BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 1159|
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UNFINISHED BUSINESS
Bill No: SB 1159
Author: Hernandez (D)
Amended: 8/19/16
Vote: 21
SENATE HEALTH COMMITTEE: 8-0, 4/6/16
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Pan, Roth,
Wolk
NO VOTE RECORDED: Nielsen
SENATE JUDICIARY COMMITTEE: 5-2, 4/19/16
AYES: Jackson, Hertzberg, Leno, Monning, Wieckowski
NOES: Moorlach, Anderson
SENATE APPROPRIATIONS COMMITTEE: 5-2, 5/27/16
AYES: Lara, Beall, Hill, McGuire, Mendoza
NOES: Bates, Nielsen
SENATE FLOOR: 25-12, 6/2/16
AYES: Beall, Block, De León, Glazer, Hall, Hancock, Hernandez,
Hertzberg, Hill, Hueso, Jackson, Lara, Leno, Leyva, Liu,
McGuire, Mendoza, Mitchell, Monning, Nguyen, Pan, Pavley,
Roth, Wieckowski, Wolk
NOES: Anderson, Bates, Berryhill, Cannella, Fuller, Gaines,
Huff, Moorlach, Morrell, Nielsen, Stone, Vidak
NO VOTE RECORDED: Allen, Galgiani, Runner
ASSEMBLY FLOOR: 60-19, 8/23/16 - See last page for vote
SUBJECT: California Health Care Cost, Quality, and Equity
Data Atlas
SOURCE: Author
SB 1159
Page 2
DIGEST: This bill requires the California Health and Human
Services Agency (CHHSA) to research the options for developing a
cost, quality, and equity transparency database that is
consistent with the confidentiality of medical information in
existing law.
Assembly Amendments (1) delete the requirement that certain
health care entities to provide medical claims, cost, and
quality information to CHHSA Secretary for the purpose of
developing information for inclusion in a health care cost and
quality database (and related provisions) and instead require
CHHSA to research the options for developing a cost, quality,
and equity transparency database that is consistent with the
confidentiality of medical information in existing law; (2)
require this research to include identification of key data
submitters; a comparative analysis of potential models used in
other states and an assessment of the extent to which
information should be included in the database; an assessment of
types of governance structures that incorporate representatives
of health care stakeholders and experts; recommendations on
potential funding approaches; an assessment on the extent to
which the database could be developed in conjunction with
existing public or private activities, as specified; and,
consultation with a broad spectrum of health care stakeholders
and experts, as specified; and (3) permit CHHSA to enter into
contracts or agreements to conduct the research described above.
Require CHHSA to make public the results of the research
described above no later than March 1, 2017, by submitting a
report to the Assembly and Senate Committees on Health.
ANALYSIS:
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
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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
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.
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This bill:
1)Requires CHHSA to research the options for developing a cost,
quality, and equity transparency database that is consistent
with the confidentiality of medical information in existing
law.
2)Requires this research to include all of the following:
a) Identification of key data submitters, including health
care service plans (health plans), health insurers,
suppliers, providers, and self-insured employers, as
defined;
b) A comparative analysis of potential models used in other
states and an assessment of the extent to which information
in addition to the following should be included in the
cost, quality, and equity transparency database:
i) Utilization data from health plan and health
insurers' 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 All-Payer
Claims Database Council, the University of New Hampshire,
and the National Association of Health Data
Organizations;
ii) Pricing information for health care items, services,
and medical and surgical episode 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
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of care available in lieu of actual cost data to allow
for meaningful comparisons of provider prices and
treatment costs;
iii) Information sufficient to determine the impacts of
social determinants of health, including age, gender,
race, ethnicity, limited English proficiency, sexual
orientation and gender identity, ZIP Code, and any other
factors for which there are peer-reviewed evidence; and,
iv) Clinical data from health care service plans,
integrated delivery systems, hospitals, and/or clinics
that is not included in the core set of data elements for
data submission proposed by the All Payer Claims Database
Council and the National Association of Health Data
Organizations.
c) An assessment of types of governance structures that
incorporate representatives of health care stakeholders and
experts, as specified;
d) Recommendations on potential funding approaches to
support the activities of the cost, quality, and equity
transparency database that recognize federal and state
confidentiality of medical information laws;
e) An assessment on the extent to which the cost, quality,
and equity transparency database could be developed in
conjunction with existing public or private activities, as
specified; and,
f) Consultation with a broad spectrum of health care
stakeholders and experts, as specified.
3)Permits CHHSA to enter into contracts or agreements to conduct
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the research described above.
4)Requires CHHSA to make public the results of the research
described above no later than March 1, 2017, by submitting a
report to the Assembly and Senate Committees on Health.
5)Sunsets the bill on January 1, 2021.
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 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 financial liability and
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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.
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 Web site, 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
California beneficiaries, and became the first Qualified
Entity to receive Medicare data.
The University of California, San Francisco is working with
the California CDI on a medical cost and quality transparency
website. According to CDI, the Web site will report average
prices paid for episodes of care or annual costs for chronic
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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 Web site 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.
The Regional Cost and Quality Atlas is an interactive Web site
to be released in Summer 2016 that will compare aggregated
cost and quality data, by payer/product type (not individual
payers), for each of 19 regions (the same regions that had
been defined for Covered California). The project is a
partnership between the Integrated Healthcare Association
(IHA), the California Healthcare Foundation, and CHHSA.
Working with large physician organizations and health plans,
IHA developed a methodology for calculating risk-adjusted
Total Cost of Care to be used as part of the Pay for
Performance program. Plans submit detailed data files
including claims and enrollment data to Truven Health Systems.
Truven uses this detail to calculate actual payments to
physician organizations for a set of enrollees divided by
number of enrollees. Payments include professional services,
pharmacy, hospital care, ancillary services, as well as
payments made by consumers to cover cost-sharing amounts.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to Assembly Appropriations Committee:
1)The activities required here are not expected to result in
significant additional state costs, as they are largely
consistent with existing activities of CHHSA, funded by an
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existing federal grant. CHHSA will incur minor costs to
submit a legislative report by March 1, 2017.
2)It should be noted this bill does not explicitly require a
database to be constructed, but it authorizes a study and
related activities. Development of a database as contemplated
here, if it were to be housed in the state, would result in
General Fund cost pressure estimated in the low millions
one-time for start-up costs and low millions ongoing, based on
an analysis by Manatt Health Solutions of a
California-specific database. Actual costs would be subject
to numerous decisions about the business requirements of such
a system, and could vary significantly depending upon existing
capabilities of bidders, assuming the database implemented
through a contract. This bill requires an analysis of
potential funding sources to support the database.
SUPPORT: (Verified8/23/16)
California Labor Federation
California Pan-Ethnic Health Network
Consumers Union
Health Access California
OPPOSITION: (Verified8/23/16)
None received
ASSEMBLY FLOOR: 60-19, 8/23/16
AYES: Alejo, Arambula, Atkins, Baker, Bloom, Bonilla, Bonta,
Brown, Burke, Calderon, Campos, Chang, Chau, Chiu, Chu,
Cooley, Cooper, Dababneh, Daly, Dodd, Eggman, Frazier,
Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez,
Gonzalez, Gordon, Roger Hernández, Holden, Irwin,
Jones-Sawyer, Kim, Levine, Linder, Lopez, Low, Maienschein,
McCarty, Medina, Mullin, Nazarian, Obernolte, O'Donnell,
Olsen, Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago, Mark
SB 1159
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Stone, Thurmond, Ting, Waldron, Weber, Wilk, Williams, Wood,
Rendon
NOES: Achadjian, Travis Allen, Bigelow, Brough, Chávez, Dahle,
Beth Gaines, Gallagher, Grove, Hadley, Harper, Jones, Lackey,
Mathis, Mayes, Melendez, Patterson, Steinorth, Wagner
NO VOTE RECORDED: Gray
Prepared by:Melanie Moreno / HEALTH / (916) 651-4111
8/23/16 20:19:27
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