Value Based Payment Program
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 Program Measures (PDF)
Value-Based Payment (VBP) Program Specifications (PDF)
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.
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.