A Healthcare Provider’s View of Progress on the Ground

Some of the best minds in the state participated in the Berkeley Forum for Improving California’s Healthcare Delivery System. As individuals and organizations, they have worked for decades to improve the quality, accessibility and affordability of care in California. In the Forum they worked to define initiatives that would be feasible, evidence-driven, reflective of the realities of California, and likely to substantially reduce healthcare expenditures in California. They laid out a series of recommendations that form a clear pathway to integrated care and more effective use of resources via risk-adjusted global budgets. For provider groups and health systems eager to assume more risk as a means to integrate and improve care, it was a clarion call. Of the seven initiatives called for in the Forum Report, the first two – global budgets/integrated care systems and patient centered medical homes – promise the greatest leverage in transforming health systems and represent more than three-fourths of the total projected reductions in expenditures. Since the issuance of the report, however, the momentum of the market has swung ever more decisively against these recommendations. While Medi-Cal has steadily increased the proportion of beneficiaries in managed care, commercial enrollment in risk-based products has continued to fall, in large part because commercial HMOs have lost their price advantage and employers cannot get reliable cost and utilization data from capitated networks. For providers, transforming healthcare has proven to be a slower and less certain task than they had expected. Instead of managing risk for populations