THE KEY TO HEALTH REFORM IS REDUCING CONSUMPTION:

Some experts estimate that at least $200 billion is wasted annually on excessive testing and treatment. This overly aggressive care also can harm patients, generating mistakes and injuries believed to cause 30,000 deaths each year.

"The changes that need to be made don't appear unrealistic, yet they seem to take an awful lot of time," said Dr. Jeff Rideout, chief executive of the Integrated Healthcare Assn., an Oakland nonprofit group that promotes quality improvement.

In California, that sense of frustration has led three of the state's biggest healthcare purchasers to band together to promote care that's safer and more cost-effective. The California Public Employees' Retirement System (CalPERS), the Covered California insurance exchange and the state's Medicaid program, known as Medi-Cal -- which collectively serve more than 15 million patients -- are leading the initiative.

Progress may be slow, but there have been some encouraging signs. In San Diego, for instance, the Sharp Rees-Stealy Medical Group said it cut unnecessary lab tests more than 10% by educating both doctors and patients about overuse.

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