Supporting the California Primary Care Association (CPCA) in Payment Reform Work

Dates: 2013

State: California

Client(s): California Primary Care Association

Services: Health Care & Public Health Planning, Training & Technical Assistance, Applied Research & Evaluation, Health Systems Transformation

Technical Expertise: Health Care Reform, Integrated Care Models, Safety Net, State and Local Public Health

The California Primary Care Association (CPCA) has recognized the critical link between payment reform and delivery system transformation that will result in Triple Aim goals of better care, improved population health and reduced cost of care per capita.

Over two years of research and engagement of CPCA members, JSI has helped CPCA to identify a multi-layered payment reform model to support the transformation of the system to one in which payment is based increasingly on outcomes rather than solely on volume, centers around patient needs, and increases the capacity and accountability of primary care as the fulcrum of a transformed delivery system that achieves Triple Aim goals. The 3-layer model includes a base payment that preserves current funding but provides increased flexibility in how services are provided; a middle layer that invests in allowing health centers to build robust patient-centered medical homes and provide system-wide coordination, and; a top layer consisting of value-based payments that reward performance on high-value measures at the system level, such as improving patient health and reducing emergency room utilization and hospital readmissions.

To move this comprehensive payment reform strategy into implementation, CPCA contracted with JSI to provide consulting and project management support to CPCA and California’s community health centers in State-level stakeholder conversations regarding payment reform, in policy discussions where payment reform and its relationship to delivery system transformation are relevant, and in moving payment reform pilot workgroups to implementation stage. Specifically, JSI assisted CPCA by:

1. Providing consulting support to the CPCA regarding policy discussions, funding requests, and state-level activities with payment reform components (e.g., State Innovation Model, Let’s Get Healthy Workgroups)
2. Building stakeholder relationships and understanding of payment reform concepts and pilots with health plans, other state PCAs, foundations, and the State
3. Providing project management and consulting support payment reform workgroups dedicated to developing details of a PPS-Equivalent Capitation Rate, PCMH supplemental payment and an overarching strategy)
4. Providing strategic advice regarding evaluating payment reform pilots

Results of this work has resulted in an FQHC payment reform pilot being proposed in state legislation. CPCA has also provided the state with stakeholder informed feedback on a potential health home program under Section 2703 of the Affordable Care Act. Ultimately, the development of such payment reforms are designed to facilitate and catalyze care transformation health centers, allowing them to better meet the needs of the populations they serve.


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