5 Things California: OD prevention programs, Statewide HIE framework, Covered CA rate increase


Eli Kirshbaum


In case you missed it, we recently released the Topical Agenda for the 2022 Los Angeles State of Reform Health Policy Conference coming up on Sept. 22nd! If you haven’t already registered, you can do so here. We’re currently working to curate speakers for each panel, so keep your eye out for a full list of conference speakers when we release the Detailed Agenda in the next few weeks.

This newsletter features a bill nearing passage that would establish multiple overdose prevention programs throughout the state, experts’ input on CalHHS’s Data Exchange Framework, and insight on Covered California’s 6% rate increase.

Thanks for your support!

Eli Kirshbaum
State of Reform 


1. OD prevention programs on the horizon

The city and county of Los Angeles, Sacramento County, and the city of Oakland will likely soon have new public overdose prevention programs. Senate Bill 57, a 2-year effort to reduce overdose deaths in California, has passed both chambers and awaits the governor’s signature.

The California Narcotics Officers’ Association and other opponents say the bill normalizes substance abuse in lieu of actionable policy to lower drug abuse. Dr. Randolph Holmes, Chair of the CA Society of Addiction Medicine Public Policy Committee, says these opponents incorrectly view drug use as a “moral failing.” Holmes also says some of the opposition is reflective of a “not in my back yard” sentiment—those who object to these programs from an aesthetic point of view.


2. OHCA begins multi-year implementation

The Office of Health Care Affordability is in the early months of its 6-year implementation period from July 2022 to June 2028. The Department of Health Care Access and Information says this time period is necessary to fully implement the OHCA’s numerous assigned duties, which include creating and enforcing health care cost growth targets and monitoring health care market consolidation. The OHCA’s supervisory Health Care Affordability Board is expected to be appointed by December 2023 and the office will begin developing a cost growth target methodology in July 2023.

While the OHCA is expected to have a positive impact on health care affordability in California, CHCF market expert Kristof Stremikis told State of Reform the negotiation process had been somewhat contentious. “Different stakeholders have different priorities when it comes to targeting the source of [the health care system’s] inefficiency,” he said. “There are folks that really want to get after the administrative complexity that providers face, or the anti-competitive behavior of large systems, or the duplicative testing or services within the system, and that is just contentious work.”


3. Experts say HIE framework is promising but has gaps

While saying CalHHS’s recently released Data Exchange Framework (DxF) for establishing a statewide HIE is “adequate,” advocates argue that a major piece missing from the state’s guidance is clarity around how it will certify qualified intermediaries in the exchange. Intrepid Ascent—a consulting group that has been instrumental in the state’s journey toward a statewide HIE—recently told State of Reform what they see as the pros and the cons of the new framework.

“A number of regional HIOs are fully operational in California and it is unclear the role that those entities will play, especially since they all have their own local rules, agreements, and policies,” the organization said. Other outstanding challenges, they said, are varying levels of readiness among participants and the alignment of the DxF policies with local or national vendor-based networks.


4. Insight on 6% Covered CA rate increase

About 4% of the recently announced 6% average statewide increase to Covered California premiums for 2023 is due to predicted increases in the cost and quantity of health care services, according to Jessica Altman, Executive Director of Covered California. Many health plans are predicting even further increases to premiums resulting from enrollees dropping out of coverage because they can’t afford them with the increasing prices.

Another contributor to the rate increase is the uncertainty surrounding the extension of ARPA subsidies that help individuals afford health insurance. “Every day matters and open enrollment is really just around the corner, so the longer we go without a decision [from the federal government], the harder it will be to implement a new subsidy structure and avoid consumer confusion and disruption,” said Altman.


5. DHCS gathers input for CYBHI virtual platform

Part of California’s new Children and Youth Behavioral Health Initiative is a new virtual behavioral health service platform DHCS is planning to launch. The department released an RFI for the platform in early July and said its services—including online educational materials, interactive games, and e-consult services—will help California proactively identify and treat youth with behavioral health needs.

“The platform is a population health model that will deliver and monitor behavioral health treatment so the most effective, least resource-intensive treatment is available statewide to young people who may not need individual counseling, but need help managing stress and building resilience,” DHCS said. The RFI closed on Wednesday, and DHCS expects to take the input into account and launch the virtual services platform in January 2024.