California is the latest state to address healthcare affordability through cost growth targets. Elizabeth Mitchell – President and CEO of Purchaser Business Group on Health – Joins us to discuss the nuts and bolts of the 3% cost growth target recently adopted by the state. Healthcare affordability is a big issue across the country. More than half of us skip or postpone care due to cost and medical bills are a leading cause of bankruptcy. Reining in medical costs is also how we’ll free up resources for what we know works to build health in America: prevention, addressing the social drivers and fostering health in communities.

We discuss:

• Two proven strategies to reduce healthcare costs: advanced primary care and effective specialty referrals
• Why better consumer “shopping” is not the path to healthcare affordability
• How price transparency gives employers new tools to negotiate, and reveals troubling facts about purchasing intermediaries

Elizabeth reminds us how troubling it is that we don’t have clear prices in a sector that makes up 20% of the economy:

“The idea that you can't find out what something is going to cost before you agree to it is outrageous. Name any other industry that refuses to show you a price. It is incredible to me that we are still fighting about transparency when it is 20 % of the US economy. I mean, this is a multi-trillion-dollar industry who feels no accountability to show pricing. So, I just think it is incredible that we do not have meaningful transparency yet.”

Relevant Links

California’s Office of Health Care Affordability sets cost growth target

Federal hospital price transparency requirements

Purchaser Business Group on Health (PBGH) website

PBGH white paper on advanced primary care

US Department of Labor clarifies the fiduciary responsibilities of self-insured employers purchasing healthcare

About Our Guest

As President and CEO, Elizabeth Mitchell advances Purchaser Business Group on Health’s (PBGH’s) strategic focus areas of advanced primary care, functional markets and purchasing value. Mitchell leads PBGH in mobilizing health care purchasers, elevating the role and impact of primary care, and creating functional health care markets to support high-quality affordable care, achieving measurable impacts on outcomes and affordability.

At PBGH, Elizabeth leverages her extensive experience in working with health care purchasers, providers, policymakers and payers to improve health care quality and cost. She previously served as Senior Vice President for Healthcare and Community Health Transformation at Blue Shield of California, during which time she designed Blue Shield’s strategy for transforming practice, payment and community health. Mitchell also served as the President and CEO of the Network for Regional Healthcare Improvement (NRHI), a network...

The scope, scale and timeline of what California is trying to do with CalAIM is truly breathtaking. Two years after the launch of the ambitious program, which offers integrated medical and social care for California's 15 million Medicaid members, Dr. Palav Babaria joins us to discuss how it’s going and what comes next. Dr. Babaria is a primary care physician who leads quality and population health management for California’s Medicaid program, Medi-Cal.

We discuss:

• Which community supports are used most, or least?
• One of the big learnings from CalAIM: the enhanced care management models that work for adults dont work for children
• How Medi-Cal is leveraging health plans as the organizers of social care because that’s where the members are
• The soon-to-be-released population health management service will address two big issues: standardized and equitable approaches to identifying high risk members and integrating state level benefits data, like for WIC

Palav reminds us that CalAIM was built through listening:

“Not everyone may know this, but CalAIM was generated from a statewide listening tour. Our previous state Medicaid director went around the state and literally asked communities… rooms full of plans, members, providers, what do you need from Medi-Cal that isn't working today? [The] smorgasbord of recommendations is what turned into CalAIM … Listening to the community and responding to the community's needs is in the core DNA of this program.”

Relevant Links

• Listen to our related episode “Reflecting on Year One of CalAIM with Jacey Cooper”
• CalAIM dashboard
• Population health management policy guide
• California and other states require managed care plans to reinvest in local communities
• NY waiver summary

About Our Guest

Dr. Palav Babaria was appointed Chief Quality Officer and Deputy Director of Quality and Population Health Management of the California Department of Health Care Services beginning in March 2021. She was formerly the Chief Administrative Officer of Ambulatory Services at Alameda Health System. In that capacity, she operationally and clinically oversaw 26 specialty clinics, four large primary care FQHCs, specialty and integrated behavioral health, and is responsible for all outpatient value-based payment programs. Prior to that role, she served as Medical Director of K6 Adult Medicine Clinic. She also has over a decade of global health experience and her work has been published in the New England Journal of Medicine, Academic Medicine, Social Science & Medicine, L.A. Times, and New York Times. Her areas of interest include ambulatory transformation in resource-limited settings, shifting to value-based care, and issues of gender in medicine. Babaria received her bachelor’s from Harvard College, as well as her MD and Masters in Health Science from Yale...

To achieve whole person care, we can try layering new social services on top of medical care. But Dr. Rishi Manchanda believes we should move further upstream and ask, what will it take to actually improve health in communities? From founding Rx the Vote to HealthBegins, Rishi is committed to building community social capital in America.

We discuss:

• Why he created HealthBegins, which is now halfway to its goal of transforming equity in 250 communities by 2025
• How California is making practice transformation a foundation of whole person care
• Rx the Vote and the important role of health organizations in voter engagement
• Kaiser Permanente's health, housing and justice initiative

Rishi thinks all public health students should study and know how to shift the political determinants of health:

“I think we can recognize there's ways to… get the dollars out the door, get the services out the door, get the access that we need while [also building] local governance. And I think that's what I see as a really interesting opportunity for us in California… There are opportunities here for public health schools, including Berkeley, to [help] public health students… understand the political determinants of health and then understand their role [to]... address them and improve them.”

Relevant Links

HealthBegins website

Rishi’s book The Upstream Doctors

Rishi's TEDx Talk: "What Makes Us Get Sick? Look Upstream."

New collaborative community health planning model in California

Policy requiring California Medicaid health plans to invest 5-7.5% of profits into local communities

California Medicaid investments in practice transformation

Kaiser Permanente's health, housing and justice initiative

Oregon CCO model

An interview with Rishi Manchanda

About Our Guest

Dr. Manchanda is Founder and President of HealthBegins, a social enterprise that provides training, clinic redesign, and technology to transform health care and the social determinants of health. Dr. Manchanda is a dual board-certified internist and pediatrician, a board member of the National Physicians Alliance, and a fellow in the California Health Care Foundation’s Healthcare Leadership Program. He is the lead physician for homeless primary care at the VA in Los Angeles, where he has built clinics for...