network outpatient and community‑based behavioral health services to advance access and equity.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6291728,"OCA previews baseline health‑spending report and new data submission guide; physician organization reporting deferred",1522,5882000,7404000,"/Search/View?dp=1&key=2529472-cf38baaad53fabc1462d3c8357c28732&start=5882&end=7404","https://assets.pipeline.soar.com/2529472-cf38baaad53fabc1462d3c8357c28732/thumbnail_5882000.jpg","/articles/6291728/California/OCA-previews-baseline-healthspending-report-and-new-data-submission-guide-physician-organization-reporting-deferred","https://secure.pipeline.soar.com/6291728-495de68013c95e963ef024af17c76625/orig.mp4?Expires=1771186631&Signature=VDccmJLIAMkpuTnkzB0k1LpjEpbgKwGgMrDKpOszuv8p8i3tJAaqQFLZFipo9tF6wz79fDx0cdI7vHDRO9ux-hSe~zQAlHz~--8H4y8SBudy~ViByb2Iojb18BhG3Mhv5JG6FoLQ9mvH5tTElsLcPArhpCvwl0oUz588MuDi8JBeIE~Y2P51vlr9Lh1-OpatXQaCmdOQIO9NuxnMaDoD3fXGqCbRwIN1wYnFKsWFOYGmvRSdSrJE5lxHs-WJV0cAar6-ry6a9C2AVqj1jUm0fT4g049n-ahlYGJMSlf-DoT2qfNvPDKxufL6KuF~kkrVCdAJtYagQVekaEyc-2c0xg__&Key-Pair-Id=KUT5TJCACFTXG","The Office of Health Care Affordability told the board it will publish a baseline total health care expenditure report covering calendar years 2022 and 2023 on or before June 1, 2025. The baseline will report statewide total health care expenditures by market category (commercial, Medicare, Medi‑Cal), by service category (hospital inpatient, outpatient, professional, pharmacy, long‑term care and other services), and by region, staff said.

Staff warned that physician‑organization level reporting is not yet ready for the baseline. OCA said the first data collection round was a learning year and that it will instruct payers in the second round (due September 1, 2025) to attribute spending to major physician organizations using Tax ID numbers. OCA plans to add physician organization reporting as soon as attribution can be validated.

Separately, staff summarized public comments on the proposed Total Health Care Expenditures Data Submission Guide (DSG2). Key points: the DSG will restore member responsibility fields to statewide TME files; CMS hospital price transparency files (machine‑readable data) were compared with HCAI annual financial data but are limited (service volumes not in CMS files and compliance varied); OCA will continue to coordinate with DHCS so Medi‑Cal MCO reporting aligns and to reduce duplicated reporting; and the office expects to collect APM and primary‑care files on a later schedule to reduce burden.

Board members and outside speakers pressed staff to include consumer affordability metrics (premiums, out‑of‑pocket), to compare OCA totals to other statewide estimates, and to pursue estimates of administrative costs on the provider side. Participants also urged OCA to be transparent about gaps and asterisks in the first baseline report. Public commenters representing employers, community groups and the UC Berkeley Labor Center said affordability should be front and center in the baseline analysis.","Staff previewed the baseline total health care expenditure (TME) report using 2022'023 data, described what will and will not be included in the June baseline report, and summarized public comments on the proposed data submission guide (DSG) revisions and new APM/primary care files.","actionData","errors"]

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OCA recommends method to identify high‑cost hospitals; proposes lower growth targets for 11 outliers

OCA outlines straw model for behavioral‑health investment benchmark focused on outpatient and community care

OCA previews baseline health‑spending report and new data submission guide; physician organization reporting deferred