公平与实践转型支付计划
卫生保健服务部（DHCS）正在为初级保健实践实施一项一次性 1.4 亿美元*的 "公平与实践转型计划"（EPT），通过研究上游护理模式、提高护理质量、基于价值的支付模式和实践转型，促进人口健康和医疗公平。这些与基于价值的支付模式相一致的努力将使 Medi-Cal 医疗服务提供者能够更好地为该州多样化的 Medi-Cal 会员提供服务。为了与DHCS 综合质量和战略以及健康公平路线图和 "2025 年前 50 人：为了与 DHCS 的 " 全面质量与战略 "和 "健康公平路线图 "以及 "2025 年前 50 强：大胆目标 "倡议的 目标保持一致，这些资金用于激励初级医疗实践（儿科、家庭实践、成人医学初级医疗、初级妇产科医疗以及初级医疗机构中的行为健康提供者）中的医疗服务系统转型，并帮助他们为参与基于价值的支付合同做好准备。在计划年度的各个阶段，这些资金被分配给以下三个部分。
*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 管理式护理计划 (MCP) 初始医疗服务提供者计划奖励付款
$ 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 提供商定向付款计划
$ 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.
付款结构包括以下内容：
- 总潜在付款 = 指定的 Medi-Cal 成员（从 2024 年 11 月起）× PMPY 乘数。
- 每个里程碑付款 = 总潜在付款 ÷ 23 或 25 个里程碑（取决于有多少个里程碑与实践相关）。
实际付款场景示例：
- Assigned members for primary care: 920
- 乘数/附加值： 305 美元
- 潜在实践付款总额（指定成员 x 乘数）： 920 x $305 = $280,6000
- Payment per Milestone achieved (Total Potential Practice Payment / 25 milestones): $11,224
表 1.
| 班级 | 开始 | End | 每位会员金额 |
|---|---|---|---|
| 一个 | 1 | 500 | $ 580.00 |
| 乙 | 501 | 700 | $ 397.00 |
| 碳 | 701 | 850 | $ 349.00 |
| 德 | 851 | 1000 | $ 305.00 |
| 埃 | 1001 | 1200 | $ 300.00 |
| 弗 | 1201 | 1400 | $ 260.00 |
| 格 | 1401 | 1600 | 180.00 美元 |
| 赫 | 1601 | 1800 | $ 170.00 |
| 我 | 1801 | 2000 | $ 162.00 |
| J | 2001 | 2250 | $ 144.00 |
| 钾 | 2251 | 2500 | $ 146.00 |
| 大号 | 2501 | 2750 | $ 145.00 |
| 米 | 2751 | 3000 | $ 121.00 |
| 否 | 3001 | 3250 | $ 110.00 |
| 哦 | 3251 | 3500 | $ 106.00 |
| 磷 | 3501 | 4000 | $ 95.00 |
| 问 | 4001 | 4500 | $ 88.00 |
| R | 4501 | 5000 | $ 85.00 |
| 年代 | 5001 | 5500 | 79.00 美元 |
| 电视 | 5501 | 6000 | 77.00 美元 |
| 乌 | 6001 | 6500 | $ 61.50 |
| 五 | 6501 | 7000 | $ 50.25 |
| 西 | 7001 | 7500 | $ 59.00 |
| 十 | 7501 | 8000 | $ 53.00 |
| 是 | 8001 | 8500 | $ 49.50 |
| 是 | 8501 | 9000 | $ 50.50 |
| AA | 9001 | 9500 | $ 48.00 |
| BB | 9501 | 10000 | $ 46.00 |
| 抄送 | 10001 | 11500 | $ 40.50 |
| DD | 11501 | 13000 | $ 45.00 |
| 电子工程 | 13001 | 14500 | $ 33.30 |
| FF | 14501 | 16000 | $ 40.00 |
| GG | 16001 | 17500 | $ 38.00 |
| 赫赫 | 17501 | 20000 | $ 37.00 |
| 二 | 20001 | 22500 | $ 36.50 |
| JJ | 22501 | 25000 | $ 31.50 |
| 乐清 | 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 美元 |
| RR | 65001 | 75000 | $ 22.00 |
| SS | 75001 | 90000 | $ 22.00 |
| TT | 90001 | 105000 | $ 21.00 |
| UU | 105001 | 120000 | 18.00 美元 |
| VV | 120001 | 138000 | 23.00 美元 |
该方法适用于所有 EPT 里程碑。EPT 计划每年需经 CMS 批准，因此可能会发生变更。EPT 计划未来需获得加州立法机构的预算授权和拨款，以及定向支付安排所需的联邦政府批准。
注意：2024-2026 年的付款计算符合 2025 年 3 月发布的 CMS 指南，并基于 2024 年 11 月的 Medi-Cal 会员数量，不包括 D-SNP 会员（根据 CMS 的要求）。
人口健康学习中心
$ 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.
资源
- EPT 常见问题解答
- 供应商定向付款计划申请说明
- 初级保健实践和 Medi-Cal 管理式医疗计划指南
- phmCAT 工具
- MCP 的 EPT 评分标准
- EPT 初始规划奖励支付流程
- 最终供应商定向付款计划类别和里程碑
计划政策和信息
联系我们
如有问题，请通过ept@dhcs.ca.gov 与我们联系。