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 or reimbursed based on value, not volume, and that both incentive and risk are being built into the payment system.
This movement towards “alternative payment models” and away from a reactive “fee-for-service” model aimed at treating acute episodes, will incentivize care that is more effective and efficient, aimed at keeping patients healthy and out of the hospital.
The Medi-Cal 2020 waiver, with its heavy emphasis on ambulatory care redesign and greater system integration, is a key stepping stone for California’s public health care systems to succeed using value-based strategies. For example, the pay-for-performance PRIME program incentivizes system transformation efforts and rewards improved clinical outcomes. The Whole Person Care program provides funding that supports cross-service coordination, not just within a health care system, but among different entities and organizations across entire counties. And the Global Payment Program is a first-in-the-nation payment reform program that aims to change the way county-owned and operated PHS in California are compensated for providing care to the remaining uninsured.
To find out more about how the Medi-Cal 2020 Waiver supports value-based strategies, download our Issue Brief on the waiver.