California health care markets vary significantly by metropolitan area. Some are highly consolidated, while others are markedly less so. Kaiser Permanente has a large presence in some areas, but a smaller one in others. The degree of commitment to population health and ACO contracting varies, and populations are different, varying by age, income, health, and access to care.
Recent developments—including ACA insurance expansions, changes in Medicare and Medicaid provider payments, ACOs, and increases in patient cost-sharing—affect the delivery of care in California markets. These developments challenge the viability of hospitals, physician groups, and other health care organizations, and they threaten to hinder access to local health services as premiums and insurance prevalence grow. In 2013, a group of health care leaders from across the state convened to address the health care delivery issues facing California. They came up with a report that sketched out a vision for health care in California in the early 2020s:
A New Vision for California’s Healthcare System: Integrated Care with Aligned Financial Incentives (PDF) (Review the Executive Summary on pages 6-9 and the Vision found on pages 12-13.)
The objective of this exercise is to develop a set of recommendations for provider organizations in each of the following California markets to change in ways consistent with the vision expressed in the Berkeley report:
Recent CHCF reports provide details regarding the diversity of organizational models and affected populations within these markets: California Health Care Almanac: Regional Markets.
Another resource to consider for ideas on how change is happening is a California Health Care Foundation Report: Many Routes to the Top: Efforts to Improve Care Quality, Coordination, and Costs through Provider Collaborations (PDF).