Researching Section 2703 Chronic Care Health Home

Dates: 2011-2013

State: California

Client(s): California Primary Care Association

Services: Health Systems Transformation, Policy Development & Implementation

Technical Expertise: Health Care Reform

With increasing health care costs and growing budget gaps, California, like many states, faces an immediate imperative to find better ways to alleviate suffering and stem the costs associated with chronic conditions.

The California Primary Care Association (CPCA), representing more than 800 Community Clinics and Health Centers, views patient-centered health home (PCHH) as a care delivery model that represents a cornerstone of a transformed health delivery system that places value on coordinated, evidence-based practices, quality outcomes and cost efficiency rather than on volume of uncoordinated health services. The Federal government also recognizes the potential value of PCHH, particularly for individuals with chronic conditions. Section 2703 of the Affordable Care Act describes the opportunity for states to submit a state plan amendment (SPA) for provision of health home services for Medicaid and dual eligible enrollees with chronic conditions.

In December 2011, CPCA commissioned JSI to conduct research and formulate a series of recommendations for the State of California to consider in pursuing a Section 2703 SPA to provide health home services to Medi-Cal and dual eligible enrollees with chronic conditions.

JSI's work included:

  • an extensive review of the literature on PCHH and chronic condition care
  • primary research with national experts on delivery system transformation
  • a review of the recent technical resources for states considering SPAs under Section 2703 of the Affordable Care Act
  • review of the three SPAs that had been approved to date
  • review of draft SPA proposals from multiple states
  • synthesis of key recommendations for how California might proceed in a position paper

CPCA circulated the JSI position paper to State Department of Health Care Services stakeholders to stimulate further conversation on how to catalyze PCHH transformation in California.


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