BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON HEALTH
                          Senator Ed Hernandez, O.D., Chair

          BILL NO:                    SB 26     
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          |AUTHOR:        |Hernandez                                      |
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          |VERSION:       |December 1, 2014                               |
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          |HEARING DATE:  |April 22, 2015 |               |               |
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          |CONSULTANT:    |Melanie Moreno                                 |
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           SUBJECT  :  California Health Care Cost and Quality Database

           SUMMARY  :  Requires the Secretary of California Health and Human Services  
          Agency to, no later than January 1, 2017, use a competitive  
          process to contract, as specified, with one or more independent,  
          nonprofit organizations in order to administer the California  
          Health Care Cost and Quality Database. Requires the nonprofit  
          organization, no later than January 1, 2019, to make a publicly  
          available, web-based, searchable database, as specified.  
          Requires the information and analysis included in the database  
          to be presented in a way that facilitates comparisons of cost,  
          quality, and patient satisfaction across payers, provider  
          organizations, and other suppliers of health care services.
          
          Existing law:
          1.Establishes the Office of Statewide Health Planning and  
            Development (OSHPD) as the single state agency responsible for  
            collecting specified health facility and clinic data for use  
            by all agencies.  Requires hospitals to make and file with  
            OSHPD certain specified reports, including a Hospital  
            Discharge Abstract Data Record with data elements for each  
            admission, such as diagnoses and disposition of the patient.  

          2.Requires OSHPD, to publish annually risk-adjusted outcome  
            reports on medical, surgical and obstetric conditions or  
            procedures, and others selected by OSHPD in accordance with  
            specified criteria.

          3.Requires OSHPD, to publish a risk-adjusted outcome report for  
            coronary artery bypass graft (CABG) surgery for all CABG  
            surgeries performed in the state. Requires the reports to  
            compare risk-adjusted outcomes by hospital in every year, and  
            by cardiac surgeon in every other year, but permits  







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            information on individual hospitals and surgeons to be  
            excluded from the reports based upon the recommendation of a  
            clinical panel for statistical and technical considerations.  

          4.Requires a hospital to make a written or electronic copy of  
            its charge description master available at the hospital  
            location.  Requires the hospital to post a notice that the  
            hospital's charge description master is available, and  
            requires any information about charges provided to include  
            information about where to obtain information regarding  
            hospital quality, including hospital outcome studies available  
            from OSHPD and hospital survey information available from the  
            Joint Commission for Accreditation of Healthcare  
            Organizations. 

          5.Establishes the Department of Managed Health Care (DMHC) to  
            regulate health plans and the California Department of  
            Insurance (CDI) to regulate health insurers.  Requires  
            specified health plans and insurers to submit reports to state  
            and federal regulators on medical loss ratios, rate filings,  
            enrollment data, as specified.

          6.Prohibits contracts between carriers and a licensed hospital  
            or health care facility owned by a licensed hospital from  
            containing any provision that restricts the ability of the  
            carrier from furnishing information to enrollees or insureds  
            concerning the cost range of procedures or the quality of  
            services.  Provides hospitals at least 20 days in advance to  
            review the methodology and data, requires risk adjustment  
            factors for quality data, and requires an opportunity for a  
            hospital to provide a link on the carrier's Website where the  
            hospital's response to the data can be accessed.

          7.Makes, under federal law, Medicare data available for the  
            evaluation of the performance of providers of services and  
            suppliers, to qualified entities, defined as a public or  
            private entity that is qualified as determined by the  
            Secretary of the federal Department of Health and Human  
            Services (HHS), to use to evaluate the performance of  
            providers of services and suppliers on measures of quality,  
            efficiency, effectiveness, and resource use, and applies other  
            requirements to qualified entities as the HHS Secretary may  
            specify, such as ensuring security of data.

          8.Prohibits a health plan from releasing any information to an  








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            employer that would directly or indirectly indicate to the  
            employer that an employee is receiving or has received  
            services from a health care provider covered by the plan  
            unless authorized to do so by the employee.  

          9.Establishes Covered California as a state-based health care  
            benefit exchange in state government to make available  
            selectively contracted qualified health plans (QHPs) for  
            individual and small group purchasers.  Requires QHPs to  
            submit data to Covered California.

          10.Establishes, under federal law, the Health Insurance  
            Portability and Accountability Act of 1996 (HIPAA), which  
            among various provisions, mandates industry-wide standards for  
            health care information on electronic billing and other  
            processes; and, requires the protection and confidential  
            handling of protected health information.

          11.Establishes the Confidentiality of Medical Information Act,  
            which prohibits providers of healthcare, health care service  
            plans, their contractors, and any business organized for the  
            purpose of maintaining medical information, from using medical  
            information for any purpose other than providing health care  
            services, except as expressly authorized by the patient or as  
            otherwise required or authorized by law.  
          
          This bill:
          1.Creates the California Health Care Cost and Quality Database  
            (database) and requires the Secretary of California Health and  
            Human Services Agency (CHHS) to, no later than January 1,  
            2017, use a competitive process to contract, as specified,  
            with one or more independent, nonprofit organizations in order  
            to administer it. Requires the competitive process and any  
            requests for proposal to be publicly posted on CHHS' Web site  
            for a minimum of 30 days for public review and comment. 

          2.Requires CHHS to include, as terms in the contract or  
            contracts:

                  a.        A requirement that the nonprofit organization  
                    administering the database establish it with  
                    parameters as specified in 13) below; develop  
                    methodologies for the collection, validation,  
                    refinement, analysis, comparison, review, reporting,  
                    and improvement of health care data, as specified;  








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                    receive information from health care entities and  
                    report that information in a form that allows valid  
                    comparisons across care delivery systems, as  
                    specified; and, comply with the requirements governing  
                    provider and supplier requests for error correction  
                    established pursuant specified federal regulations. 
                  b.        A prohibition on the nonprofit from using data  
                    received for any purpose not specified in this bill or  
                    in the contract, or receiving funding from any other  
                    source to accomplish the same purposes sought under  
                    this bill unless that funding is received from another  
                    nonprofit or government source and is for the purpose  
                    of research or education.
                  c.        A requirement that the nonprofit identify the  
                    type of data, purpose of use, and entities and  
                    individuals that are required to report to, or that  
                    may have access to, the database. Prohibits an entity  
                    or individual from being required to report to, and  
                    from having access to, the database until the review  
                    committee established under 13) below has approved the  
                    nonprofit determination.

          3.Requires, for the purpose of developing information for  
            inclusion in the database, health plans, insurers,  
            self-insured employers, and suppliers and providers, as  
            defined,  to provide the nonprofit organization:

                  a.        Utilization data from medical, dental, and  
                    pharmacy claims.  In the case of entities that do not  
                    use claims data (including, but not limited to,  
                    integrated delivery systems), encounter data  
                    consistent with the core set of data elements for data  
                    submission proposed by the APCD Council, the  
                    University of New Hampshire, and the National  
                    Association of Health Data Organizations; and,
                  b.        Pricing information for health care items,  
                    services, and medical and surgical episodes of care  
                    gathered from allowed charges for covered health care  
                    items and services.  In the case of entities that do  
                    not use or produce individual claims, price  
                    information that is the best possible proxy to pricing  
                    information for health care items, services, and  
                    medical and surgical episodes of care available in  
                    lieu of actual cost data to allow for meaningful  
                    comparisons of provider prices and treatment costs.








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          4.Permits a multiemployer self-insured plan that is responsible  
            for paying for health care services provided to beneficiaries  
            and the trust administrator for a multiemployer self-insured  
            plan to provide the information in 3) above.

          5.Permits the nonprofit organization to report an entity's  
            failure to comply with 3) above to the entity's regulating  
            agency.  Permits the regulating agency to enforce the  
            requirement in 3) above using its existing enforcement  
            procedures. Requires moneys collected pursuant to the  
            authorization to enforce to be subject to appropriation by the  
            Legislature.  Specifies that the failure to comply with 3)  
            above is not a crime.

          6.Requires all uses and disclosures of data made pursuant to  
            this bill to comply with all applicable state and federal laws  
            for the protection of the privacy and security of data,  
            including, but not limited to, HIPAA and the federal Health  
            Information Technology for Economic and Clinical Health Act  
            and implementing regulations.

          7.Requires all policies and protocols developed in the  
            performance of the contract to ensure that the privacy,  
            security, and confidentiality of individually identifiable  
            health information is protected.  Prohibits the nonprofit  
            organization from publicly disclosing any unaggregated,  
            individually identifiable health information, as defined, and  
            requires the nonprofit to develop a protocol for assessing the  
            risk of reidentification stemming from public disclosure of  
            any health information that is aggregated, individually  
            identifiable health information.

          8.Requires confidentially negotiated contract terms contained in  
            a contract between a health plan or insurer and a provider or  
            supplier to be protected in any public disclosure of data made  
            pursuant to this bill.  Prohibits individually identifiable  
            proprietary contract information included in a contract  
            between a health plan or insurer and a provider or supplier  
            from being disclosed in an unaggregated format.

          9.Requires the nonprofit organization to receive, process,  
            maintain, and analyze information from data sources,  
            including, but not limited to, data received pursuant to  
            subdivision #3 above, claims from private and public payers,  








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            disease and chronic condition registries, third-party surveys  
            of quality and patient satisfaction, reviews by licensing and  
            accrediting bodies, and local and regional public health data.  
            Requires aggregated payer and provider performance on  
            validated measures of clinical quality and patient experience,  
            such as measures from the Healthcare Effectiveness Data and  
            Information Set (HEDIS) and Consumer Assessment of Healthcare  
            Providers and Systems (CAHPS), to be collected from  
            accrediting organizations, including, but not limited to, the  
            National Committee for Quality Assurance (NCQA), URAC, and the  
            Joint Commission.

          10.Requires the nonprofit organization to include in an  
            analysis, performed pursuant to 9) above, to include all of  
            the following:

                  a.        Population-level data on prevention,  
                    screening, and wellness utilization;
                  b.        Population-level data on behavioral and  
                    medical risk factors, interventions, and outcomes;
                  c.        Population-level data on chronic conditions,  
                    management, and outcomes;
                  d.        Population-level data on trends in utilization  
                    of procedures for treatment of similar conditions to  
                    evaluate medical appropriateness;
                  e.        Facility and physician organization risk  
                    adjusted performance information on the quality,  
                    efficiency, and outcomes of care that are aligned with  
                    national efforts, including, but not limited to, those  
                    of the National Quality Forum, related to defining  
                    cost and quality measures; and,
                  f.        Data that permits consideration of  
                    socioeconomic status and disparities in care due to  
                    race, ethnicity, gender, sexual orientation, and  
                    gender identity.

          11.Requires the nonprofit organization, no later than January 1,  
            2019, to make publicly available a web-based, searchable  
            database, as specified. Requires the information and analysis  
            included in the database to be presented in a way that  
            facilitates comparisons of cost, quality, and satisfaction  
            across payers, provider organizations, and other suppliers of  
            health care services. Requires the database to be regularly  
            updated to reflect new data submissions.









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          12.Prohibits the implementation and ongoing administration costs  
            of the database from being paid using General Fund (GF)  
            moneys.

          13.Requires CHHS to convene a review committee, composed of a  
            broad spectrum of health care stakeholders and experts,  
            including, but not limited to, representatives of the entities  
            that are required to provide information pursuant to 3) above  
            and representatives of purchasers, including, but not limited  
            to, businesses, organized labor, and consumers, to develop the  
            parameters for the establishment, implementation, and ongoing  
            administration of the database, including a business plan for  
            sustainability without using GF moneys, as specified. Requires  
            the review committee to hold public meetings with  
            stakeholders, solicit input, and set its own meeting agendas.  
            Makes review committee meetings subject to the Bagley-Keene  
            Open Meeting Act.

          14.Requires CHHS to arrange for the preparation of an annual  
            report to the Legislature and the Governor, as specified,  
            based on the findings of the review committee, including input  
            from the public meetings, that shall, at a minimum, examine  
            and address the following issues:

                  a.        Assessing California health care needs and  
                    available resources;
                  b.        Containing the cost of health care services  
                    and coverage;
                  c.        Improving the quality and medical  
                    appropriateness of health care;
                  d.        Increasing the transparency of health care  
                    costs and the relative efficiency with which care is  
                    delivered;
                  e.        Use of disease management, wellness,  
                    prevention, and other innovative programs to keep  
                    people healthy and reduce disparities and costs and  
                    improving health outcomes for all populations;
                  f.        Efficient utilization of prescription drugs  
                    and technology;
                  g.        Reducing unnecessary, inappropriate, and  
                    wasteful health care;
                  h.        Educating consumers in the use of health care  
                    information; and,
                  i.        Using existing data sources to build the  
                    database.








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          15.Prohibits the review committee from being convened until the  
            Director of Finance (DOF) has determined that sufficient  
            private or federal funds have been received and that the funds  
            have been appropriated for that purpose. Requires the review  
            committee to continue to function for as long as DOF has  
            determined that the database is established and is being  
            administered.

          16.Prohibits the members of the review committee from receiving  
            per diem or travel expense reimbursement, or any other expense  
            reimbursement.

           FISCAL  
          EFFECT  :  This bill has not been analyzed by a fiscal committee.

           COMMENTS  :
          1.Author's statement.  According to the author, beginning in  
            March 2014, the Senate Committee on Health convened several  
            health care experts to discuss factors that contribute to the  
            growing cost of health care in California and efforts to make  
            care more affordable. At a second hearing in February of this  
            year, the Committee heard testimony related to some major cost  
            drivers in the health care system, including pharmaceuticals,  
            hospital costs, and the effects of geographic location on  
            contracting. The third, held in March of this year, served to  
            educate members and the public about the effect of health care  
            costs on consumers. This series of hearings examined policy  
            solutions to control health care costs as millions of  
            Californians obtain coverage under the federal Patient  
            Protection and Affordable Care Act (ACA).  Testimony presented  
            at the hearings illustrated the complexity of the health care  
            market and the array of approaches to containing costs.  In  
            addition to expanded coverage, the author believes that, like  
            past health care reform efforts, a long-term, comprehensive  
            action agenda for California policymakers is necessary to  
            ensure that health care costs are appropriate and health care  
            premiums are affordable, especially given that the ACA  
            contains a mandate for individuals to purchase coverage.  The  
            author states this bill is intended to help make available  
            valid performance information to promote care that is safe,  
            medically effective, patient-centered, timely, efficient,  
            affordable and equitable.  This bill seeks to put provider  
            cost and performance information into the hands of consumers  
            and purchasers so that they are able to understand their  








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            financial liability and realize the best quality and value  
            available to them.
            
          2.All-Payer Claims Databases.  According to the National  
            Conference of State Legislatures, several states have  
            established databases that collect health insurance claims  
            information from all health care payers into a statewide  
            information repository, referred to as "all-payer claims  
            databases."  An all-payer claims database is designed to  
            inform cost containment and quality improvement efforts.  
            Payers include private health insurers, Medicaid, children's  
            health insurance and state employee health benefit programs,  
            prescription drug plans, dental insurers, self-insured  
            employer plans and Medicare. The databases contain eligibility  
            and claims data (medical, pharmacy and dental) and are used to  
            report cost, use and quality information. The data consist of  
            "service-level" information based on valid claims processed by  
            health payers. Service-level information includes charges and  
            payments, the provider(s) receiving payment, clinical  
            diagnosis and procedure codes, and patient demographics. To  
            mask the identity of patients and ensure privacy, states  
            usually encrypt, aggregate and suppress patient identifiers.   
            Colorado, Kansas, Minnesota, Tennessee, Maine, Maryland,  
            Massachusetts, New Hampshire, Utah and Vermont all have APCDs.  
            Most of these states have chosen to house their APCDs at a  
            state agency (either an existing agency or a newly created  
            entity); one state (Colorado) has its APCD run by a nonprofit  
            organization.  The papers emphasize the importance of engaging  
            key stakeholders early and often, including payers, health  
            care providers, employers, state agencies, and consumers.  The  
            papers note that for most states, legislation creating an APCD  
            usually articulates broad reporting goals which are further  
            refined in rules or regulations for data collection or data  
            use.
          
          3.Existing California initiatives. In California, the California  
            Healthcare Performance Information System (CHPI) is a  
            voluntary physician performance database with statistical  
            analysis that will eventually publish information online.  
            According to the CHPI website, starting in 2015, output will  
            be an analysis of claims data aggregated from more than 12  
            million patients enrolled in CHPI's three participating  
            California health plans- Blue Shield, Anthem Blue Cross and  
            United Healthcare, as well as Medicare. CHPI was federally  
            certified to include data from Medicare's five million  








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            California beneficiaries, and became the first Qualified  
            Entity to receive Medicare data. 

            The University of California, San Francisco is working with  
                                                                                      the California Department of Insurance (CDI) on a medical cost  
            and quality transparency website. According to CDI, the  
            website will report average prices paid for episodes of care  
            or annual costs for chronic conditions, as well as quality  
            measures where available. Prices will be aggregated across  
            payers and providers, and shown at the regional level based on  
            the 19 California rating regions (some regions may need to be  
            consolidated pursuant to the terms of the data license  
            agreement). The website is expected to provide price  
            information for 95 to 99 episodes of care or conditions. Five  
            to 15 of those episodes or conditions will have both price and  
            quality information as well as consumer education content  
            created by Consumers Union. Quality information will consist  
            of existing performance, appropriateness, and outcome  
            measures. 

          4.Double referral.  This bill has been double referred.  Should  
            it pass out of this Committee, it will be referred to the  
            Senate Judiciary Committee.

          5.Related legislation.  SB 275 (Hernandez), requires OSHPD to  
            adopt a regulation that adds physician identifiers to the  
            patient level data elements that are required to be collected  
            and reported by hospitals and surgical clinics. SB 275 passed  
            out of the Senate Health Committee by a vote of 7-0.
          
            SB 546 (Leno), establishes a rate approval process for large  
            group health insurance products prior to the implementation of  
            any rate change that equals or exceeds certain triggers, or at  
            the request of a large group purchaser. Establishes a rate  
            review process of a health plan's or insurer's entire  
            aggregated large group market products and requires DMHC and  
            CDI to conduct a public meeting regarding large group rate  
            changes for each plan or insurer that offers coverage in the  
            large group market on or before November 1, 2016 and annually  
            thereafter.  SB 546 is set to be heard in this Committee on  
            April 22, 2015.

          6.Prior legislation.  SB 1322 (Hernandez), of 2014, was  
            substantially similar to this bill.  SB 1322 was held on the  
            Assembly Appropriations Committee suspense file.








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            SB 1182 (Leno) Chapter 577, Statutes of 2014, requires health  
            plans and insurers to share specified data with purchasers  
            that have 1,000 or more enrollees or that are multiemployer  
            trusts.

            SB 1340 (Hernandez), Chapter 83, Statutes of 2014, expands  
            provisions related to gag clauses in contracts between health  
            plans or insurers and providers.  

            AB 1558 (Roger Hernández), of 2014, would have created the  
            California Health Data Organization within the University of  
            California to organize data provided by health plans and  
            insurers on a website to allow consumers to compare the prices  
            paid for procedures, as specified.  AB 1558 was held on the  
            Senate Appropriations Committee suspense file.

            SB 746 (Leno), of 2013, would have established new data  
            reporting requirements on all health plans applicable to  
            products sold in the large group market and established new  
            specific data reporting requirements related to annual medical  
            trend factors by service category, as well as claims data or  
            de-identified patient-level data, as specified, for a health  
            plan that exclusively contracts with no more than two medical  
            groups in the state to provide or arrange for professional  
            medical services for the enrollees of the plan (referring to  
            Kaiser Permanente).  SB 746 was vetoed by the Governor, who  
            urged all parties to work together in the effort to make  
            health care costs more transparent.

            SB 1196 (Hernandez), Chapter 869, Statutes of 2011, prohibits  
            a contract between a health plan insurer and a provider or  
            supplier, from prohibiting, conditioning, or in any way  
            restricting the disclosure of claims data related to health  
            care services provided to an enrollee or subscriber of the  
            health plan or carrier, or beneficiaries of any self-funded  
            health coverage arrangement administered by the carrier to a  
            qualified entity, as defined. 

            SB 751 (Gaines and Hernandez), Chapter 244, Statutes of 2011,  
            prohibits contracts between carriers and hospitals from  
            containing any provision that restricts the ability of the  
            carrier from furnishing information to enrollees or insureds  
            concerning cost range of procedures or the quality of  
            services.  








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            AB 2389 (Gaines), of 2009, would have prohibited a contract  
            between a health facility and a carrier from containing a  
            provision that restricts the ability of the carrier to furnish  
            information on the cost of procedures or health care quality  
            information to carrier enrollees.  AB 2389 died in the  
            Assembly on Concurrence.

            AB 2967 (Lieber), of 2008, would have established a Health  
            Care Cost and Quality Transparency Committee to develop and  
            recommend to the CHHS Secretary a health care cost and quality  
            transparency plan, and would have made the Secretary  
            responsible for the timely implementation of the transparency  
            plan.  AB 2967 died on the Senate Inactive File.

            SB 1300 (Corbett), of 2008, would have prohibited a contract  
            between a health care provider and a health plan from  
            containing a provision that restricts the ability of the  
            health plan to furnish information on the cost of procedures  
            or health care quality information to plan enrollees.  SB 1300  
            died on the Senate Floor.

            AB 1296 (Torrico), Chapter 698, Statutes of 2007, requires a  
            health plan or contractor offering health benefits to  
            California Public Employees' Retirement System (CalPERS)  
            members and annuitants to disclose to CalPERS the cost,  
            utilization, actual claim payments, and contract allowance  
            amounts for health care services rendered by participating  
            hospitals to each member and annuitant.  

            AB 1 X1 (Nuñez) of 2007, among many other provisions relating  
            to health care reform, contained nearly identical language as  
            that contained in AB 2967.  AB1 X1 failed passage in the  
            Senate Health Committee.
             
           7.Support.  The California Primary Care Association writes that  
            stakeholders across California begin to work together to  
            develop the framework of this new and improved delivery  
            system, it has become increasingly clear that a single  
            trustworthy, accurate clearinghouse of claims and quality data  
            is necessary to move us in the direction we seek.  The  
            National Multiple Sclerosis Society - California Action  
            Network states that there is no cure for MS and therefore,  
            individuals living with the disease manage it through medical  
            care and a myriad of prescription medications.  This bill will  








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            provide an important resource for people living with a chronic  
            condition such as MS as it will address price transparency and  
            education consumers about health related expenses.  AARP  
            states that information about the performance of our health  
            care system should be collected, analyzed, and made publicly  
            available, addressing safety, effectiveness, patient-centered  
            responsiveness, timeliness, equity, and efficiency.  The  
            California Teachers Association states that making better  
            health care decisions requires a level of transparency that  
            has been a challenge within an industry that systematically  
            opposes transparency.  Kaiser Permanente writes that as a  
            growing proportion of care is paid for through capitated,  
            bundled and value-based arrangements, health care data that is  
            based only on claims will provide an increasingly incomplete  
            and inaccurate picture of statewide costs and quality.  Kaiser  
            believes that this bill will advance the critical conversation  
            in California about the best way to collect, measure, and  
            compare health care data toward achieving key policy goas of  
            improving health and the quality of care and reducing cost  
            trends over the long term.  
          
          8.Support if amended.  Consumers Union (CU), Health Access  
            California, SEIU California, California Labor Federation, and  
            CALPIRG suggest amendments to create a public governance body  
            with a spectrum of viewpoints (including consumer advocates,  
            labor, and other purchasers) that would be responsible for  
            developing a plan to ensure comprehensive and efficient  
            collection of data from physicians, hospitals and other  
            sources. CU states that these provisions would ensure greater  
            public accountability for the design, implementation, and  
            oversight of the database and better ensure it develops the  
            information consumers want to choose the best-value care and  
            give providers the information and incentives they need to  
            improve their performance. CU contends that contracting out  
            certain data collection functions could still be undertaken,  
            but the parameters and prioritization would remain in the  
            public domain in a fully transparent way. Such a body should  
            have participation from diverse and varying points of view,  
            including consumer advocates, labor and other purchasers.

            These groups urge a greater focus on health equity to be added  
            to the bill, so that disparities among different communities  
            can be monitored and ultimately reduced.  Categories of data  
            elements need to be specified (such as race, ethnicity,  
            primary language spoken, ZIP code, and sexual orientation).  








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            Integrating stronger, more explicit health equity provisions  
            would make the database a more accurate and meaningful tool  
            for the critical task of reducing disparities and improving  
            community health. 

            Finally, these groups urge closing a loophole in section  
            127672(d)(3) that would prevent full transparency by allowing  
            providers to broadly deem contract information "proprietary"  
            and to require contract language that would allow information  
            required in other sections of the bill to be kept  
            confidential. 

            California Pan-Ethnic Health Network (CPEHN) also urges  
            inclusion of language to ensure a greater focus on health  
            equity and to ensure that the governance is responsive to the  
            needs of consumers.  In addition, CPEHN proposes amendments  
            that would require the database to include the capability to  
            map data on mortality and morbidity rates as well as other  
            relevant data on the social and environmental factors that  
            impact health to better pinpoint areas with disparities and  
            highlight potential problems or incongruities in access and  
            quality of care.   
          
          9.Support in concept.  CAPG writes that they support policy  
            measures that encourage the implementation of the Triple Aim  
            (decreased costs, improved patient experience and development  
            of population health management), appreciates the stakeholder  
            meetings conducted by the author, and look forward to working  
            together on the creation of such a database in the Golden  
            State.

          10.Concerns.  The California Association of Health Plans (CAHP)  
            are concerned that the database should be "searchable" by the  
            public when confidential and proprietary information is  
            included in the data submitted because it is unclear what will  
            be made public and how the information will be shared. CAHP  
            believes it is critical that specific contractual payment  
            arrangements remain confidential as proprietary information.   
            CAHP agrees that a neutral third party should be responsible  
            for the database; however, they recommend that the  
            organization convene a technical workgroup tasked with  
            developing the data elements to be collected rather than  
            specifying what should be initially included in the database  
            in statute. CAHP states that for the purposes of the initial  
            implementation it is recommended to use a phased-in plan  








          SB 26 (Hernandez)                                  Page 15 of ?
          
          
            approach based on enrollment size and that claims data should  
            begin with medical and pharmacy data, which would help to  
            identify coding and other data issues prior to including the  
            smaller and specialty plans that could be added after  
            implementation. If Medicare data is to be included, then the  
            database administer should apply to the federal Centers for  
            Medicare and Medicaid Services to be a Medicare Data Sharing  
            for Performance Program.  Finally, CAHP writes that the use of  
            existing informational sources such HEDIS, OSHPD, and the  
            Department of Health Care Services should be included to avoid  
            the repetitious reporting of data and that these items could  
            be identified in the technical workgroup mentioned above and  
            the workgroup could be responsible for extracting the data  
            from these sources or could ensure that the database is  
            capable of receiving the data as currently extracted for these  
            systems. 

          11.Oppose.  The California Right to Life Committee (CRLC) states  
            that heath care data will include patients requiring end of  
            life care and various groups are actively promoting end of  
            life plans, and they assume that one of these groups would be  
            involved in the process as a non-profit agency.  CRLC also  
            states that these groups could be invited to the review  
            committee created under this bill and it foresees these groups  
            working in tandem with any statewide POLST registry or similar  
            end of life mandated health care form that removes the patient  
            from the decision making.

           SUPPORT AND OPPOSITION  :
          Support:  AARP
                    American Federation of State, County, and Municipal  
                    Employees
                    California Primary Care Association
                    California Teachers Association
                    Kaiser Permanente
                    National Multiple Sclerosis Society - California  
                    Action Network
          
          Oppose:   California Right to Life Committee, Inc.

                                      -- END --
          
          
          









          SB 26 (Hernandez)                                  Page 16 of ?