[{"_1":2,"_124":-5,"_125":-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",[32,76,88,100,112],{"_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",6230201,"mediaKeyId","3442673-c055a2037871ce088cf35830b8296a2a","parentId",3442673,"title","OCA proposes aligned quality and equity measure set; plans to collaborate on hospital safety measures","audioSeconds",331,"startMs",13366000,"endMs",13697000,"viewUrl","/Search/View?dp=1&key=3442673-c055a2037871ce088cf35830b8296a2a&start=13366&end=13697","thumbnailUrl","https://assets.pipeline.soar.com/3442673-c055a2037871ce088cf35830b8296a2a/thumbnail_13366000.jpg","articleUrl","/articles/6230201/California/OCA-proposes-aligned-quality-and-equity-measure-set-plans-to-collaborate-on-hospital-safety-measures","mediaUrl","https://secure.pipeline.soar.com/6230201-2bd66cf2b655feb28aac8eee1afb71ed/orig.mp4?Expires=1771051886&Signature=UE5gw-thF1td1-~d9bu1rBbI~WJXatiOMlAX4agVI~W1lOD6BPs3GS-BU3yCUwGcyXFb5RACQJzmRCWt9-moBOyOtLeK0uZtTJxK9EBunHodqNFHq9-ztu5NOBnEyaNGkyqqJKXPQNUNO2A76OKEZ4hAC8nd7La-5bK334p3xat8NHzO7bpokYtEIqSSI8oY5-RlJLv1W5UPBElyd5n783gfu-5qeaSFkmtPS5qLuny29en29eyjXAor9Pfx29RKlBPRdIbtvMn-1G43VZKeWaYwpNfc3F1Ar6i9tXrcIuYbPcuIIXH5U~LhiWiMWwfoJdGb8uBoF6pHGHebtdGrFw__&Key-Pair-Id=KUT5TJCACFTXG","author","Department of Health Care Access and Information","date","2025-05-22T11:19:57.117Z","article","OCA presented a recommended quality and equity measure set that relies on existing public measure sets and committed to a coordinated process to add hospital patient safety measures after further interagency work.

Staff said OCA will adopt (or adopt a subset of) three existing measure sets to reduce reporting burden and align state reporting. For payers, OCA proposed using the Department of Managed Health Care’s Health Equity and Quality Measure Set (including its stratification rules). For physician organizations, OCA proposed a subset of the Office of the Patient Advocate (OPA) healthcare quality report card measures. For hospitals, OCA proposed using the full HCAI hospital equity measures reporting program and its stratification requirements. Staff noted that measures and stratification will evolve; OCA plans annual review and updates.

Several advisory members and public commenters urged OCA to add hospital patient‑safety measures, including healthcare‑associated infection (HAI) metrics. Staff described existing HAI reporting by the California Department of Public Health (CDPH) and said CDPH does not currently stratify HAIs by demographic characteristics. To address the concern, OCA plans to collaborate with Covered California, CalPERS and other agencies to develop an aligned set of hospital patient‑safety measures and to consider adding them to OCA’s measure set in fall 2025. OCA also said it will work with sibling agencies and measure‑set owners on improved demographic data collection (race/ethnicity, language, disability, sexual orientation and gender identity) and with research partners to explore extended equity analysis beyond simple stratification.

Public commenters and committee members supported alignment but raised caveats: some urged more behavioral‑health measures and broader stratification; others worried about small sample sizes for CAHPS surveys and the administrative burden of new measures. Several stakeholder commenters emphasized the value of outcome measures and the need for improved race/ethnicity data collection; one commenter noted Covered California has reached roughly 80 percent self‑reported race/ethnicity capture.

Staff said OCA will begin public reporting on the measure set in its June 2027 annual report and will coordinate measure changes with measure owners and regulated entities in advance of reporting.","mediaType","Video","parentTitle","March 2025 | Health Care Affordability Advisory Committee Meeting","oneSentenceSummary","OCA proposed adopting existing, publicly available measure sets for payers, physician organizations and hospitals, and said it will work with sibling state agencies to consider adding hospital patient‑safety (HAI) measures and to improve demographic stratification over time.","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},6230206,"AltaMed outlines programs that reduced hospital use and improved outcomes for high‑risk patients",30,12010000,12040000,"/Search/View?dp=1&key=3442673-c055a2037871ce088cf35830b8296a2a&start=12010&end=12040","https://assets.pipeline.soar.com/3442673-c055a2037871ce088cf35830b8296a2a/thumbnail_12010000.jpg","/articles/6230206/California/AltaMed-outlines-programs-that-reduced-hospital-use-and-improved-outcomes-for-highrisk-patients","https://secure.pipeline.soar.com/6230206-e2080b9d91f36233465b53c460f00c68/orig.mp4?Expires=1771051886&Signature=Xq~LPMqplWmnFZjcBNL7i4j8Gp4fBXWweDEK7voM4KlDO-XyAziNfTWxmzMmKusWA1-uaumTeBjz~CS4vWXJV5jRm9WL4XsXMiNt~Yc-alN7v1Yiq2HthEdsLOEz8LVCBiodc~jRO1wFF-TeyEeFINJTTE7wNQ2dhh2TrX6Q5tDz4xUrN5RL8itoLwUxxsoX7h4xY7r8MSQsdQZRryw8cc9pK2QyTsj8EM1JbUMIfx5OKbtExLokNzKyntOd5Syu9NmAki5p6SppNx1CVzVQLof7Tmmn7Hq46ACVZtCsZPGnA6jO0Eh~D3HnnW57Cf9nZ3lYu6n84nh9fuN~2Cq5gQ__&Key-Pair-Id=KUT5TJCACFTXG","AltaMed presented several operational strategies it uses to lower costs and improve outcomes for medically and socially complex patients, drawing on full‑risk contracting, care teams and workforce development.

Efrain Telematis, described as “UltaMed Senior Vice President and Chief Operations Officer,” described a multiyear transformation: AltaMed operates 67 clinics in Los Angeles and Orange counties, serves roughly half a million patients and is primarily Medi‑Cal‑funded. The system has layered affiliates, including a managed services organization and a delegated (Knox‑Keene) entity that can accept global risk and support contracting with plans and hospitals.

Speakers outlined key programs:
• VIVA Gold Senior Care: a team‑based, lower‑panel concierge primary‑care model for older adults with higher social and clinical complexity. AltaMed reported lower ED use and fewer admissions among enrolled seniors and said the model provides same‑day access and home visits where needed.
• Enhanced Care Management (ECM): case‑management teams and community health workers focused on high‑need members; AltaMed reported reductions in ED and readmissions where ECM is used but noted administrative challenges in enrollment and workforce retention.
• Home‑visitation and street‑medicine teams: nurse‑practitioner‑led teams that perform home visits and outreach to high‑risk patients who cannot easily access clinic care.
• Hospitalist employment and transitions: AltaMed employs hospitalists at key partner hospitals to improve discharge planning and post‑discharge follow‑up.
• Workforce and pipeline investments: a residency program in family medicine, nurse‑practitioner residency, site medical director training, a nursing collaborative and other pipeline programs to recruit and retain bilingual clinicians from the communities served.

Telematis and committee members said the organization’s move to capitation and risk contracts permitted targeted investments in care navigation, registries and non‑physician teams. Committee members asked about continuity vs access in the VIVA Gold model; AltaMed said patients can still see their PCP and that primary clinicians help identify patients who would benefit from the senior program. AltaMed also said most telehealth services are provided by an in‑house 24/7 telehealth team, integrated with same‑day clinic access.

Committee members praised AltaMed’s wildfire response and its flexible deployment of clinical teams during emergencies. AltaMed said it is willing to share models and data with peers and state staff for replication and learning.","AltaMed described value‑based programs—VIVA Gold senior care, enhanced care management, home visits, hospitalist integration and workforce pipeline investments—that it said reduced emergency visits and hospitalizations and improved care for complex patients served by this large FQHC system.",{"_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},6230212,"OCA outlines behavioral health spending measurement and options for a focused investment benchmark",1665,5989000,7654000,"/Search/View?dp=1&key=3442673-c055a2037871ce088cf35830b8296a2a&start=5989&end=7654","https://assets.pipeline.soar.com/3442673-c055a2037871ce088cf35830b8296a2a/thumbnail_5989000.jpg","/articles/6230212/California/OCA-outlines-behavioral-health-spending-measurement-and-options-for-a-focused-investment-benchmark","https://secure.pipeline.soar.com/6230212-8587fef7f5cf5ebf8782dd1b74678de4/orig.mp4?Expires=1771051886&Signature=dullDd0aN3KMnEyPwjCC6npzv9xOjZ1jLLfPZpAPbrLbpeWbmG5yfwCQ8G4K7ZZP9nshbnwQgwLJMeilCbfIEGJvuA~hU6wMHqwOtC6ZGnZylwX2a47jTLgZsuzFCCIuDl13iEm6zVRCi1m0mj05y6d8DbhnP6GrCV-51da9Z2bI-39h2QiCXSYDqajNeaJo9Pj61RRSL2iLsgmZ9elBZ9GTyvTxXxgl8VBxYjL-O1LZPJyBg~bLz7LQNRUtnOLwFVKKBBm6eYohhHB1OMv3vxe~D~6EgYgJG6mvSwnHSoPVDrw5JzweHnp-WlUqomh2sMJx9nNNoW90g4EG33swoA__&Key-Pair-Id=KUT5TJCACFTXG","OCA presented its proposed approach to measuring behavioral health spending and canvassed options for a behavioral health investment benchmark to incentivize prevention, community‑based services and integration with primary care.

Staff described a two‑part measurement strategy: a numerator of behavioral health spending (claims and allocated non‑claims payments) and a denominator of total medical expenses. For claims‑based spending OCA proposes including lines where the primary diagnosis is a behavioral health diagnosis and additional service codes for screening/assessment; pharmacy spending would be included when the National Drug Code (NDC) corresponds to a behavioral health treatment. Non‑claims spending would be captured through an expanded framework that classifies payments into categories (for example, capitation, performance payments, population health payments) and allocates portions to behavioral health using established formulas. OCA said it would include behavioral health capitation in full and allocate a portion of broader capitations and practice transformation payments to behavioral health where appropriate.

On the benchmark design, staff described two broad approaches: set the benchmark as a percentage of total medical expenses (consistent with OCA primary care practice) or as a per‑member‑per‑month (PMPM) amount (used in Rhode Island’s recent benchmark). OCA noted tradeoffs: a TME percentage signals reallocation across the health spending pie, while PMPM better reflects the incremental per‑member cost of expanding community‑based care and can guard against undue inflation if TME rises. Staff also asked whether the benchmark should focus on short‑term annual improvement, a long‑term investment target (e.g., through 2034) or a combination — and whether the timeline should align with OCA’s other multi‑year goals (primary care/APM goals to 2034 and spending‑growth targets through 2029).

Committee members and public commenters emphasized capturing behavioral health in primary care (integration), the importance of including outpatient and community‑based services, and the need to measure access and equity. Several committee members urged OCA to consider Medi‑Cal dynamics and how non‑plan payments (employer EAPs, nonprofit funding) are counted. Some suggested a PMPM approach; others preferred a TME‑based goal that would require resource reallocation rather than overall spending increases.

OCA said it will present a recommended benchmark to the board in July 2025 after ongoing work with an investment and payment work group and stakeholder engagement. Staff said they will continue to refine the service categories, NDC lists for behavioral health drugs, and non‑claims allocation methods and will align reporting with payer submission timetables.","OCA staff described a proposed method to measure behavioral health spending (claims and non‑claims) and presented options for a narrower investment benchmark that would prioritize outpatient and community‑based services, asking the advisory committee for input on measurement choices and timelines.",{"_33":101,"_35":36,"_37":38,"_39":102,"_41":103,"_43":104,"_45":105,"_47":106,"_49":107,"_51":108,"_53":109,"_55":56,"_57":58,"_59":110,"_61":62,"_63":64,"_65":111,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6230217,"New bill would expand OCA reporting and add private equity, health systems and MSOs to oversight",76,386000,462000,"/Search/View?dp=1&key=3442673-c055a2037871ce088cf35830b8296a2a&start=386&end=462","https://assets.pipeline.soar.com/3442673-c055a2037871ce088cf35830b8296a2a/thumbnail_386000.jpg","/articles/6230217/California/New-bill-would-expand-OCA-reporting-and-add-private-equity-health-systems-and-MSOs-to-oversight","https://secure.pipeline.soar.com/6230217-81d1bdaaae0f30d2495ec44fa8badd0b/orig.mp4?Expires=1771051886&Signature=ozBJG5l0tpvLwX1SlM9--fYKXj7HtCLSWeK5QvS9leruLnXdOmnu20wk7OQ~6kpGQPhRWVP-oAHEiZKF72DW10S~WZyzHDtEKM~gwHTUlqVRaLoWl82oALep4bWLa~LMn3ICkZnz2HR0jA7gWQUYA9rYEW6S~CBSmU7WZ5DLsGq9SGt4JvL0Tnxn1aBDngC6Q~1Qpd433qF7EUk6e8g9OPlbYO4OiXULozL1cK53vMBTess-VNTVSROj~G~boDgrUFc1UkqjSqiv3o7p06qk0sBedwp1CiCgLdlY~YbvA0kH3qQ-RAWEw9iOQKYFhyyw8rBncvfHVNlfeUy5rzu2vA__&Key-Pair-Id=KUT5TJCACFTXG","OCA staff briefed the committee on AB 1415, a bill introduced this legislative session that would change who is covered by the state spending‑growth law and who must notify OCA of proposed mergers and acquisitions.

The director’s office said AB 1415 would add “healthcare systems” and management services organizations (MSOs) to the definition of entities subject to OCA’s spending growth target statute and would allow OCA to collect data at the health‑system level. The bill would also add private equity groups, hedge funds and newly created entities formed for a transaction to the list of parties required to provide notice to OCA before a proposed merger or acquisition takes effect.

OCA staff characterized the additions as a response to concerns that complex deals and newly formed acquisition vehicles can obscure who ultimately controls price‑setting and market power. The bill is moving through the legislative process; staff framed the committee briefing as an early update for advisory members.

The committee did not take formal action on the bill during the meeting. Staff said they would continue monitoring legislative progress and report back to the board and advisory committee as the bill moves through the session.","OCA staff told the advisory committee that Assembly Bill 1415 (AB 1415), introduced by Assemblymember Mia Bonta and sponsored by Health Access, would expand the entities subject to the spending growth law and require additional pre‑transaction reporting from private equity, hedge funds and transaction‑specific entities.",{"_33":113,"_35":36,"_37":38,"_39":114,"_41":115,"_43":116,"_45":117,"_47":118,"_49":119,"_51":120,"_53":121,"_55":56,"_57":58,"_59":122,"_61":62,"_63":64,"_65":123,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6230223,"OCA advances hospital sector regulations and proposes adjusted targets for 11 high‑cost hospitals",1281,1578000,2859000,"/Search/View?dp=1&key=3442673-c055a2037871ce088cf35830b8296a2a&start=1578&end=2859","https://assets.pipeline.soar.com/3442673-c055a2037871ce088cf35830b8296a2a/thumbnail_1578000.jpg","/articles/6230223/California/OCA-advances-hospital-sector-regulations-and-proposes-adjusted-targets-for-11-highcost-hospitals","https://secure.pipeline.soar.com/6230223-4d470ebffa03c19e5896873308ea6da1/orig.mp4?Expires=1771051886&Signature=OQoO3gkpy915nhB-d0o0b1HmGy5IPqibPkX6INCUUGSx47vQVBw2i44JclpSzPVexi8UA2WWE-JlGXMYslW2wQkruAlfFYXB1Zxz1KC2PGF-rvLTRHx6WfpUB4v16dqD-fWs~Z5-b3U9LmFwkc7mG3jVLOukri3fmW-jg1qgvD2TUf7ekzrH3U~eLwpTwq5N8teR9DD7-p~vZ-uj-qAiYNKkeE-pFQGTVOxFEwvBIPBFF-khG8Yny17lSb-NLA2Gzy3ogHSYtyaQn3gTVMGZNLrPPgKiC7S3f~NSD16HHGYZqBr6~9YRnNvmSDYYRtJvT8HA~XM04EeSY9Zm~YRRIw__&Key-Pair-Id=KUT5TJCACFTXG","The Office of Health Care Affordability presented its proposed hospital sector definition regulations and a recommended methodology for identifying disproportionately high‑cost hospitals and setting adjusted sector targets.

OCA staff said the proposed sector, drawn from Health and Safety Code section 12 50, would include general acute care hospitals, acute psychiatric hospitals, special hospitals, chemical dependency recovery hospitals and psychiatric health facilities. CJ Howard, “Assistant Deputy Director over the Healthcare Spending Targets branch within the office of healthcare portability,” briefed the advisory committee on the agency’s plan to submit the regulation package to the Office of Administrative Law this spring.

The board‑level policy matter matters because hospitals account for a large share of healthcare spending and the sector designation allows a tailored target‑setting approach. OCA also proposed a five‑step methodology to identify “repeat outliers” (hospitals above the 80th percentile on both a unit‑price and a relative‑price measure for 3 of 5 years, 2018–2022). Using commercial inpatient net patient revenue per case‑mix‑adjusted discharge (NPR per CMAD) and a commercial‑to‑Medicare payment‑to‑cost ratio, staff said the approach flagged 11 hospitals as repeatedly disproportionately high cost.

OCA recommended the hospital sector target start by default equal to the statewide spending target and that targets for the identified high‑cost hospitals be adjusted downward by a “cost relativity” factor. Under the example shown to the committee, a statewide target of 3.5 percent divided by an average cost relativity of 1.9 would yield an adjusted target of about 1.8 percent for that group of hospitals.

Public commenters and committee members pressed staff on details. Beth Capelle of Health Access said she backed the proposed regulation “defining all hospitals as general acute care as hospitals for the purpose of defining sector,” and added, “This includes Kaiser hospitals.” In contrast Ben Johnson of the California Hospital Association told the committee, “California hospitals oppose the establishment of a hospital sector at this time, given that it comes years ahead of schedule and, before OCA has done major pieces of due diligence,” and warned proposed targets could force service reductions at hospitals already reporting low cash reserves.

Committee members asked about measurement choices and next steps. Questions included how long‑term care or long‑term acute care beds are treated under the statutory definition; clarification that Kaiser system reporting is handled differently because statute treats fully integrated delivery systems separately; concerns about outpatient volume (committee members noted shifting care away from inpatient settings); and how capitation and Medicare Advantage payments are allocated in hospital financial filings. Staff said Kaiser facilities are included in reporting but were excluded from the high‑cost outlier analysis because comparable financial data were not available in the same form. Staff also said they will continue to meet individually with the 11 identified facilities and report back to the board on preliminary follow‑up work.

OCA opened a 45‑day public comment window on the target methodology (closing April 11), and the board has until June 1 to set 2026 targets. The advisory committee recommended additional regional checks, suggested a rolling recent‑years approach (for example a rolling three‑year window) and urged staff to include outpatient intensity measures over time.

Among next steps, OCA staff said they will: continue individual meetings with the 11 hospitals; investigate recent data anomalies at specific facilities; finalize the public comment summary; and return to the board with any proposed modifications before formalizing targets.","The Office of Health Care Affordability (OCA) presented draft hospital sector regulations and a methodology to identify and set adjusted spending‑growth targets for 11 repeatedly high‑cost hospitals, drawing support from patient‑advocacy groups and opposition from the California Hospital Association.","actionData","errors"]

Article not found

OCA proposes aligned quality and equity measure set; plans to collaborate on hospital safety measures

AltaMed outlines programs that reduced hospital use and improved outcomes for high‑risk patients

OCA outlines behavioral health spending measurement and options for a focused investment benchmark

New bill would expand OCA reporting and add private equity, health systems and MSOs to oversight

OCA advances hospital sector regulations and proposes adjusted targets for 11 high‑cost hospitals