San Diego has long been a geographically well-defined health care market with high managed care penetration and a consolidated provider sector. In recent years, hospital systems have faced increasing cost pressures as commercial health plans have responded to employer demands for more affordable premiums. Safety-net providers expanded capacity to deal with the large Medi-Cal expansion that began in 2014, but continue to grapple with how to provide adequate care for a new enrollee population that is far sicker, with more complex medical and social service needs, than the providers' previous patient base.
Key developments include:
- While the hospital market remained largely stable in recent years, most of the smaller hospitals have been losing volume and struggling financially.
- Major systems are pursuing population health strategies and increasingly using provider-sponsored health plans to take full risk for more patients.
- The challenges of independent practice are leading many primary care physicians to choose employment at system-affiliated groups.
- In the two years since Medicaid eligibility was first expanded under the ACA, San Diego's Medi-Cal managed care enrollment almost doubled to 700,000. Many Medi-Cal enrollees without a regular primary care provider sought care at hospital emergency departments, and access gaps for many kinds of specialty care and behavioral health care were even more severe.
- San Diego County's commitment to providing health care for low-income residents continues to be limited, although the county Health and Human Services Agency has become more active in fostering collaborations between health and other social services.