Sacramento: Pressures to Control Costs Persist Alongside Growing Capacity and Access Challenges

Mathematica Policy Research


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Since the last round of this study four years ago, Sacramento’s regional health care market has largely recovered from the economic downturn. Yet continuing pressure remains on hospitals to control costs. Meantime, providers, both mainstream and safety-net, are being challenged to expand primary care capacity to meet demand from newly insured patients under the Affordable Care Act (ACA).

An analysis of the Sacramento marketplace reveals these developments:

  • Market positions among the region’s hospital systems are shifting. This comes after several years of relatively stable inpatient market shares among these systems. Kaiser Permanente seems to be gaining strength, while Dignity Health appears to be losing ground.
  • Narrow-network collaborations between plans and providers are not gaining traction as had widely been expected. Opportunities for savings have been elusive, making it difficult to sustain the low-premium trend.
  • Consolidation continued in the physician sector, as young physicians increasingly chose higher reimbursement and more controllable lifestyles in large, system-affiliated medical groups over the autonomy of independent practice.
  • Emergency departments faced overcrowding from patients without access to primary or urgent care, and from patients with mental health needs.
  • The Sacramento-area safety net saw improvements in cohesion and coordination, yet support for the safety net here was still not as strong as in other California counties.

Since 2009, CHCF has published a series of regional market studies that examine the health care markets in specific regions across California. These studies highlight the range of economic, demographic, and health care delivery and financing conditions in California. They are published as part of the CHCF California Health Care Almanac, an online clearinghouse for key data and analyses examining California’s health care system.