Payment Reform

CalAIM and Specialty Behavioral Health Care: Lessons from Other States on Value-Based Payment

Joshua Breslau, Marcela Horvitz-Lennon, Nicole Eberhart, Jonathan Levin, Jonah Kushner, Mallika Bhandarkar

Behavioral Health

This paper summarizes existing research and profiles five examples of value-based payment models across the US. The authors provide recommendations that California can follow to inform future behavioral health payment reforms.

Implementation Guide for the California Federally Qualified Health Center Alternative Payment Model

Center for Health Care Strategies

Payment & Financing

This guide is for leaders and staff in FQHCs that are considering or have committed to participating in the California Federally Qualified Health Center Alternative Payment Model.

Medi-Cal Quality Strategy Explores Bold Steps Toward Health Equity

January 26, 2022

Christopher Perrone

The strategy will shape how health care will be provided to almost one in three Californians.

Risky Business: California Health Centers Weakened by the COVID-19 Pandemic Prepare for the Future

Carol Backstrom, Lauren Block, Allison Coleman

Telehealth, Workforce

California's Federally Qualified Health Centers experienced many financial challenges as a result of the COVID-19 pandemic. This report summarizes policy options that have the potential to improve FQHC stability, address health equity, and ensure access to a broader range of services in the long term.

A Golden Opportunity to Narrow California’s Racial Health Disparities

The Los Angeles Times Editorial Board

Medi-Cal, Payment & Financing

The state now has a rare opportunity to force health insurers to do more to improve the care that people with low incomes receive through Medi-Cal.

Medi-Cal: California Has a Rare Opportunity to Improve Health Care Equity

Sandra R. Hernández

Medi-Cal, Payment & Financing

About 10 million Californians get their health care through a Medi-Cal managed care plan, but the state's contracts with those plans fail to ensure that these enrollees get the high-quality care they deserve.

Use ‘Carrots and Sticks’ to Spur Better Quality, Equity From Medi-Cal Managed Care Plans

February 4, 2021

Christopher Perrone

Medi-Cal, Payment & Financing, Health Equity

California has a rare opportunity to institute long-overdue financial incentives tied to health plan performance.

How Legal Changes in Response to COVID-19 Can Improve Access to Community Behavioral Health

Robert Belfort, Julian Polaris

Behavioral Health, Medi-Cal

This report discusses the impact of temporary legal reforms on outpatient and residential behavioral health services in California and identifies the most promising candidates for long-term reform.

Paying Medi-Cal Managed Care Plans for Value: Design Recommendations for a Quality Incentive Program

Medi-Cal, Payment & Financing

This report recommends a new way to pay Medi-Cal managed care plans (MCPs) designed to improve the quality of care for Medi-Cal enrollees. The Department of Health Care Services would withhold part of its capitation payments to MCPs, who could earn back some or all of the amount withheld depending on their performance on quality measures.

How California Could Encourage Adoption of Alternative Payment Models

October 14, 2020

Payment & Financing, Health Care Costs, Medi-Cal

Research has shown that APMs can help reduce costs and improve quality.

Video: How Health Center Patients Benefit Under Patient-Centered Payment

Payment & Financing, Medi-Cal

This short animated video explains how old payment rules are hurting three fictional health center patients, Veronica, Michael, and Janelle, and how each would benefit under the switch to patient-centered payment.

How Health Centers Can Improve Patient Care Through Value-Based Payment Models

Center for Health Care Strategies

Payment & Financing, Medi-Cal

Patients in health centers across the country are benefiting from state-led value-based payment models that reward high-quality, cost-effective care. The value-based payment models described in this brief aim to provide patients with coordinated, team-based health care that is convenient to access and best meets their needs.

Modernizing Payment to California’s Community Health Centers

Health centers are crucial to California's response to COVID-19. But the care they provide is still dictated by old payment rules that severely hamper health centers' ability to care for patients during COVID-19 and, in some cases, keep their doors open. This collection focuses on how California can change the way it pays health centers to better serve patients and to create a more resilient foundation for primary care in Medi-Cal.

Time to Modernize Payment to Health Centers

Medi-Cal, Payment & Financing

This issue brief outlines why these old payment rules are hurting patients during the COVID-19 crisis, and how transitioning to a new way of paying for care, called patient-centered payment, will allow health centers to better serve patients going forward.

Infographic — Old Payment Rules Are Hurting Health Center Patients During the COVID-19 Crisis

Payment & Financing, Medi-Cal

Old payment rules are hindering the ability of FQHCs and FQHC Look-Alikes (health centers) to care for their approximately four million Medi-Cal patients, especially during the COVID-19 crisis. This infographic shows what kind of care is possible for patients under traditional versus patient-centered payment.