Big decisions are being made in health care, many of them affecting California businesses, but the business community won’t have much say in those decisions if leaders don’t step up and participate in defining the future of the health care landscape.

That’s one of the points in a report due out today from the Bay Area Council. The report, “Road Map to a High Value Health System,” analyzes the sources of rising health care costs in California and outlines choices to lower those costs.

“The broader business community and organizations representing the business community have run the gamut from hostile to disengaged,” according to report author Micah Weinberg. “Our message is, if we don’t participate in this process, we’re going to get something we don’t like. So we wanted to make sure businesses get involved.”

Solutions for costs include moving toward the medical home model, accountable care organizations, bundled payments and value-based hospital purchasing, according to the report. The report also calls for a Medicare oversight board and establishment of a quality-innovation center.

“Health care reform has to work for hospitals and health care businesses,” Weinberg said, “but it also has to work for non-health care businesses.”

To accomplish that will take participation of businesses in California. The BAC wants to shift the discussion to include them. “When I talk to people about the elements of the ACA, whenever I talk about the specific provisions in it, it goes over very well,” Weinberg said. But he reported an intransigence and resistance to health care reform in a more general discussion. “Folks tend to have positive reaction to the elements of health care reform,” he said, “but not to the name.”

California business leaders are often leery of the state’s Health Benefit Exchange, Weinberg said. “There’s a lot of concern over whether the exchange actually adds value in the marketplace,” he said, “and a lot of skepticism particularly about the small group market in the exchange.”

The multi-pronged approach to cutting health care costs is vital, he said, as is the state’s move toward integrated delivery systems. In the long run, Weinberg said, it will pay off to bring California businesses on board.

“This is a real opportunity to engage the business community, right now,” Weinberg said. “It’s a dialogue that could be more robust.”