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