Site Visit to Northern California — Risk, Accountability, and Staying Power in Next-Generation Managed Care

This three-day site visit looked at private health insurance and delivery of care in a market notable for high managed care penetration, relatively low premium costs, and sophisticated provider groups. Federal congressional and regulatory staff heard from health insurance purchasers (both public and private), health plans, hospital systems, and physician groups about the changing relationships and accountabilities in this market and the ways various organizations were positioning themselves to survive the turmoil and emerge the stronger for it. Participants also heard from two county health programs about how competition and realignment in the private market were impacting safety-net services for the indigent. The site visit incorporated a trip to Sacramento to meet with regulators and members of the Governor\u27s Managed Care Improvement Task Force. Some participants took advantage of an opportunity to tour On Lok, the nation\u27s premier PACE (Program of All-inclusive Care for the Elderly) program serving the frail elderly