McGeorge
School of Law
Ethical Pricing
Decisions in Healthcare
Course Materials
Friday, Sept. 25 | 8:30 a.m. | McGeorge School of Law
Sponsored by a Grant from the Sierra Health Foundation
ABOUT THE CONFERENCE
The Affordable Care Act was focused primarily upon expanding access to health care by extending
insurance coverage to the uninsured. That coverage was made more affordable by creating more
competitive insurance markets and by significantly expanding government subsidies. However, the
Act did little to address the underlying costs of health care. This symposium will shine a spotlight on
how pricing decisions are made in the healthcare industry, the changing market conditions that
influence pricing decisions, and whether those decisions can be made more equitably and ethically.
The focus will be particularly upon pricing decisions for hospital services and for pharmaceuticals.
Ethical Pricing Decisions in Healthcare | 1
PROGRAM
Prelude 8:30 a.m. - 8:45 a.m.
Welcome from the Host
Maria Pallavicini, Provost, University of the Pacific
Introduction from Program Moderator
Emily Whelan Parento, Associate Professor of Law and Gordon D. Schaber Health Law Scholar,
University of the Pacific McGeorge School of Law
Legal and Ethical Principles Regarding Pricing Decisions 8:45 a.m. - 10:15 a.m.
(Moderator: Professor Emily Whelan Parento)
“Legal Restrictions on Pricing Decisions”
Ann Marie Marciarille, Associate Professor of Law, University of Missouri-Kansas City
“When It Comes to Health Care, Should Price Matter?”
Steven Tharratt, M.D., Chief Medical Executive, California Prison Health Care Services
“Health Care Pricing Decisions from an Insurance Perspective”
Matt Graham, Director, Leavitt Partners
Pricing Decisions for Hospital Services 10:30 a.m. - 12:00 p.m.
(Moderator: Professor Melissa Brown, McGeorge School of Law)
“Hospital and Provider Pricing - A View from CMS”
David W. Sayen, Regional Administrator, San Francisco Regional Office, Center for Medicare &
Medicaid Services
“Regulatory Options to Foster Market Competiation”
Robert Berenson, M.D., Urban Institute Fellow, Urban Institute
“Hospital Pricing Decisions: The Real Challenge of Keeping the Lights On”
Anne McLeod, Senior Vice President, Health Policy & Innovation, California Hospital Association
Lunch
Pricing Decisions for Pharmaceuticals 1:30 p.m.- 3:00 p.m.
(Moderator: Eric Boyce, Pharm.D., Associate Dean for Academic Affairs, Thomas J. Long
School of Pharmacy and Health Sciences, University of the Pacific)
“Cost- and Value-Based Rationales for Drug Prices”
Gregg H. Alton, Executive Vice-President, Corporate & Medical Affairs, Gilead Sciences, Inc.
“Sustainable Pricing for Pharmaceuticals”
Charles Bacchi, President & CEO, California Association of Health Plans
“Government’s Role as Market Participant and Regulator”
Harry Hendrix, Chief, Pharmacy Division, California Department of Health Care Services
2 | McGeorge School of Law
Welcome
Dr. Maria Pallavicini, Provost, University of the Pacific
Biography
As Provost, Dr. Maria Pallavicini serves as the University’s chief academic officer and has overall responsibility
for the institution’s educational and research programs, library services, enrollment, financial aid, registrar and
continuing education. She oversees Pacific’s liberal arts college and eight other schools on campuses in Stockton, Sacramento and San Francisco, encompassing 120 academic programs, 839 faculty, 6,700 students,
and a $115 million budget.
Prior to Pacific, Provost Pallavicini joined UC Merced in 2002 to establish the School of Natural Sciences for
the new research university. She recruited faculty and staff and worked with them to establish undergraduate
and graduate teaching programs and research programs in mathematics, biology, chemistry, environmental
sciences, and physics. UC Merced opened in 2005. The School of Natural Sciences now includes 53 ladderrank faculty and approximately 30% of UC Merced’s 3,200 undergraduates, and teaches more than half of
the total student credit hours at UC Merced.
Provost Pallavicini holds a B.S. in biochemistry from UC Berkeley, and a Ph.D. in Pharmacology from the
University of Utah, Salt Lake City. She has held research positions at the Lawrence Livermore National Laboratory, the Lawrence Berkeley National Laboratory, and the Ontario Cancer Institute in Toronto. She was a
professor at UC San Francisco, where she taught and ran an active research program, for more than 11 years
prior to joining UC Merced as a tenured professor and founding dean.
Dr. Pallavicini’s research interest is in understanding the genetic and functional changes in stem cells in cancer (leukemia and breast cancer) that affect stem cell fate decisions. She has authored or co-authored more
than 80 peer-reviewed articles in scientific journals and has presented on stem cells and cancer at scientific
conferences around the world. She has held leadership positions in numerous professional societies and
served on scientific editorial and advisory boards.
Dr. Pallavicini has taught freshman general education courses on stem cell biology, and health and disease, as
well as advanced courses in cancer biology and genetics, and trained numerous graduate students and postdoctoral fellows in health sciences.
A native of San Francisco, Provost Pallavicini has three adult daughters who live in California, all of whom attended University of California schools.
Ethical Pricing Decisions in Healthcare | 3
Legal and Ethical Principles
Regarding Pricing Decisions
Emily Whelan Parento, Associate Professor of Law and Gordon D. Schaber Health Law Scholar, University of
the Pacific McGeorge School of Law
Biography
Professor Emily Whelan Parento joined Pacific McGeorge in July 2015 as Associate Professor and the Gordon
D. Schaber Health Law Scholar. Her primary scholarly focus is the intersection of domestic health law and
policy with the human rights framework for the right to health and health equity. Professor Parento has written in both national and global health law and policy, examining issues such as the impact of the Affordable
Care Act on health disparities, legal strategies to strengthen health equity, and global trends in obesity-related
regulation. Prior to coming to Pacific McGeorge, Professor Parento served as Executive Director of the Office of
Health Policy for the Commonwealth of Kentucky, advising the administration of Governor Steven L. Beshear
during the implementation of the Affordable Care Act.
Before her government service, Professor Parento held a fellowship at the O’Neill Institute for National and
Global Health Law at Georgetown University Law Center; she also served as a visiting assistant professor at
the University of Louisville Louis D. Brandeis School of Law, where she taught courses in health, food and
drug, and administrative law. Earlier in her career she served as a federal judicial clerk and practiced litigation
at Davis Polk & Wardwell in New York and California.
Professor Parento has published in a number of venues, including the Indiana Law Journal, the Notre Dame
Journal of Law, Ethics, & Public Policy, the Loyola Law Review, and the Hastings Center Report. In her
government service, Professor Parento led development and implementation of multiple grants, including a $2
million grant from the Centers for Medicare & Medicaid Services to develop a State Innovation Model Design
to transform health care delivery and financing in Kentucky, as well as an award from the National Governors
Association to develop a state health workforce plan. Professor Parento has also presented at numerous health
policy conferences and symposia and testified at multiple legislative hearings. She holds a JD and LLM from
Georgetown University Law Center, a BBA from the University of Notre Dame, and is admitted to the state
bars of California (inactive), New York, and Kentucky.
4 | McGeorge School of Law
Legal Restrictions on Pricing Decisions
Ann Marie Marciarille, Associate Professor of Law, University of Missouri-Kansas City
Biography
Ann Marie Marciarille is an associate professor of law specializing in health care law. Her research interests
are in health care regulation and finance with a particular interest in health care reform. Before joining UMKC,
she had a long career as health law attorney, including 10 years as a health care antitrust prosecutor for the
California Attorney General’s office and several years as a legal services attorney specializing in health care
matters.
Professor Marciarille is a summa cum laude graduate of Amherst College and a cum laude graduate of Harvard Law School, where her studies were focused on public interest representation. She also holds a Masters
in Theology, specializing in ethics, from Harvard Divinity School.
She has published articles on Medicare reform, health care finance reform and health care provider quality
issues. Professor Marciarille taught Health Law, Health Care Reform, Elder Law, Disability Law, and Public
Health Law at the University of California, Hastings College of the Law, Boalt Hall/Berkeley Law School and
Pacific McGeorge School of Law.
Ethical Pricing Decisions in Healthcare | 5
When it Comes to Health Care, Should Price
Matter?
Steven Tharratt, M.D., Chief Medical Executive, California Prison Healthcare Services
Biography
Steven Tharratt M.D. is the Director of Health Care Operations for California Correctional Health Care Services. Dr. Tharratt comes to CCHCS from the California Emergency Medical Services Authority in the Health
and Human Services Agency where he served as the director. Dr. Tharratt was also a Professor of Medicine
and Anesthesiology at the University of California, Davis School of Medicine where he served as Division Chief
of Pulmonary/Critical Care and Sleep Medicine. Dr. Tharratt will coordinate all medical services within the
California Department of Corrections and Rehabilitation 33 adult prisons.
Dr. Tharratt received his medical degree from the University of California, Los Angeles and his Master of
Preventative Veterinary Medicine degree (Public Health) from the University of California, Davis. He is boardcertified in internal medicine, pulmonary diseases, critical care medicine, emergency medicine and medical
toxicology.
6 | McGeorge School of Law
Health Care Pricing Decisions from
an Insurance Perspective
Matt Graham, Director, Leavitt Partners
Biography
Matt Graham is a Director at Leavitt Partners and works in our Salt Lake City office. He has a background in
tracking and evaluating the evolving capabilities and business models of exchange technology vendors and the
platforms they support. Mr. Graham has over a decade of project and client management experience, in both
the public and private sectors. Mr. Graham has led primary research efforts exploring and writing about various health insurance topics, including: payer and broker employer engagement strategies in an ACA context;
payer sales cycles and compliance documentation processes; and health plan, employer, and broker sentiment
regarding health insurance exchange adoption. Mr. Graham is frequently asked to speak on how public and
private exchanges are fundamentally altering how health insurance is being purchased and sold.
Prior to joining Leavitt Partners, Mr. Graham served as Vice President of Business Development for Gaiacor
Management, a privately held international agricultural management company. In this capacity, he identified, developed and presented new business opportunities to management, investors and foreign government
officials. Before Gaiacor Management, he was Chief Financial Officer for Sweetwater International, and was
responsible for oversight of all financial aspects of the establishment and operation of a $34 million farming
operation overseas. Prior to Sweetwater, Graham served as a Regional Manager for the Microfinance Information eXchange (MIX), the global clearinghouse for microfinance data, analytics and performance information.
Mr. Graham holds a master’s degree in international relations from Johns Hopkins School of Advanced International Studies, and a bachelor’s in Spanish from the University of Utah.
Ethical Pricing Decisions in Healthcare | 7
Pricing Decisions for Hospital Services
Melissa Brown, Director, Legal Clinics Professor of Lawyering Skills McGeorge School of Law
Biography
Professor Melissa Brown is an expert in Elder and Health Law. She teaches the Elder and Health Law Clinic
and seminar as well as the law school’s course on Elder Law and Social Policy. She is the author of a wellregarded treatise on Elder Law and has directed professional education programs for the law school on healthrelated issues. Professor Brown is an experienced lawyer with a wealth of experience in workers’ compensation as well as issues facing the elderly and disabled. This experience makes her an excellent mentor for her
students.
8 | McGeorge School of Law
Hospital and Provider Pricing
David W. Sayen, Regional Administrator, San Francisco Regional Office, Center for Medicare
& Medicaid Services
Biography
David Sayen assumed the position of Regional Administrator of the Centers for Medicare & Medicaid Services,
Region IX in February 2008. David is based in San Francisco, and his jurisdiction includes California, Arizona,
Nevada, Hawaii, and the Pacific Territories. He replaces Acting Regional Administrator Charlotte Yeh, who is
returning to her regular duties as Regional Administrator of the New England region of CMS.
David brings more than 29 years of Federal service and experience in health and human services programs to
the position of Regional Administrator. Since 2002, he has served as Associate Regional Administrator for the
Division of Medicare Health Plans Operations, leading all private health plan contract operations for Medicare
Advantage and the Medicare Prescription Drug benefit in Region IX. From 1999 to 2002, he was the Associate Regional Administrator for the Division of Medicare Financial Management, where he ran the Medicare
Contractor Financial Management and Program Integrity functions.
From 1998 to 1999, David led a team charged with ensuring that 11 Medicare claims processors successfully prepared for Y2K. From 1994 to 1998, he directed all Medicare managed care and fee-for-service
customer service operations as Branch Chief, Medicare Managed Care Branch, in the Philadelphia Regional
Office of CMS.
In 2003 David was named a Senior Fellow of the Council on Excellence in Government Fellowship, and he
is also a member of the Adaptive Business Leaders Healthcare Roundtable of Northern California. He earned
a bachelor’s degree in philosophy from Temple University, Philadelphia, PA in 1977 and an MBA with an
emphasis on health administration from Temple University in 1991.
David lives with his family in Alameda, CA.
Ethical Pricing Decisions in Healthcare | 9
Regulatory Options to Foster
Market Compitition
Robert Berenson, M.D., Urban Institute Fellow, Urban Institute
Biography
Robert Berenson joined Urban as an Institute fellow in 2003. In this position he conducts research and provides policy analysis primarily on health care delivery issues, particularly related to Medicare payment policy,
pricing power in commercial insurance markets, and new forms of health delivery based on reinvigorated
primary care practices.
In 2012, Berenson completed a three-year term on the Medicare Payment Advisory Commission, the last two
years as vice chair. From 1998 to 2000, he was in charge of Medicare payment policy and private health
plan contracting in the Centers for Medicare and Medicaid Services. Previously, he served as an assistant
director of the White House Domestic Policy Staff under President Carter.
Berenson is a board-certified internist who practiced for 20 years, the last 12 years in a Washington, DC,
group practice. While practicing he helped organize and manage a successful preferred provider organization
serving the Washington, DC, metropolitan area. He is coauthor of The Managed Care Blues & How to Cure
Them with Walter Zelman, and Medicare Payment Policy and the Shaping of U.S. Health Care, with Rick
Mayes. He publishes frequently in numerous publications, including the New England Journal of Medicine,
Health Affairs, New York Times, and New Republic.
Berenson is a graduate of the Mount Sinai School of Medicine, a fellow of the American College of Physicians,
and on the faculty at the George Washington University School of Public Health and the Fuqua School of Business at Duke University.
10 | McGeorge School of Law
Hospital Pricing Decisions:
The Real Challenge of Keeping the Lights On
Anne McLeod, Senior Vice President, Health Policy & Innovation, California Hospital Association
Biography
Anne McLeod serves as CHA’s health care reform resource for member hospitals. Using her knowledge of both
federal and state health care reform legislation and regulations, she coordinates CHA’s efforts on the development, communication, and implementation of policies related to health care reform. She also provides leadership for the design, development and implementation of the hospital fee and other financing programs.
Anne joined CHA in 2007 and immediately began working on health policy and financing issues with then
Gov. Schwarzenegger’s health care reform team. She works closely with the California Legislature, the Executive Branch, and regulatory agencies, including the Department of Health Care Services. She also represents
hospitals’ interests with the management and governing board of the California Health Benefit Exchange.
Before joining CHA, Anne served as a financial executive at several of California’s hospitals and health systems, and in California’s banking industry. She earned an undergraduate degree in finance, a post-graduate
degree from the prestigious Pacific Coast Banking School held at the University of Washington’s Graduate
School of Business and a master’s degree in public health policy and management from the University of
North Carolina at Chapel Hill.
Ethical Pricing Decisions in Healthcare | 11
Pricing Decisions for Pharmaceuticals
Eric Boyce, Pharm.D., Associate Dean for Academic Affairs, Thomas J. Long School of Pharmacy and Health
Sciences, University of the Pacific
Biography
Dr. Eric Boyce received his bachelor of science in pharmacy in 1975 and his doctor of pharmacy in 1984
from University of Utah. He joined the Pacific Pharmacy Practice family in 2006. Dr. Boyce was recently appointed to a three-year term to the Editorial Board for the American Journal of Pharmaceutical Education.
When asked what he finds most rewarding about being at Pacific, he answered “assisting students become
health care professionals through development of a strong knowledge base, enhanced ability to communicate
and problem solve, and professional and patient caring attributes; assisting faculty further development their
abilities in teaching, scholarship, and service; and assisting in the development, improvement and support for
the School’s academic programs.”
Outside of the classrooms, Dr. Boyce enjoys playing golf, hiking, and photography.
12 | McGeorge School of Law
Cost- and Value-Based Rationales
for Drug Prices
Gregg H. Alton, Executive Vice-President, Corporate & Medical Affairs, Gilead Sciences, Inc.
Biography
Gregg Alton joined Gilead Sciences in 1999. From 2000 to 2009 he served as General Counsel. In his
current role, Mr. Alton is responsible for legal affairs, government affairs, medical affairs, public affairs and
emerging market activities. Prior to joining Gilead, Mr. Alton was an attorney at the law firm of Cooley Godward, LLP, where he specialized in mergers and acquisitions, corporate partnerships and corporate finance
transactions for healthcare and information technology companies. Mr. Alton is a member of the boards of
the AIDS Institute, the Boys and Girls Clubs of Oakland and Celladon Corporation. He is also a member of the
U.S. Government’s Industry Trade Advisory Committee on Intellectual Property Rights, the advisory boards of
UCSF Global Health Group, USC Schaeffer Center for Health Policy and Economics, Pharmozyme, Inc. and
the Dean’s Advisory Council at Stanford Law School. In addition, he serves on Partners In Health’s Board of
Trustees. Mr. Alton received a bachelor’s degree in legal studies from the University of California at Berkeley,
and holds a JD from Stanford University.
Ethical Pricing Decisions in Healthcare | 13
Sustainable Pricing for Pharmaceuticals
Charles Bacchi, President & CEO, California Association of Health Plans
Biography
Charles Bacchi is the President & CEO for the California Association of Health Plans
(CAHP). For the last nine years Mr. Bacchi served in leadership positions at CAHP, most
recently as Executive Vice President, leading the Association’s advocacy before the
California Legislature, the California Health Benefit Exchange, and the Department of
Managed Health Care on behalf of CAHP’s health plan members that provide health
coverage to 21 million Californians.
A veteran of California’s political community, Mr. Bacchi has 20 years of experience in the
California legislative, advocacy, and trade association arenas. Bacchi was at the center of
California’s health reform efforts. Under the Affordable Care Act, health plans play a critical
role in offering millions of Californians access to health care. As state policymakers crafted
California’s approach to ACA implementation, Bacchi played a prominent role as the health
plan voice on a range of issues, including translation of the ACA into state law, the start-up
of Covered California, and the expansion of the state’s Medicaid program, Medi-Cal.
In previous roles with the California Chamber of Commerce and the Legislature, Mr. Bacchi
was instrumental in developing and negotiating the bi-partisan 2004 California workers
compensation reform package and the bi-partisan 1998 school bond effort that reformed
funding for school construction and limited fees on new homebuyers.
14 | McGeorge School of Law
Government’s Role as Market Participant
and Regulator
Harry Hendrix, Chief Pharmacy Division, California Department of Health Care Services
Biography
Mr. Hendrix is responsible for overseeing the nearly $3 billion Medi-Cal fee-for-service drug program and
serves as the principal policy-maker and advisor for all aspects of Medi-Cal’s fee-for-service pharmacy, drug
contracting, medical supply and nutritional benefits, drug rebate and vision service programs. Mr. Hendrix
has over fifteen years of state government experience; fourteen of which have been with DHCS, most of which
he served in managerial positions within the Medi-Cal Managed Care Division, and as Chief of the Drug Rebate Branch within the Pharmacy Benefits Division prior to becoming Chief over that Division.
Mr. Hendrix earned a Bachelor of Arts degree in Psychology from San Diego State University, and a Masters of
Science degree in Educational Leadership from Minnesota State University, Mankato.
Ethical Pricing Decisions in Healthcare | 15
NOTES
16 | McGeorge School of Law