CHA News Article

Updated California Regional Health Care Cost and Quality Atlas Available

The Integrated Healthcare Association has released the second edition of its California Regional Health Care Cost & Quality Atlas, reflecting multi-payer data by geographic region — including commercial insurance, Medicare and Medi-Cal — on more than 30 standardized measures of health care quality, cost, patient cost sharing and utilization. Developed with support from the California Health Care Foundation and the California Health and Human Services Agency, the atlas includes information about care provided in 2013 and 2015, just before and after the Affordable Care Act (ACA) coverage expansions took effect. The updated atlas incorporates new characteristics to allow comparison among market segments, subpopulations and the overall insured population. The new characteristics include large group, small group and individual coverage; self-insured employers; Covered California; risk-sharing arrangements; accountable care organizations; and clinical condition cohorts.

According to the data, clinical quality in 2015 varied across the state’s 19 geographic regions by an average of 25 percentage points, and costs ranged from 22 percent below the statewide average to 29 percent above.

According to the report:

  • In 2015, commercial health maintenance organizations (HMOs) outperformed preferred provider organizations (PPOs) on average by 14 percentage points across 10 clinical quality measures of preventive, acute and chronic care, and did so at a 9 percent average lower total cost of care.
  • PPO quality improved markedly since the first atlas results from 2013, showing a 7 percentage point improvement. PPO-based accountable care organization models stress greater care integration and performed better than the general PPO population, which may have been a factor in improved overall PPO clinical quality from 2013 to 2015.
  • Patient cost sharing in PPOs in 2015 was $838 per member versus $69 per HMO member. The 4.3 million PPO members included in the most recent atlas paid an additional $3.3 billion out of pocket for covered care in 2015 compared to HMO members.
  • Results for Medicare Advantage (MA, HMO) compared to fee-for-service Medicare reveal that Medicare Advantage outperforms fee-for-service on quality by an average of 22 percentage points and shows a 25 percent better total cost on a risk-adjusted basis. Given the costs of care for the Medicare population, this translates to thousands of dollars of savings per member, including on average $1,800 per member in out of pocket costs.
  • For the 11 million Californians now enrolled with full-scope benefits in the Medi-Cal program, overall quality performance decreased from 2013 to 2015. During the same period, there were millions of new enrollees through the ACA coverage expansion. The rate of Medi-Cal emergency department visits also increased from 2013 to 2015. However, regions with the greatest increase in visits were not necessarily regions with the largest enrollment increases.