OCA previews baseline spending report, updates data submission guide and APM/primary‑care reporting timeline

Summary

OCA staff previewed the baseline report that will present 2022–2023 total medical expense (TME) data by payer, region and service category; described where physician‑organization attribution and primary‑care/APM data will fit into future reporting; and summarized public comments on the revised data submission guide (DSG2) and timelines.

Monterey — Office of Healthcare Affordability staff told the Board on Feb. 25 that the agency will publish a baseline report, due by June 1, 2025, using calendar‑year 2022–23 data to show statewide total medical expense (TME) and enrollment by payer and to disaggregate spending by service category and region.

The baseline will combine claims‑based TME with plan administrative costs and profit where available, showing aggregate TME, per‑capita/TME per member per year measures, and year‑over‑year changes. Staff said commercial, Medicare Advantage and many Medi‑Cal managed‑care figures will be included though OCA is still working to consolidate Medi‑Cal MCO data with DHCS. Staff recorded that 2022 commercial and MA files are already in hand and that OCA will incorporate Medi‑Cal managed‑care MCO data with assistance from the Department of Health Care Services.

Staff explained what will not appear in the initial baseline: physician‑organization level reporting and…

OCA previews baseline spending report, updates data submission guide and APM/primary‑care reporting timeline

Summary

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