The San Diego Purchaser Cooperative: Improving Healthcare Together

Problems in the healthcare industry impact us all.  Premium increases are outpacing inflation, taking more from our paychecks and contributing to industry-wide layoffs. Pricing for the same medical treatments from different providers can vary within the same community up to 100 percent depending on the physician and the insurer.

It has been estimated that as much as 50 percent of healthcare spending is used to treat just five percent (5%) of the population, with 20 percent of healthcare expenses in the U.S. today being medically unnecessary.* Now more than ever, we must demand change in the cost and delivery of healthcare.

Local purchasers in San Diego have come together to impact how healthcare services are provided and paid for.  This effort is focused through the San Diego Purchasers Cooperative, a Section 501(c)(6) non-profit organization that brings together a diverse group of San Diego’s public and private employers who are committed to improving healthcare through collaborative efforts. CHCC Member California Schools Voluntary Employees Benefits Association (“VEBA”), a driving force in healthcare improvement for more than 18 years, has worked hard to bring change to a new level by involving local healthcare purchasers and giving them the education, clout and collective voice they need to demand change. CHCC supports this effort through education and information in an effort to ensure better quality care that saves lives and money for all healthcare consumers in the San Diego region.

The Co-Op uses proven quality data and techniques developed to accomplish the Co-Op’s mission and to put corrective action into place.

The Importance of Stakeholders

The Co-Op seeks to lower costs and improve quality for its more than 90,000 members.  It does this by aggregating local demand, identifying innovative cost-reduction strategies with diverse stakeholder groups – that include purchasers, providers, carriers and health systems – and working together toward change. 

The Importance of High-Quality, Verifiable Data

Through the Co-Op, change is driven by the analysis of aggregate data from multiple employer healthcare purchasers.  Today, most healthcare purchasers are limited to basing their purchasing decisions on a narrow view of the experience of their own population, which makes it impossible to get high-quality care at the most reasonable price.  By aggregating claims and performance data from many purchasers in a local market, as well as statewide, members of the Co-Op can make better purchasing decisions that lead to better outcomes, saved lives and lower costs.

Another example of how the Co-Op impacts healthcare in the local market is that Co-Op members can participate in an innovative “Medical Appropriateness Study” that focuses on identifying inappropriate and excessive care through the use of the aggregated data. This study looks at the aggregate claims and medical outcome data from a vastly broader population to start identifying trends and holding the healthcare system accountable for delivering the high-quality care that members need, at costs that the purchasers can afford.

* Data from the Kaiser Family Foundation, California Office of the Patient Advocate and Dartmouth Institute for    Health Quality and Clinical Practice.