1. In the Nick of Time: Federal Reform and Californias Healthcare Delivery System Micah Weinberg Senior Research Fellow, California Program

2. All you wanted to know about California … Distinct regional markets and delivery systems Homeland and hotbed of care integration –Kaiser, delegated model, IHA –But managed care eroding (down 7% 02-08) Care integration hasnt controlled costs –Hospital prices now rising at twice national average –Growing provider clout foreshadows challenge $20 billion state budget deficit –Dysfunctional government, future looks even more grim

4. One truly scary thing about health reform: far from being a government takeover, it counts on local communities and clinicians for success. - Dr. Atul Gawande

5. Projects with promise California Task Force on Affordable Care Partnership between Blue Shield, Hill Physicians, Catholic Healthcare West for CalPERS Integrated Healthcare Association – Plan for Bundled Knee and Hip Replacement with Cedars Sinai, Blue Shield, others Medi-Cal Waiver process promoting care integration in public programs

6. Preserving the CA Safety Net? Uncertainty with state budget Medical Home: Federal Government to Cover 90% of cost for Medicaid Beneficiaries with Chronic Illnesses who are in a Medical Home New Payments to Federally-Funded Clinics: $12.5 billion (up from ~ 2 billion) in Legislation Rural Safety Net Hospitals: Helped with New Federal Payments

7. To the extent that federal reform creates a marketplace that rewards value, it builds on the best parts of the California delivery system …and does so just in the nick of time. Micah Weinberg weinberg@newamerica.net weinberg@newamerica.net (916) 706-2664