Payment Reform Support for the California Primary Care Association (CPCA) & California Association of Public Hospitals & Health Systems (CAPH)

Dates: 2014-2015

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, Primary Care, Safety Net

From 2011-2014, JSI assisted the California Primary Care Association (CPCA) and the California Association of Public Hospitals & Health Systems (CAPH) – representing over a thousand non-profit and County-based Federally Qualified Health Centers (FQHCs) across California – by conducting research on alternative payment models, educating members on select promising payment reform strategies for primary care, advocating for payment reform in statewide policy efforts with a focus on leveraging Federal funding, and spearheading stakeholder discussions with both the Department of Health Care Services (DHCS) and managed care Medi-Cal plans to advance payment reform for FQHCs. Through this work, CPCA and CAPH put forward a comprehensive payment reform strategy that provides:

  • Greater flexibility in the FQHC base payment so that FQHCs can render primary care services through patient-centered, high-quality modalities that move beyond the current system of only paying for face-to-face visits with select providers while also abiding by Federal guidance regarding FQHC Alternative Payment Methodology (APM).
  • Investment in patient-centered health home (PCHH) services, including both catalytic investment in transformation to PCHH and sustained funding for currently non-reimbursable care coordination and case management services that can ultimately reduce total cost of care and improve quality and patient experience for complex patients.
  • Aligned financial incentives with desired Triple Aim outcomes through shared savings and pay-for-performance.
  • Workgroups have acknowledged that gaining access to health plan data and agreeing on standard common metrics to assess Triple Aim outcomes represent two cornerstones of “payment for value” initiatives as well as represent critical measures for evaluating changes in the payment and delivery systems.
JSI built on prior work outlined above by providing CPCA and CAPH support in four major areas:
  • Consulting Support to CPCA and CAPH Regarding Policy Discussions, Funding Requests and State-Level Activities with Payment Reform Components
  • Payment Reform Work Group Project Management
  • Building Stakeholder Understanding and Partnerships
  • Research and Evaluation Support
Portions of this work were also supported by the Blue Shield of California Foundation and The California Endowment


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