The Department of Health Care Services is implementing a one-time $700 million primary care provider practice transformation program to advance health equity and reduce COVID-19-driven care disparities by investing in up-stream care models and partnerships to address health and wellness and funding practice transformation. These efforts aligned with value-based payment models will allow Medi-Cal providers to better serve the state’s diverse Medi-Cal enrollee population. To align with the goals of the DHCS Comprehensive Quality Strategy and Equity Roadmap, these funds will pay for delivery system transformation payments to primary care practices (pediatrics, family practice, adult medicine primary care, primary care OB/GYN, and behavioral health providers in primary care settings) focused on advancing DHCS’ equity goals in the “50 by 2025: Bold Goals” Initiative and to prepare them to participate in alternative payment models. These funds will be allocated in three separate pathways throughout the phases of the program year(s):
Medi-Cal Managed Care Plan (MCP) Initial Provider Planning Incentive Payments
$25 million incentivized MCPs to identify and work with small-to medium-sized independent practices in 2023 using standardized assessment tools to support these practices as they developed practice transformation plans and applications to the larger EPT Provider Directed Payment Program. Completion of a standardized practice assessment tool, called the pmhCAT, was a required activity for practices.
EPT Provider Directed Payment Program
$650 million ($325 million General Fund) over 5 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. $200 million of the $650 million will be dedicated to preparing practices for value-based care. This includes implementing practice infrastructure, such as electronic health record systems, data collection, recording capabilities, improved data exchange, and implementation of care management systems.
A total 719 practices applied by October 2023 for this program, and in January 2024, DHCS was able to accept applications from 211 practices, representing a maximum potential commitment of $387 million over 5 years. Practices have the potential to earn the full amount they applied for, based on assigned Medi-Cal lives at the time of application in October 2023 and completion of activities/milestones during the program. Details regarding a potential future cohort will be provided at a later date. Of the total applications DHCS accepted, below are characteristics of the practices:
- 83% from HPI quartiles 1 and 2 (based on zip codes for clinical practice sites)
- Practice type (total adds to more than 100% as categories are not mutually exclusive):
- 51% small independent practices
- 42% Federally Qualified Health Centers (FQHCs) or FQHC Look-Alike
- 4% large health systems (County-owned, District Public Hospitals, etc.)
- 5% tribal health programs
- Populations of focus:
- 5.2% focused on pregnant individuals
- 40.8% focused on children/youth
- 18.5% focused on adults with preventive health needs
- 28.9% focused on adults with chronic conditions
- 6.6% focused on individuals with behavioral health conditions
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. Aligned with the DHCS Comprehensive Quality Strategy, DHCS added a uniform number of points to all applications meeting the following criteria:
- Applications with a youth/children population of focus (12 additional points to achieve 40% of practices choosing this population)
- Applications with a pregnant individual population of focus (20 additional points to achieve 5% of practices choosing this population)
- Applications from tribal health programs (15 additional points to ensure an adequate number of practices serving this population)
DHCS then determined a uniform points threshold (77 points) which would result in a list of practices that would stay within the budget allocated for this phase of the program. Finally, DHCS identified counties that had applicants but no accepted practices. If 1-2 additional points per practice resulted in accepting practices from these counties (indicating the practices were good applicants), then DHCS added points. This step resulted in inclusion of four practices from two counties that would have otherwise been unrepresented, while still maintaining the budget for the program. For the remaining counties without accepted practices, the addition of a minimum of 10 points would have been required, indicating the practices were not ideal candidates for the program.
DHCS is committed is sharing these details to support transparency in the selection process but may also revise selection and scoring criteria for potential future cohorts to support Medi-Cal goals and meet key quality and health equity objectives.
The Statewide Learning Collaborative
($25 million over 5 years) to serve as the program office for the Provider Directed Payments Program and to support participants. Support will include 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 achievement of states quality and 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.
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Please contact us with questions at ept@dhcs.ca.gov.
