Researching Payment Reform and Alternative Financial Models for Health Centers in California

Dates: 2011-2012

State: California

Client(s): California Primary Care Association

Services: Health Care & Public Health Planning, Health Systems Transformation

Technical Expertise: Health Care Reform

The Affordable Care Act has elevated the Triple Aim - to improve patient experience and population health while reducing costs to the overall health system - as a guiding principle for a much-needed delivery system transformation that promotes value over volume of care. Inasmuch as health centers receive the bulk of their payments based on the volume of face-to-face encounters through the prospective payment system (PPS), it is critical for health centers to consider how alternative payment models will best support the delivery system transformation necessary to achieve the Triple Aim goals.

Representing over 800 member community clinics and health centers, the California Primary Care Association (CPCA) engaged JSI in April 2011 to conduct both a landscape scan and primary research with other states and to provide specific recommendations for next steps for CPCA to take in payment reform efforts.

As part of this project, JSI performed the following activities:

  • a literature review of payment reform efforts and innovations in both the public and private sectors
  • interviews with national experts and state Medicaid agency and primary care association leaders from eight states, and 10+ health center leaders in California
  • synthesis and gathering feedback on preliminary findings with CPCA stakeholders
  • composition of a January 2012 report - Building a Foundation for Payment Reform for Community Health Centers in California - which lays out a conceptual framework and vocabulary for payment reform discussions and key findings regarding four models that represent the areas of most activity nationally and in California: pay for performance (P4P), patient-centered medical home (PCMH), accountable care organizations (ACOs), and primary care capitation.

CPCA has utilized the JSI report and recommendations as a platform to engage health centers, safety-net partners, funders, and the State of California DHCS partners in meaningful discussions about payment models for catalyzing and sustaining transformation to a new delivery system.


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