A Tale of Two Cities: The Worst of Times or the Best of Times? L.A. v. San Diego

By Gregg A. Masters, MPH

Comparing and contrasting healthcare markets or their essential component parts can be a perilous board room exercise if the intent is to make sense of strategy options, that inform enterprise or entity choice, and meaningfully benchmark forward progress.

In pursuit of the ‘triple aim’: better experience of care, improved population level outcomes, and lower per capita costs, the quest to gage forward progress into the broad brush ‘new, new accountable care’ paradigm, it’s vitally important to understand the granular nature of markets, its constituent players, and the relative balance of power therein.

Los Angeles Study: California Healthcare Foundation ACO

In the run-up and consideration process of the rule set to articulate and map the glide path for the formation and launch of accountable care organizations (ACOs) and derivative – i.e., ‘off balance sheet equivalent’ – commercial or privately negotiated versions, much concern was directed to the potential complications of incentivizing such ‘wholesale’ provider integration. Many warned that disproportionate pricing leverage would result as modern day versions of Paul Ellwood’s ‘SuperMeds’ would rule their respective turfs. The net effect being the continued power shift away from purchasers or their health plan agents’ assumed ability to restrain the ‘rapacious apetite’ of an often expansionist, capital starved (you know the crane as mascot) and yet margin (contract restrained) challenged provider marketplace – not exactly the ‘shift’ outcome intended by either the ACA or subparts specific to ACOs.
San Diego Study | California Healthcare Foundation ACO
So courtesy of recent updates to previous market studies funded by the California Healthcare Foundation and fielded by the The Center for Studying Health System Change, we have insights into two emerging ‘accountable care’ Southern California strategy footprints. For details see: ‘Los Angeles: Fragmented Healthcare Market Shows Signs of Coelescing’, and ‘San Diego: Healthcare Providers Expand Capacity as Competition Increases for Well Insured Patients’

For prior tea leave interpretations, see: IPA + HIT (aka technology stack) x MSO = ACO, and California Association of Physician Group (CAPG) CEO Don Crane’s take in Smart Money, ACOs and Risk Savvy Medical Managers. So which footprint is more in alignment with the intent of the ACA’s triple aim, you be the judge? I say, what up San Diego?

And the beat goes on….


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