By Alec Rosenberg

Not even the star of "The Nanny" can escape the watchful eye of the California Health Benefits Review Program (CHBRP).

"Nanny" actress Fran Drescher, a uterine cancer survivor, sponsored a bill two years ago that would have required health insurers to cover tests for gynecological cancers. Since AB 1774 mandated a health benefit for Californians, the state was required to study its medical, financial and public health impacts. Rather than rely on a partisan report, lawmakers turned to CHBRP, a unique University of California-run service that provides fast, in-depth, objective analyses of proposed health benefit laws.

Within weeks, CHBRP concluded that AB 1774 could lead to genetic testing of many women at more than $2,300 apiece, potentially driving its total cost to $2.7 billion. The bill failed.

"The program has raised the level of debate in Sacramento," said CHBRP Director Susan Philip. "It has allowed policymakers to weigh these bills carefully, looking at the costs and the public health and societal benefits."

Administered by the UC Office of the President, CHBRP provides the state Legislature with independent analysis of the medical, financial and public health impacts of bills that mandate or repeal health insurance benefits, ranging from services to help smokers quit to health care reform. With more people becoming eligible for health insurance under the new federal Patient Protection and Affordable Care Act, CHBRP's studies of how benefit laws will impact Californians are increasingly essential.  

CHBRP completes its analyses — 11 in 2010 — within 60 days. It draws its members from six UC campuses (Berkeley, Davis, Irvine, Los Angeles, San Diego and San Francisco) and three non-UC institutions (Loma Linda University Medical Center, Stanford University and the University of Southern California).

"This is one of the best kept secrets in the nation," said task force member Dr. Sheldon Greenfield, a UC Irvine professor of medicine. "No one campus could provide the levels of expertise. It represents the richness of the university system that no single campus could mimic."

While more than half of the nation's states have laws requiring reviews of proposed health benefit mandates, none is quite like California's. Some states use commissions; others rely on outside consultants. In Oregon, the Oregon Health & Science University reviews Medicaid decisions. But only California turns to universities for a broad range of evidence-based reviews covering a benefit mandate bill's impacts.

"CHBRP is a model for how UC can contribute to health care policy and legislation for the state of California," said Dr. John Stobo, UC senior vice president for health sciences and services. "It should serve as a national example for how academic medical centers should use their expertise for the health of their communities."

CHBRP works closely with legislative staff, answering their questions and holding briefings for them.

"CHBRP's work is trusted and people on all sides of the debate rely on them," said Peter Hansel, staff director of the Senate Health Committee. "CHBRP's analyses help legislators gauge the relative magnitude of the impacts of each pending bill, in terms of whether a bill is a relatively high- or low-cost bill, and whether the benefit or service being mandated is one that insurers tend to cover or not. They also help legislators understand who's at risk for not getting particular services."

Established in 2002, CHBRP is funded by the state through a small yearly assessment on health plans and insurers in California. CHBRP has analyzed 70 bills to date, ranging from coverage of asthma education to vision services. Eight of those bills have become law.

Pending bills of note this year include AB 1825, which would require health insurance policies regulated by the state Insurance Department to cover maternity services for women in California. The bill, approved June 30 by the Senate Health Committee, is similar to AB 98, which the governor vetoed last year.

SB 220 would require health insurance policies that provide outpatient prescription drug benefits to include coverage for tobacco cessation services. Philip noted that Assemblyman Nathan Fletcher, a Republican vice chair of the Assembly Health Committee who normally opposes mandates, said he was going to change his vote to yes because of CHBRP's analysis of the bill's long-term implications.

Some bills that CHBRP reviews target specific populations such as AB 228, which provides coverage of transplantation services for HIV patients. Other bills would create broad-based changes to health care in California such as three introduced this year: AB 1904 regarding out-of-state carriers, AB 2587 regarding benefit mandates and SB 890 regarding basic health care services.

"All of these analyses provided meaningful input into the discussion on what health care reform should be like and how it is going to work," said CHBRP Task Force Vice Chair Ed Yelin, a UCSF professor in residence of medicine and health policy.

Academics like working for CHBRP because they can see a direct correspondence between their work and the results, Yelin said. However, CHBRP does not play an advocacy role; it provides neutral, evidence-based reports. CHBRP has a strong conflict-of-interest policy to ensure independent analysis.

"We will tell you what the temperature is, but we won't tell you whether it is hot or cold," said Yelin, recounting what Michael Drake, who is now UC Irvine's chancellor, told the Legislature when CHBRP started. "We provide the scientific evidence. It's the Legislature's job to decide whether we should turn on the A/C or turn it off."

CHBRP has become known for meeting its deadlines. The National Quality Forum cited CHBRP's quick turnaround in a May paper. Within 60 days, CHBRP does a systematic literature review for its medical effectiveness analysis, which in academic circles can typically take a year, as well as an actuarial cost analysis and public health analysis. Also, a National Advisory Council — experts from outside California who represent major stakeholders with an interest in health benefit mandates — reviews each report before it goes to legislators.

"I really do think that is one of the reasons we are respected," Philip said. "We're able to give legislators the work on time."

Alec Rosenberg is the health communications coordinator in the UC Office of the President's Integrated Communications group. For more information, visit the UC Newsroom or follow us on Twitter.