This study examines medical payments, prices, and utilization for various types of services by nonhospital and hospital providers in California and compares them with 17 other states. It also examines how these metrics of medical payments and care have changed, mainly from 2014 to 2019. Claims with experience through 2020 for injuries up to and including 2019 were analyzed. In some cases, a longer period was used to supply historical context for key metrics. Information from other WCRI studies was also included to provide a more complete picture of the system in California.

California implemented multiple policy changes in recent years. The drug formulary required by Assembly Bill (AB) 1124 became effective in January 2018, and data in this report reflect up to 27 months of experience following the implementation of that policy initiative. AB 1124 and Senate Bill (SB) 1160, two major fraud-fighting measures, were enacted in January 2017. The data in this study reflect up to 39 months of experience after the passage of these bills. SB 863, a comprehensive reform legislation, went into effect in January 2013. Results in this report reflect the state’s system performance seven years after the implementation of SB 863. In addition, during the analysis period of this study, California went through multiple medical fee schedule updates for hospital outpatient department and ambulatory surgery center services, and nonhospital professional services. These regulatory changes are also potential factors influencing the results discussed in this report.

The results we report include experience on claims through March 2020, at the very beginning of the coronavirus (COVID-19) pandemic. The study, therefore, provides a pre-COVID-19 baseline for evaluating the impact of the virus on workers’ compensation claims. 

CompScope™ Medical Benchmarks for California, 22nd Edition. William Monnin-Browder. October 2021. WC-21-25

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