What is CHCC?

The California Health Care Coalition (CHCC) is a nonprofit membership organization bringing public- and private sector employers, unions and health and welfare trust funds together to require California’s health industry to deliver safe, effective, prevention-oriented, efficient and fairly priced healthcare. Our Members currently represent over three million Californians. We believe that performance transparency and accountability in healthcare will save lives, reduce costs and preserve and expand access to affordable comprehensive benefits for California employers, workers, families and their communities.

What Problems does CHCC Address?

Poor quality: California ranks 42nd among the states in healthcare quality, according to a 2009 Commonwealth Fund report.* Our healthcare “non-system” has many interacting but uncoordinated parts, with multiple points at which failure can and does occur. Research shows widespread under-use of effective care, provider-driven over-use of unwarranted services, and misuse of services that reflects provider, not patient, treatment preferences when more than one medically reasonable treatment option exists. Medical errors are also far too common. In short, quality problems not only exist everywhere, as the Institute of Medicine reported in 2001, they are also disturbingly persistent.

High costs, high prices and misaligned incentives: Poor quality is tremendously costly. Experts estimate that 30 percent of healthcare spending reflects poor quality care.**  High prices further add to high costs. As California hospitals and physicians have consolidated into larger and larger economic units, they have been able to negotiate significant rate increases without regard to the quality or efficiency of their services. How we pay for care also contributes to poor quality. Fee-for-service payment arrangements encourage provider-driven overuse or misuse of services, because providers get paid more when they deliver more services regardless of whether they are necessary. They also get paid more when quality failures result in higher utilization, as is the case when patients are admitted or readmitted into hospitals for preventable reasons.

Little performance disclosure or accountability: Despite decades of alarming statistics, scant progress has been made toward meaningful improvement in the safety, appropriateness and quality of care. One major obstacle to reform is the lack of transparency and accountability of the healthcare services that are provided, the outcomes of those treatments and the costs that were paid for them.  Although the health plans have access to extraordinary amounts of treatment and claims data within their coverage boundaries, they share none of that data publicly.  There simply is too little publicly reported and available performance data on hospitals and physicians. In California, we spend tens of billions of dollars annually on healthcare services, yet we lack information to be able to make informed decisions regarding which providers in our communities achieve the best patient outcomes, which are most efficient, what they get paid for their services and which should be avoided because of consistently sub-standard performance.

That is CHCC’s Overall Strategy?

CHCC’s strategy brings employers, unions and trust funds together to leverage their educational efforts at the federal, state and local levels to require performance transparency and improvement for the billions of dollars our Members spend to provide coverage to their workers and their families.

At the federal level, many of the health plans have become so consolidated that it requires a national perspective and a large collective voice to get their attention.  Even the health plans with California subsidiaries and affiliates often establish their business practices at their corporate headquarters outside of California.  To encourage the health plans to adopt patient- and purchaser-friendly best management practices, CHCC has engaged them on their own national turf to discuss how their contracting practices with service providers and with their plan purchasers can have a positive impact on healthcare outcomes and costs.

It is at the state level that medical practices are reported and monitored.  Consequently, CHCC is focused on working with doctors and hospitals, the health plans, and the government agencies responsible for medical reporting to make healthcare data more accessible to patients and to purchasers.  Accountability for over-inflated costs and bad patient outcomes cannot be achieved until there is transparency in service and cost data.  CHCC believes that information is power and informed choices come from the ability to access statistically sound, quality information about service providers on a state and local level.

CHCC’s focus on local initiative organizing reflects two key facts. First, healthcare services are locally delivered, so consumers can most rapidly affect the quality and cost of healthcare when they organize locally. Second, the purchasing community is highly fragmented, leaving purchasers without the necessary market influence to require performance information or improvement. Even the largest purchasers in a community represent only a tiny fraction of the business of a major commercial health plan or community provider. When CHCC organizes and represents the interests of multiple employers, trust funds and unions, we effectively engage health plans and providers on quality and cost issues that benefit everyone.

When more and more public and private employers, trust funds and unions join CHCC, we build our collective power to hold providers accountable for the consistent delivery of safe, effective, efficient and fairly priced healthcare services.  In essence, we save lives while lowering the cost of care for everyone.

Who governs CHCC and how is CHCC financed?

CHCC is governed by a 16-member labor-management Board of Directors who are elected by the voting representatives of our Member organizations. Each Member organization appoints two voting representatives who participate in annual board elections. Voting representatives can also nominate candidates and run for election to the Board.

CHCC operations are primarily financed through membership dues. As we grow, we anticipate that additional revenues will be generated through educational conferences and the distribution of informative materials.  After all, information is power!  Regardless, we strongly believe that CHCC will be most successful if we remain largely self-financed, independent, objective and credible as we help inform the healthcare debate.

*  Aiming Higher: Results from a State Scorecard on Health System Performance,

The Commonwealth Fund, Douglas McCarthy, M.B.A., Sabrina K. H. How, M.P.A. and Cathy Schoen, M.S., Joel C. Cantor, Sc.D., and Dina Belloff, M.A., Rutgers University Center for State Health Policy, at page 79 (2009).

** Ibid, Reducing the Cost of Poor-Quality Health Care through Responsible Purchasing Leadership.