our and we've heard some discussion of this before, but jamie robinson. and we have our friends to thank for the readable one page chart. the hospitals that were not . participating in the calpers experiment. bob? >> bob grist, with all the discretion that the pairs have e in setting reference pricing that you've disclosed in this p panel. and with the tendency of employers to cost shift in terms of employees, usually in greater deductibles or co payments. what are the protections for consumers from reference pricinn which sets a standard price and expects the consumer to pay anything over that reference he price? it seems like a very dangerous a precedent even ifti it's in they interest of the pair in the cint shortot run. you haven't given any indicatiok paat this isn a way of reducing total health care costs, we don't know if the hospital is going to follow the procedure with regard to other pairs or whether they're going to shift u thoset costs on to other procedures and i'm not sure how comfortable we should feel aboul this particular short term stra

jamie robinson, and we have our friends to thank for these very readable one-pagers summarizing jamie robinson's article. there's a lovely chart on that second page that shows you the impact on the pricing of these services in the hospitals that were not participating in the calpers experiment. yes, bob. >> bob grist with the association of community health. with all the discretion that the payers have in setting reference pricing that you've disclosed in this panel and with the tendency of employers to cost shift onto employees usually in the form of greater deductibles or co-payments, what are the protections for consumers from reference pricing which sets a standard price and expects the consumer to pay anything over that reference price? it seems like a very dangerous precedent even if it's in the interests of the payer in the short run. you haven't given any indication that this is a way of actually reducing total health care costs. we don't know whether the hospital is going to follow this procedure with regard to other payers or whether they're going to shift those costs onto o

evaluation results of the program and these are mainly from a study that we did with uc berkeley, jamie robinson and tim brown, which was published in health affairs in august of this year. that i think is in your packet. so this is looking at utilization, this is the volume of hip or knee replacements. and the first three lines in this chart have to do with cal pers anthem enrollees, what's unique about their study, they were able to get from anthem, the non-cal pers enrolee data as well. so we can look at where our members were going before and after the imp limitation of the program. the first line is the volume, the number of procedures and then the second line is looking at what percentage of your members went to the reference based pricing facilities. it was about 50% before the imp limitation of the program. and an increase to 63% after. non-cal pers members, 54% to their reference based pricing facilities. then dipped and came back. i have a additional representation of that next. the dark blue line being the cal pers reference base said pricing usage. you can see it went up dramatically