Value Based Payment Program
The Department of Health Care Services (DHCS) is releasing, as described below, the Value-Based Payment (VBP) Program measures. Additional details about the measure specifications will follow. The final measure set is subject to federal approvals.
Value-Based Payment (VBP) Program Measures
Value-Based Payment (VBP) Program Specifications
Value-Based Payment (VBP) Program Measures Valuation Summary
For FY 19-20 the Governor’s Budget proposes a VBP through Medi-Cal managed care health plans (MCPs) that will provide incentive payments to providers for meeting specific measures aimed at improving care for certain high-cost or high-need populations. These risk-based incentive payments will be targeted at physicians that meet specific achievement on metrics targeting areas such as behavioral health integration; chronic disease management; prenatal/post-partum care; and early childhood prevention. At May Revision, a total of $544.2M ($250M Proposition 56 funds) in 2019-20 is proposed for this program, of which $140M ($70M in Proposition 56 funds) is specifically for Behavioral Health Integration. The program will be implemented for at least three years in the managed care delivery system, subject to funding approved in the final 2019 Budget. The implementation date will be July 1, 2019 for all measures including behavioral health integration measures; and January 1, 2020 for the Behavioral Health Integration Project Plan component.
When determining these measures, DHCS took into consideration several factors including: stakeholder and advocate comments, whether or not a measure aligned with other Department quality efforts; the number of impacted beneficiaries; and whether or not the measure could be run administratively, among others.
To address and consider health disparities, DHCS will pay an increased incentive amount for events tied to beneficiaries diagnosed as having a substance use disorder or serious mental illness, or who are homeless.
DHCS will convene the next VBP webinar on Thursday, June 13, 2019 at 1:00 p.m. Comments or concerns can be submitted to DHCS_PMMB@dhcs.ca.gov.