In this HealthAffairs podcast , Arnold Milstein, M.D., discusses important aspects of the California health-policy landscape. Milstein, a professor of medicine at Stanford University and medical director of the Pacific Business Group on Health, discusses four “perturbations” in the California healthcare market, as summarized below by HealthAffairs editors:

• “Increased transparency, specifically at the level of the healthcare provider.
• “Experiments in patient incentives—that go beyond incentives to choose less expensive plans or medications—in the form of narrow and tiered networks and reference pricing.
• “Private Accountable Care initiatives led notably by Anthem and Blue Shield plans, reinforced by the Medicare Accountable Care Organization (ACO) program and California’s traditional robust managed-care market.
• “Provider consolidation, propelled by hospital acquisition of or close affiliation with physician groups.”