The landscape of health care is shifting. The way providers receive funds needed to care for patients – especially our communities’ most vulnerable – must shift with it. As providers become more focused on primary and preventive care, value-based strategies are helping ensure that providers are being reimbursed based on value, not volume, and that both incentives and risk are being built into the payment system.
Ambulatory Care Redesign
Ambulatory care redesign means rethinking traditional provider roles in order to empower every member of a primary care team to care for each patient with the right level of care, in the right place, and at the right time. This work leads directly to better patient outcomes and more efficient systems.
California’s public health care systems aim to provide a high quality health care experience to all patients they serve. This requires a focus on effectiveness and efficiency – not just in the care itself, but in designing and improving the system through which that care is delivered. Performance excellence refers to the process of managing change and building continuous improvement into the way a health care system does business.
Social Determinants of Health
California’s public health care systems strive to provide high-quality, equitable health care to all who need it. But we know that health care itself is only one component of an individual’s overall health, and that each person’s physical environment, social and community context, education, and economic stability all contribute to his or her health and well-being. All of these factors together are social determinants of health.
When a health care system is data-driven, that means it is taking the critical information it receives, from all sources, ensuring that data is accurate and reliable, and using it to promote better care and service for patients. Data-driven organizations are implementing comprehensive information utilization strategies to help drive stronger outcomes, payment reform, quality improvement, and disparity reduction.
Medi-Cal 2020 Waiver Implementation
Medi-Cal 2020 is a five year renewal of California’s Section 1115 Medicaid Waiver, which includes four aligned programs that will shift the focus away from hospital-based and inpatient care, towards outpatient, primary and preventative care – in other words, from volume to value.