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The California Healthcare Marketplace and CalPERS
by
Albert Lowey-Ball
Associate Professor, Health Policy and Economics, Holy Names College
President, Albert Lowey-Ball Associates, Inc. (ALBA)
Consultant to The Lewin Group, Affiliated with Daniel Russell Charles Co.
Presentation to The League of California Cities
The California State Association of Counties
Newport Beach, CA
January 24, 2002
I. Introduction and Overview
A. Former Director, Santa Barbara Health Initiative
Worked with Sacto, SD, LA, SM, Orange Counties
B. Former HOAC Consultant on Medi-Cal and Indigent Services Projects
C. Experience with CalPERS on Rate Development, Contracting Criteria
D. Consultant to the State on Health Insurance Options
E. Consultant to Private Sector on Managed Health Care Challenges
II. Recent Healthcare Marketplace Developments
A. Dramatic Concentration and Increased Uninsurance
Health Plan Concentration Weakens Purchaser Position
Uninsurance Results in Adverse Cost Shifts
B. Increased Premium and Provider Prices, Narrowing Benefits
Increases Greatest Since Mid 90s
Trend to Increased CoPays and Flexible Benefits
C. Weaknesses of Medical Groups/Physician Networks/PPOs
D. Hospital/Health Systems and Networks
E. Challenges to County Health Systems and Medi-Cal and Link to County
Employment Systems
F. Healthcare Winners and Losers
Health Plan Identification
Hospital/Health Systems Identification
Medical Group/Physician Network Identification
III. Recent Developments at CalPERS
A. Increased Premiums, Benefits Package Refinements
B. Financial Viability of CalPERS PPO Options
Adminstrative Service/Network Issues
Reserving and Premium Issues
C. CalPERS Organizational Structural and Governance Issues
D. Carve-Outs, Utilization Review
E. Data Receipt and Reporting
D. Group Service Requirements and CalPERS Fees
IV. Economic Review of Options to Cities and Counties
A. Straightened Situation of Rural Jurisdictions/Lack of Plans and Providers
B. Contiued Full CalPERS Affiliation/Enhanced Bargaining Position
C. CalPERS Plus SI/PPO Option
D. Separate Approach/Full HMO/PPO Selection
E. Separate Approach/Regional Risk Pool/
PPO Network Development and
F. Administrative Issues and Negotiations
ALBERT LOWEY-BALL ASSOCIATES, INC.
1421 16TH ST., STE. 200
SACRAMENTO, CA 95814
(916) 446-5705 F(916)446-3915
e:albainc@aol.com
www.albainc.com
ALBERT LOWEY-BALL ASSOCIATES, INC. (ALBA) has been incorporated as a Subchapter S
Corporation under California Statutes since 1994. Albert Lowey-Ball, MS, MA, is the sole stockholder of the
Corporation. ALBA is certified as a Small Business Enterprise (SBE) by the California Department of
Transportation. Albert Lowey-Ball is President and John Meissner, JD, is Secretary of the Corporation.
ALBA provides rate and contract development, economic forecasting and market analysis, network and plan
development and administration and government document development services to clients in the public
sector, hospitals, health plans, medical groups and computer services firms coping with the challenges of
managed healthcare.
ALBA is an Associate in Coalition Management Services (CMS), an unincorporated partnership based in
Reno, registered in the State of Nevada. This firm administers the Nevada Health Care Coalition. The Lead
Associate is Michael Ginder, MPA. ALBA is an Associate in Wilson Business Integrators, Inc., dba The
Wilson Group, a Black-owned consulting firm based in Sacramento. It provides technical business services
to public agencies and nonprofit organizations. Bruce Wilson, MBA, is President. The firm holds several
State and County CMAS certifications as well as the State Master Service Agreement (MSA 009, 2000).
Albert Lowey-Ball is individually MSA-certified through The Wilson Group as a benefits consultant.
ALBA Attorney: John Meissner, JD, Johnson, Fort, Meissner and Joseph, Sacramento
ALBA CPA: Laura Pregent, Williams Patrick Olds, Sacramento
ALBA has four Associates with whom it informally collaborates on an ongoing basis:
Charles R. Daniel, President, DRC-Co
Edward L. McClendon, MHA, Sacramento, Hospital Operational Consultant
V. Arthur Naldoza, Principal, Naldoza & Associates, Healthcare Legislative and Policy
Advocacy
John Troidl, PhD, Davis, Principal, Health Services Management, Health Care Clinic Operational
Consultant
ALBA’s staff is ethnically diverse and consists of part-time student employees
Andrew Oliveira, Research and Bookkeeping,
Martin Fuentes, Computer Services,
Heather Montgomery, Executive Assistance
January 9, 2002
ALBERT LOWEY-BALL
President, Albert Lowey-Ball Associates, Inc.
1421 16th St., Ste. 200
Sacramento, CA 95814
(916) 446-5705 F(916) 448-8312
albainc@aol.com www.albainc.com
SUMMARY STATEMENT ON EXPERIENCE AND BACKGROUND
Albert Lowey-Ball is President of Albert Lowey-Ball Associates, Inc. (ALBA), a small
healthcare management consulting firm based in Sacramento, CA. The firm is a certified
Small Business Enterprise (SBE) and is CMAS- and MSA-certified through its association
with The Wilson Group of Sacramento. Lowey-Ball is also MSA-certified as a benefits
consultant.
He served as a health economist in HCFA in the Carter (1977-1978) administration and as
a health agency director in the Jerry Brown (1978-1980) administration. He designed and
administered one of the State’s first successful Medi-Cal managed care plans (the Santa
Barbara Health Initiative, 1980-1984). His consulting firm provides technical services to
public agencies, providers, purchasers, plans and vendors in the managed health care arena,
mostly in California. The services focus on market assessment, economic forecasting,
premium and provider rate development and negotiations, provider network development
and administration, public agency technical liaison and due diligence on
mergers/acquisitions. His clients have included many major hospital/health systems, health
plans, health care agencies and data systems vendors in California. He has been involved in
numerous Medicaid managed care development and implementation efforts in California,
Oregon, New York, Georgia and Colorado. He wrote a report on CalPERS as a health
benefits purchaser within the framework of a competitive approach to national health
insurance for the Kaiser Family Foundation (1993). He recently published a chapter on
national health insurance in a book on global health care markets (2000).
He provided technical advice on a State health insurance proposal in the late 80s and to the
Governor’s Managed Care Improvement Task Force (1998). He briefly participated as a
volunteer with the Clinton Health Policy Task Force (1993). He made presentations to the
European Union and the Israel Health Ministry on health policy, health insurance and
managed care in the U.S. (1994). Lowey-Ball has provided testimony on health insurance
and Medicaid managed care to the US Congress, the California and Oregon Legislatures
and to several County Boards of Supervisors in California. He has given numerous
presentations on the California health care marketplace to professional and trade groups.
He was educated at Rice University (BA, 1964), Georgetown University (MS, 1966) and
University of Maryland (MA, 1969, PhD Candidacy, 1970), the latter degrees in
economics. He has been on the Adjunct Faculty at the University of San Francisco in
Health Policy and Economics in the Masters of Health Services Administration program
since 1984. He also serves as an occasional Lecturer in the Masters of Medical
Management program at Dominican University of California, a part-time Associate
Professor of Health Policy and Economics at Holy Names College in Oakland and as a
Research Affiliate at the UC Davis Medical School.
October 8, 2001
