Value-Based Care
For patients who are covered by Medi-Cal or uninsured, access to care often depends on the strength of the safety net. These patients frequently have the greatest health and social needs and the fewest resources, requiring care that goes beyond the traditional medical model.
California’s public health care systems have been meeting these needs for more than a decade through innovative, value-based approaches designed to improve patient outcomes, advance equity, and contain costs. SNI’s member systems continue to lead the nation in implementing and scaling these approaches through statewide programs.
For patients, value-based care is delivering results
Recent results from California’s public health care systems show measurable gains for Medi-Cal patients, including improvements in preventive care, behavioral health screening, and chronic disease management. More details appear in the Quality Incentive Pool section below.
A smarter model for better outcomes
Value-based care gives public health care systems a more ambitious and transformative way to care for patients with low incomes. By tying payment to quality rather than volume, value-based care shifts health care away from traditional, high-volume models.
These incentives reward systems for improving patient outcomes and encourage preventive, comprehensive, and coordinated care. They support systems in providing more proactive, cost-effective care and addressing patients’ health and social needs earlier.
Evidence shows this approach can deliver results: a 2024 Medicaid-focused research study of the safety net found that value-based care models can improve quality and chronic disease management.
The challenge of transformation
California’s public hospital systems are committed to value-based care because of what it is already making possible for patients. But this transition from volume to value is complex. Delivering on the full promise of value-based care requires strategic investment in patient engagement, data infrastructure, processes to track outcomes and address disparities, stronger care coordination across sectors, and workforce development.
How SNI supports member systems in value-based care
SNI equips its members to implement and succeed in value-based care programs by strengthening their knowledge, capabilities, and peer connections. Our work focuses on:
- Expert guidance – We closely support systems in understanding value-based care program goals, interpreting reporting requirements, navigating challenges, and using performance data to guide improvement.
- Measurement expertise and insights – We help systems collect accurate and meaningful data, analyze trends, and track disparities to advance equity, using these insights to strengthen care delivery across value-based programs.
- Peer learning and shared problem-solving – We convene system for in-person meetings and webinars to discuss challenges, exchange ideas, learn from one another and experts, and spread practices that work as they implement these programs.
- Practical tools and resources – We create best practices, guides, reports, frameworks, and other content that translate value-based care strategies into actionable steps for better patient outcomes.
Key Programs
SNI supports member systems as they participate in several statewide value-based care programs, each with unique goals and patient impact:
Quality Incentive Pool
Driving higher-quality and more equitable patient care
For the millions of individuals enrolled in Medi-Cal, the Quality Incentive Pool (QIP) is a sweeping and proven driver of better care. It accelerates and expands public health care systems’ quality improvement work by tying essential funding to clear goals and measurable progress for patients.
As California’s most far-reaching value-based care program, QIP evaluates how well public hospital systems perform on 40 quality measures. These range from ensuring children receive recommended immunizations to helping adults control high blood pressure.
As a result of systems’ focused efforts to improve performance on these measures, patients are staying healthier and avoiding hospitalization due to better chronic disease management, more timely postpartum care, regular cancer and depression screenings, and other core services.
Between 2021 and 2024, SNI helped systems achieve measurable gains through QIP, including:
- More than 1.3 million patients screened for depression with follow-up plans
- Nearly 500,000 children and adolescents received well-care visits
- More than 76,000 patients achieved diabetes control
Advancing quality for greater impact
QIP helps systems turn quality goals into practical changes in care delivery. This work often means redesigning processes, coordinating across teams, and testing new strategies that better meet patient needs.
Through QIP, systems continue to transform care delivery by:
- Designing new patient engagement strategies
- Improving data systems and analytics, including identifying and tracking disparities
- Creating new workflows and care processes
- Increasing care coordination
- Developing workforce capabilities
- Strengthening partnerships to expand services
These changes act as a force multiplier, embedding improvements across systems and extending QIP’s impact to more patients over time.
“Every step forward in these [QIP] quality measures resulted in better care for the patients and communities we serve.”
How SNI supports member systems in QIP
QIP is a demanding, high-stakes program for California’s public health care systems. Working closely with systems, SNI provides expert guidance grounded in specialized QIP knowledge to help them improve performance and secure essential funding for patient care.
We do this by:
- Providing reporting and measurement expertise. We interpret the state’s extensive annual QIP reporting requirements for systems and help them collect and submit accurate, reliable, and meaningful data. In partnership with the National Committee for Quality Assurance (NCQA), we work to align QIP with national standards so systems can spend less time and effort on data collection and reporting efforts.
- Delivering performance management technical assistance. We provide one-on-one guidance to help systems navigate complex QIP requirements, resolve performance measurement reporting challenges, and identify practical solutions. This hands-on support and troubleshooting enable systems to overcome obstacles and move forward quickly.
- Facilitating peer learning to problem-solve and spotlight successful strategies. Through in-person meetings, forums, and webinars, we bring systems together to discuss challenges, share what is working, and learn from peers, as well as subject matter experts about how to improve performance on QIP’s quality measures. We analyze statewide QIP results to identify trends, gaps, and bright spots. We use these insights to surface and spread successful quality improvement strategies across systems.
- Shaping QIP at the state level with system input. SNI works closely with California’s Department of Health Care Services (DHCS) and other state partners to refine and implement QIP in ways that are beneficial to patients and feasible for public hospital systems. Drawing on systems’ real-world experiences and our performance measurement expertise, we support DHCS in QIP’s design, measure selection, and reporting. We also create opportunities for systems to inform QIP’s evolution and to participate in select national measure development forums as quality leaders.
Global Payment Program
Expanding primary and preventive care for individuals without health insurance
For millions of individuals without health insurance in California, public health care systems deliver better care through the Department of Health Care Services’ (DHCS) Global Payment Program (GPP).
Since its launch in 2016, GPP has restructured financing for uninsured care, encouraging systems to move away from costly, episodic emergency and inpatient services. This approach is designed to expand access to primary and preventive care, delivering higher value for uninsured populations and reducing avoidable costs.
An independent review of GPP’s early years confirmed that systems’ redesigns delivered measurable improvements for patients who are uninsured. Outpatient visits and care coordination increased, while emergency room visits and hospital stays declined. Systems continue to build on this progress today.
Redesigning care for the uninsured
To enable this transformation, SNI’s member systems continue to expand capacity, invest in primary and preventive care, introduce non-traditional services such as technology-enabled care, strengthen data infrastructure, and build community partnerships across sectors.
These system-level changes translate into real benefits for individuals without health insurance. Patients have greater access to care and coordinated services that keep them healthy.
How SNI supports member systems in GPP
SNI supports systems in GPP by playing an integral role in the program’s ongoing implementation and evolution, including meeting the requirements for the formal evaluation of the GPP. We help systems navigate GPP by clarifying complex reporting and evaluation requirements, providing technical assistance, and analyzing performance and equity data. Our work allows systems to confidently meet GPP’s demands.
We do this by:
- Clarifying reporting requirements. We interpret DHCS’ guidance and translate it into practical steps, helping systems collect and submit accurate, reliable data.
- Providing technical assistance. We offer one-on-one support to troubleshoot reporting challenges, validate data, and resolve issues quickly so systems can meet program requirements accurately and efficiently.
- Providing ongoing program guidance. We lead ongoing webinars to share updates and address members’ questions, helping systems stay aligned with evolving GPP requirements.
- Analyzing performance and equity trends. We review GPP data across systems to identify gaps, strengths, and disparities in access to care for uninsured populations. These insights enable systems to better understand their progress in the program, guide their improvement strategies, and strengthen equity-related reporting.
CalAIM
Addressing patients’ health and social needs
Many Medi-Cal patients have complex health and social needs, including homelessness, severe mental illness, justice system involvement, and other hardships. California’s public health care systems are core providers of care for these patients.
Through the state’s California Advancing and Innovating Medi-Cal (CalAIM) program, SNI’s member systems connect patients to medical care, behavioral health care, and social services. The program is designed to better address the full range of factors that affect patients’ health while also supporting more cost-effective care.
Launched in 2022, CalAIM is an ambitious, multi-year initiative to transform California’s Medi-Cal delivery system. Early results show that CalAIM is delivering measurable improvements for patients and proving to be cost-effective in specific areas. More than half of participating providers report that patients have improved access to services such as housing and medically supported meals, as well as better coordination of care.
Connecting health and social services
Through CalAIM, systems partner with behavioral health providers, social service agencies, and community-based organizations (CBOs) to integrate care and address patients’ health-related social needs like housing and food security, known as CalAIM’s community supports. Through CalAIM’s enhanced care management, patients also benefit from care managers who coordinate patients’ access to a comprehensive range of services, from mental health counseling to substance use care treatment.
How SNI supports member systems in CalAIM
SNI helps member systems navigate CalAIM by providing guidance, surfacing on-the-ground experience, and sharing feedback with state partners. This helps inform program decisions so they better reflect what systems need to serve patients with complex health and social needs.
We do this by:
- Providing practical guidance on CalAIM implementation
- Elevating implementation challenges to the California Department of Health Care Services (DHCS)
- Sharing member systems’ experiences, lessons learned, and innovations with DHCS
- Keeping systems abreast of evolving CalAIM requirements and updates
Laying the groundwork for CalAIM
SNI’s support for CalAIM builds on our role in shaping its foundation. From 2015–2021, we worked closely with systems that developed and piloted Whole Person Care, the precursor to today’s CalAIM program.
While systems implemented novel Whole Person Care pilots, SNI supported them by convening member systems, behavioral health providers, social service agencies, and CBOs to share promising practices and problem-solve through a statewide learning collaborative. We also collected and analyzed data, conducted research, provided coaching, and produced resources to educate stakeholders on evolving policy.
As the first initiative of its kind in the nation, Whole Person Care demonstrated how integrating medical, behavioral, and social services could improve outcomes for patients with the most complex needs. Our member systems that led this work established themselves as national leaders, paving the way for CalAIM’s launch in 2022.