{ "version": 1, "generatedAt": "2026-09-07T04:32:07.308636+00:00", "data": { "asOf": "2026-08-23", "tracks": [ { "track": "Commercial prices relative to Medicare", "publisher": "RAND Corporation", "period": "2022 claims in the Round 5.1 study", "finding": "California was among the states where average commercial hospital prices exceeded 300% of Medicare prices in 2022.", "allStudyAverage": 2.54, "allStudyAverageUnit": "share of Medicare", "sourceUrl": "https://www.rand.org/pubs/research_reports/RRA1144-2-v2.html", "method": "Actual private insurer allowed amounts divided by simulated Medicare payments for the same services at the same hospitals.", "caveat": "The public report supports the above-threshold California finding but does not supply a current service-level California rate file in this artifact. The study sample and claims period are 2020\u20132022 and are not the 2024 HCAI cohort." }, { "track": "Hospital net patient revenue per adjusted unit", "publisher": "California HCAI Office of Health Care Affordability", "period": "2023 hospital measurement", "finding": "Facility-level payer measures are available for the core cohort; medians are published separately by payer and setting below.", "sourceUrl": "https://hcai.ca.gov/document/hospital-measurement-combined-dataset-2022-2023/", "method": "OHCA-reported net patient revenue divided by case-mix-adjusted discharges or intensity-adjusted visits.", "caveat": "Net patient revenue per adjusted unit is a spending/payment proxy, not a negotiated price for a standardized service. Facility distributions contain legitimate and potentially anomalous extremes; this summary uses medians and does not winsorize source values.", "measures": [ { "field": "ip_npr_per_cmad_thrd", "label": "Commercial / other third-party inpatient NPR per case-mix-adjusted discharge", "denominator": "inpatient CMAD", "facilityCount": 296, "median": 22069.51 }, { "field": "ip_npr_per_cmad_mcar", "label": "Medicare inpatient NPR per case-mix-adjusted discharge", "denominator": "inpatient CMAD", "facilityCount": 294, "median": 10749.81 }, { "field": "ip_npr_per_cmad_mcal", "label": "Medi-Cal inpatient NPR per case-mix-adjusted discharge", "denominator": "inpatient CMAD", "facilityCount": 296, "median": 13669.36 }, { "field": "op_npr_per_iav_thrd", "label": "Commercial / other third-party outpatient NPR per intensity-adjusted visit", "denominator": "outpatient intensity-adjusted visit", "facilityCount": 274, "median": 223.07 }, { "field": "op_npr_per_iav_mcar", "label": "Medicare outpatient NPR per intensity-adjusted visit", "denominator": "outpatient intensity-adjusted visit", "facilityCount": 273, "median": 103.98 }, { "field": "op_npr_per_iav_mcal", "label": "Medi-Cal outpatient NPR per intensity-adjusted visit", "denominator": "outpatient intensity-adjusted visit", "facilityCount": 275, "median": 185.71 } ] } ], "notCombinedReason": "The RAND and OHCA tracks differ in payer population, period, unit, and method. They are presented side by side and are never combined into one price index.", "peerReviewedCaliforniaEvidence": [ { "id": "melnickFonkych2016", "citation": "Melnick GA, Fonkych K. Inquiry. 2016;53:0046958016651555.", "doi": "10.1177/0046958016651555", "pmcid": "PMC5798729", "peerReviewed": true, "geography": "California statewide hospital sample", "period": "2004-2013", "population": "Commercial inpatient allowed payments from Blue Shield of California; about 230 hospitals in 2012", "priceConcept": "Case-mix-adjusted allowed payment per inpatient admission", "design": "Longitudinal hospital analysis with regression adjustment", "finding": "Prices per admission increased 76% across all hospitals. Adjusted prices increased 113% at hospitals in the two largest systems versus 70% at other hospitals; by 2012-2013 the large-system differential was $3,964 (25%).", "limitation": "One commercial payer, nominal prices, historical period, and observational design; the study does not establish that system membership alone caused the differential.", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC5798729/" }, { "id": "zhuangShapiro2023", "citation": "Zhuang T, Shapiro LM, Baker LC, Kamal RN. Clin Orthop Relat Res. 2023;481(6):1061-1068.", "doi": "10.1097/CORR.0000000000002489", "pmcid": "PMC10194750", "peerReviewed": true, "geography": "One large California health system", "period": "March 2021 price files and 2021 CMS quality measures", "population": "Public insurer-negotiated facility prices for total joint arthroplasty; 22 hospitals, 18 with complete quality data", "priceConcept": "Payer-specific negotiated facility price for DRG 470", "design": "Cross-sectional descriptive and correlation analysis", "finding": "Across 18 hospitals, the overall mean negotiated price was $54,500 (SD $23,200); payer-type means ranged from about $20,300 for Medicaid to $78,800 for commercial out-of-network coverage. No tested price-quality correlation met the study's corrected significance threshold.", "limitation": "Single system, one procedure, posted prices rather than claims-paid amounts, incomplete quality data, and cross-sectional associations.", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10194750/" }, { "id": "brodke2019", "citation": "Brodke DJ, Guo C, Aouad M, Brown TT, Bozic KJ. J Bone Joint Surg Am. 2019;101(24):2212-2218.", "doi": "10.2106/JBJS.19.00475", "pmcid": "PMC10799682", "peerReviewed": true, "geography": "California CalPERS and same-carrier comparison population", "period": "2009-2013; reference pricing began January 2011", "population": "2,023 CalPERS and 8,024 non-CalPERS total joint arthroplasty patients", "priceConcept": "Insurer and patient payments for hospital total joint arthroplasty", "design": "Difference-in-differences observational evaluation", "finding": "Reference pricing was associated with a 19-percentage-point increase in lower-priced hospital selection and a $5,067 reduction in mean insurer payment, while mean patient out-of-pocket payment increased $1,991; most measured quality indicators did not change significantly.", "limitation": "Employer PPO population, elective joint replacement, observational parallel-trends design, and policy effects are not a statewide hospital price level.", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10799682/" }, { "id": "robinson2015", "citation": "Robinson JC, Brown TT, Whaley C, Finlayson E. JAMA Intern Med. 2015;175(11):1783-1789.", "doi": "10.1001/jamainternmed.2015.4588", "pmcid": "PMC10799681", "peerReviewed": true, "geography": "California CalPERS and Anthem comparison population", "period": "2009-2013; reference payment began January 2012", "population": "35,195 CalPERS colonoscopy episodes before/after and 258,616 Anthem comparison episodes", "priceConcept": "Allowed price for colonoscopy across hospital outpatient departments and ambulatory surgery centers", "design": "Difference-in-differences observational evaluation", "finding": "Reference payment increased use of low-priced facilities by 17.6 percentage points and reduced adjusted price by 21.0%; CalPERS reported $7.0 million (28%) lower spending over two years, with no statistically significant complication change.", "limitation": "Includes hospital and nonhospital sites, one purchaser and carrier, outpatient procedure only, and observational policy evaluation.", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10799681/" }, { "id": "farrell2010", "citation": "Farrell KS, Finocchio LJ, Trivedi AN, Mehrotra A. J Gen Intern Med. 2010;25(2):110-114.", "doi": "10.1007/s11606-009-1176-5", "pmcid": "PMC2837489", "peerReviewed": true, "geography": "353 California acute-care hospitals", "period": "Post-AB 1045 field experiment published 2010", "population": "Written estimate requests for hysterectomy, cholecystectomy, or screening colonoscopy from a hypothetical uninsured patient", "priceConcept": "Hospital-provided self-pay price estimate", "design": "Audit study", "finding": "Only 28% of hospitals responded. Estimates varied from $3,500-$65,300 for hysterectomy, $2,700-$36,000 for cholecystectomy, and $350-$5,805 for colonoscopy; 75% of estimates exceeded the median California Medicare reimbursement.", "limitation": "Estimates were often non-comparable, sometimes excluded physician fees, and do not represent negotiated insurer prices or actual paid claims.", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC2837489/" } ], "remainingBoundary": "Precise current service-level allowed prices require normalized hospital machine-readable files or claims data. Public CMS transparency files are free but need a separately scoped harvesting, normalization, and validation pipeline; HCAI HPD claims access is restricted and not required for this public-data Almanac." } }