By some estimates, up to 30% of all patient care in the United States is at best ineffective — or at worst harmful — and increases costs for everyone. To address concerns regarding the increased use of wasteful medical services, in 2015, the Integrated Healthcare Association (with funding from CHCF) convened Smart Care California, a public-private partnership comprised of large health care purchasers, provider organizations, and consumer groups, to promote safe, affordable care in California. It is cochaired by the state’s leading health care purchasers: the Department of Health Care Services, which administers Medi-Cal; Covered California, the state’s health insurance marketplace; and the California Public Employees’ Retirement System. Collectively, these groups purchase or manage care for more than 16 million Californians — or 40% of the state.

Smart Care California focuses its work in the following three areas:

Opioid Safety

About 11 Californians die from a drug overdose every day, and opioids — prescription pain relievers, heroin, and fentanyl — are the main driver of overdose deaths. Smart Care California promotes actionable approaches, such as launching an opioid initiative, for health plans and providers to address this epidemic. Smart Care California produced a checklist (PDF) of goals for plans and payers to consult. CHCF created an opioid safety health plan toolkit and a resource center of organizations that can support health plans in implementing medication-assisted treatment (MAT) in multiple settings, including help with delivery systems and electronic health record management. CHCF also worked with Cal Hospital Compare to create an Opioid Safe Designation for hospitals working to improve opioid safety and integrate addiction treatment into hospital services.

C-Sections

Every year in California, 500,000 babies are born. Medi-Cal pays for about half of all births. Between 1997 and 2014, California’s cesarean section (c-section) rate increased dramatically from about one in five births to more than one in three births.

While life-saving in certain cases, c-sections pose serious risks to both babies and mothers, and once a woman has a cesarean, about nine in ten end up having a c-section for subsequent births, increasing their risk of major complications. Smart Care California is working with hospitals and clinicians to reduce the rate of low-risk, first-birth c-sections across the state at every hospital to the Healthy People 2020 goal of 23.9%. To further advance this goal, Smart Care California publishes an annual Honor Roll (PDF) of California hospitals that meet this target. CHCF, the California Maternal Quality Care Collaborative, and Consumer Reports have partnered to create a c-section consumer education campaign, My Birth Matters.

Low Back Pain

Low back pain is one of the most common causes of disability in the country — more than 80% of Americans will experience low back pain in their lifetime. Imaging tests, including CT scans, MRIs, and x-rays, are commonly performed to diagnose the seriousness of the condition. However, most patients do not benefit from imaging studies and may be unnecessarily exposed to harmful radiation through them. Unnecessary imaging can also lead to surgeries that may not improve pain, or that may even cause further injury and disability. Additionally, overprescribing of opioids for low back pain contributes to the worsening of the opioid epidemic. There is a compelling need to reduce over-imaging and ensure evidence-based treatment for low back pain. A complete list of participating plans, providers, and consumer groups is available on the Smart Care California website.