Kev Pab Cuam Them Nqi Rau Kev Hloov Pauv ntawm Kev Ncaj Ncees thiab Kev Xyaum
Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tab tom siv ib qho kev pab cuam $ 140 lab * Kev Sib Luag thiab Kev Hloov Pauv (EPT) ib zaug rau cov kev kho mob thawj zaug los txhawb kev noj qab haus huv ntawm cov pej xeem thiab kev sib luag ntawm kev noj qab haus huv los ntawm kev ua haujlwm ntawm cov qauv kev kho mob sab saud, txhim kho qhov zoo ntawm kev kho mob, cov qauv them nqi raws li tus nqi, thiab kev hloov pauv kev kho mob. Cov kev siv zog no uas sib haum nrog cov qauv them nqi raws li tus nqi yuav tso cai rau cov chaw muab kev pabcuam Medi-Cal kom pab tau cov pej xeem Medi-Cal ntau haiv neeg hauv lub xeev zoo dua. Yuav kom ua raws li lub hom phiaj ntawm DHCS Comprehensive Quality and Strategy and Health Equity Roadmap thiab"50 by 2025: Bold Goals" Initiative, cov nyiaj no txhawb nqa kev hloov pauv ntawm kev xa khoom hauv kev kho mob thawj zaug (kev kho mob menyuam yaus, kev kho mob hauv tsev neeg, kev kho mob rau cov neeg laus, kev kho mob OB/GYN thawj zaug, thiab cov kws kho mob kev coj cwj pwm hauv kev kho mob thawj zaug) thiab npaj lawv kom koom nrog kev cog lus them nqi raws li tus nqi. Cov nyiaj no raug muab faib rau peb ntu thoob plaws hauv cov theem ntawm xyoo (cov) kev pab cuam piav qhia hauv qab no.
*The original version of EPT had a total of $700 million in funding. In the final State of California Fiscal Year 2024-2025 budget, the amount of funding was reduced to $140 million.
Medi-Cal Managed Care Plan (MCP) Cov Kev Pab Them Pib Pib Npaj Nyiaj Txhawb Kev Them Nyiaj
$ 25 million (12.5 million General Fund) incentivized MCPs to identify and work with small-to medium-sized independent practices in 2023 using a standardized assessment PhmCAT to support these practices as they developed practice transformation plans and applications to the larger EPT Provider Directed Payment Program.
EPT Tus Muab Kev Qhia Qhia Them Nyiaj
$ 97 million ($48.5 million General Fund) over 3 years supports delivery system transformation, specifically targeting primary care practices that provide primary care pediatrics, family medicine, internal medicine, primary care OB/GYN services, or behavioral health services that are integrated in a primary care setting to Medi-Cal members.
A total of 197 practices are participating in the program with the potential to earn an adjusted maximum payout based on the assigned Medi-Cal lives and successful completion of activities/milestones.
The selection process for the Provider Directed Payment Program included two steps: (1) using a DHCS provided rubric, a review and points scoring (out of 90 total) of all applications by the MCP indicated in the practice’s application, and then (2) a DHCS review of applications recommended by the MCPs. Please see EPT Cohort 1 Selection Methodology for a detailed description of the selection process for practices.
Technical assistance and milestones focus on the following population health management (PHM) domains: access, empanelment, data to enable PHM, care delivery model (includes mental health, social health, and care delivery for populations of focus), value-based payment, and key performance indicators. Please see The Population Health Learning Center for more on milestones.
The Payment Structure suav nrog cov hauv qab no:
- Tag nrho cov peev xwm them nyiaj = Cov tswv cuab Medi-Cal tau txais (txij lub Kaum Ib Hlis 2024) × PMPY tus lej sib npaug.
- Kev them nyiaj ib ntus = Tag nrho cov peev txheej them nyiaj ÷ 23 lossis 25 lub sijhawm tseem ceeb (nyob ntawm seb muaj pes tsawg lub sijhawm tseem ceeb rau kev xyaum).
Piv txwv ntawm Kev Them Nyiaj Scenario:
- Assigned members for primary care: 920
- Tus nqi sib tw / ntxiv rau: $ 305
- Tag Nrho Muaj Peev Xwm Kev Them Nyiaj (Tshem cov tswv cuab x tus lej sib npaug): 920 x $ 305 = $ 280,6000
- Payment per Milestone achieved (Total Potential Practice Payment / 25 milestones): $11,224
Table 1.
| Chav kawm | Pib | End | Raws li Tus Tswv Cuab |
|---|---|---|---|
| A | 1 | 500 | $ 580.00 |
| B | 501 | 700 | $ 397.00 |
| C | 701 | 850 | $ 349.00 |
| D | 851 | 1000 | $ 305.00 |
| E | 1001 | 1200 | $ 300.00 |
| F | 1201 | 1400 | $ 260.00 |
| G | 1401 | 1600 | $180.00 |
| H | 1601 | 1800 | $ 170.00 |
| Kuv | 1801 | 2000 | $ 162.00 |
| J | 2001 | 2250 | $ 144.00 |
| K | 2251 | 2500 | $ 146.00 |
| L | 2501 | 2750 | $ 145.00 |
| M | 2751 | 3000 | $ 121.00 |
| N | 3001 | 3250 | $ 110.00 |
| O | 3251 | 3500 | $ 106.00 |
| P | 3501 | 4000 | $ 95.00 |
| Q | 4001 | 4500 | $ 88.00 |
| R | 4501 | 5000 | $ 85.00 |
| S | 5001 | 5500 | $79.00 Nws |
| T | 5501 | 6000 | $77.00 Nws |
| U | 6001 | 6500 | $ 61.50 |
| V | 6501 | 7000 | $ 50.25 |
| W | 7001 | 7500 | $ 59.00 |
| X | 7501 | 8000 | $ 53.00 |
| Y | 8001 | 8500 | $ 49.50 |
| Z | 8501 | 9000 | $ 50.50 |
| AA | 9001 | 9500 | $ 48.00 |
| BB | 9501 | 10000 | $ 46.00 |
| CC | 10001 | 11500 | $ 40.50 |
| DD | 11501 | 13000 | $ 45.00 |
| EE | 13001 | 14500 | $ 33.30 |
| FF | 14501 | 16000 | $ 40.00 |
| GG | 16001 | 17500 | $ 38.00 |
| HH | 17501 | 20000 | $ 37.00 |
| II | 20001 | 22500 | $ 36.50 |
| JJ | 22501 | 25000 | $ 31.50 |
| KK | 25001 | 27500 | $ 30.50 |
| LL | 27501 | 30000 | $ 28.50 |
| MM | 30001 | 35000 | $ 28.00 |
| NN | 35001 | 45000 | $ 26.00 |
| OO | 45001 | 55000 | $ 22.50 |
| PP | 55001 | 60000 | $ 28.50 |
| QQ | 60001 | 65000 | $23.00 Nws |
| RR | 65001 | 75000 | $ 22.00 |
| SS | 75001 | 90000 | $ 22.00 |
| TT | 90001 | 105000 | $ 21.00 |
| UU | 105001 | 120000 | $18.00 Nws |
| VV | 120001 | 138000 | $23.00 Nws |
Cov txheej txheem no siv tau rau txhua qhov EPT tseem ceeb. Qhov kev pabcuam EPT yuav raug tso cai txhua xyoo los ntawm CMS thiab yog li yuav raug xa mus rau cov kev hloov pauv. Qhov kev pab cuam EPT yog nyob rau yav tom ntej daim ntawv tso cai nyiaj txiag thiab kev tsim nyog los ntawm California Cov Cai Lij Choj thiab cov kev pom zoo los ntawm tsoom fwv tsim nyog ntawm kev them nyiaj ncaj qha.
Nco tseg: Kev xam nyiaj them rau xyoo 2024–2026 yog ua raws li CMS cov lus qhia tau tshaj tawm thaum Lub Peb Hlis 2025 thiab raws li lub Kaum Ib Hlis 2024 Medi-Cal cov tswv cuab suav, tsis suav nrog D-SNP cov tswv cuab (raws li CMS xav tau).
Population Health Learning Center
$ 18 million ($9 million General Fund) over 3 years funds the program office for the Provider Directed Payment Program. The program office will be monitoring and supporting implementation of practices’ transformation activities, sharing, and spreading of best practices, facilitating technical assistance for practices (through state and national partners), and support the achievement of the state’s quality and health equity goals. DHCS partners with the Population Health Learning Center to provide the Learning Collaborative and serve as the program office for the Provider Directed Payment Program.
Cov peev txheej
- EPT FAQs
- Tus Kws Pab Tswv Yim Qhia Txog Kev Them Nyiaj Them Nqi Cov Lus Qhia
- Kev Taw Qhia Txog Kev Ua Haujlwm Pabcuam Ntiag Tug thiab Medi-Cal Managed Care Plans
- phmCAT Tool
- EPT Scoring Rubric rau MCPs
- EPT Initial Planning Incentive Payments Process
- Qhov Chaw Pabcuam Kawg Qhia Kev Them Nyiaj Them Nqi thiab Cov Ntsiab Lus Tseem Ceeb
Txoj Cai Kev Pabcuam thiab Cov Ntaub Ntawv
- Phau Ntawv Qhia Kev Pab Txog Kev Siv EPT CY2025
- EPT-PL 25-001 Lub Hom Phiaj Txo Qhov Tsis Sib Xws ntawm EPT
- EPT-PL 25-002 Lub Hom Phiaj Txo Qhov Tsis Sib Xws ntawm EPT
Tiv tauj peb
Thov hu rau peb yog tias muaj lus nug ntawm ept@dhcs.ca.gov.