California

in 2010, California was approved for a Section 1115 Medicaid Waiver launching the Bridge to Reform which resulted in several changes including expanding Medicaid coverage, reforming safety-net hospitals, and promoting coordinated systems of care for dual eligibles and persons with disabilities. The Delivery System Reform Incentive Pool (DSRIP) is a program offering safety-net hospitals in California funds to make investments in infrastructure, system design and improvements in population health. More than half of participating hospitals expanded medical homes which included expanding primary care capacity, chronic care management, and integration of physical and behavioral health care. Under the Bridge to Reform, the California Children's Services Program Demonstration included pilot programs to improve coordination of care through medical homes, improve satisfaction with care, and develop family-centered care. In 2012, a waiver amendment provided for the California Duals Demonstration program - Cal MediConnect - that will be implemented in eight California counties in 2014. The program aims to improve care coordination for dual eligible beneficiaries and drive high quality care through medical homes.

California encourages issuers selling Qualified Health Plans (QHPs) in the Marketplace, Covered California, to assist enrollees in selecting a primary care provider, Federally Qualified Health Center (FQHC) or a patient-centered medical home (PCMH) within 60 days of enrollment.

Primary Care Innovations and PCMH Activity

Dual Eligible	2703 SPA	CPC	CPC+	PCMH QHP	PCMH Legislation	Private Payer

Public Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program
AAMC Project CORE: Coordinating Optimal Referral Experiences - California	Grant	California, Iowa, New Hampshire, Virginia, Wisconsin	CMS Health Care Innovation Award (Round 2)
Advanced Illness Management (AIM) program - Sutter Health	Grant	Northern California	CMS Health Care Innovation Award (Round 1)
Aligning Forces for Quality - Humboldt University	Grant	Humbolt County	Aligning Forces for Quality
Alzheimer's and Dementia Patient-Centered Care Project - UCLA	Grant	Western area of Los Angeles County	CMS Health Care Innovation Award (Round 1)
Brown & Toland Physicians - CMS Pioneer ACO	Medicare	San Francisco Bay Area	CMS Pioneer ACO
California Academy of Family Physicians Fresno PCMH Initiative	Grant	Fresno
California Health Care Coverage Initiative (HCCI) - Bridge to Reform	Medicaid	Statewide; 56 out of 58 counties	Medicaid Section 1115 Waiver
California Health Homes Program	Medicaid		ACA Section 2703 Health Homes
Challenge to Achieve the Triple Aim - Lifelong Medical Care	Grant	Alameda, Contra Costa, and Marin counties	CMS Health Care Innovation Award (Round 1)
CMS State Innovation Model Design Award - California	Grant	Statewide	CMS State Innovation Model (SIM)
Coordinating All Resources Effectively (CARE) - California	Grant	California, Colorado, Florida, Missouri, Pennsylvania, Texas, Ohio	CMS Health Care Innovation Award (Round 2)
Delivery of Behavioral Health Services in Primary Care Using Telehealth	Grant	Los Angeles area	Patient-Centered Outcomes Research Institute (PCORI) Programs
Heritage California ACO - CMS Pioneer ACO	Medicare	Southern, Central California	CMS Pioneer ACO
Intensive Outpatient Care Program - Pacific Business Group on Health	Grant	Statewide	CMS Health Care Innovation Award (Round 1)
MediConnect - Dual Eligible integrated care program	Medicare, Medicaid	Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara counties	CMS Dual Eligible Demonstration, Medicaid Section 1115 Waiver
Monarch Healthcare - CMS Pioneer ACO	Medicare	Orange County	CMS Pioneer ACO
Online Mental Health Services Program - HealthLinkNow Patient Centered Medical Home	Grant	Montana, Wyoming	CMS Health Care Innovation Award (Round 1)
Pharmacy Services in Safety-Net Clinics - University of Southern California	Grant	Santa Anna, Huntington Beach, and Garden Grove communities	CMS Health Care Innovation Award (Round 1)
PTN - Local Initiative Health Authority of Los Angeles County (L.A. Care)	Grant	California	Transforming Clinical Practices Initiative (TCPI)
PTN - National Rural Accountable Care Consortium (NRACC)	Grant	All 50 states	Transforming Clinical Practices Initiative (TCPI)
PTN - Pacific Business Group on Health (California Quality Collaborative)	Grant	Statewide	Transforming Clinical Practices Initiative (TCPI)
Ravenswood Family Health Center Innovation Project - South County Community Health Center	Grant	Southeast San Mateo County	CMS Health Care Innovation Award (Round 1)

Private Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program
Anthem Blue Cross ACO Initiative	Commercial	Southern California	Blue Cross Blue Shield Value-Based Care Program
Cigna Accountable Care Organization - Palo Alto Medical Foundation	Commercial	Alameda, San Mateo, Santa Clara, and Santa Cruz counties	Cigna Collaborative Care Program
Cigna Accountable Care Organization - Santa Clara County IPA	Commercial	Bay Area	Cigna Collaborative Care Program
Cigna Collaborative Accountable Care (CAC) Program - Brown and Toland Physicians	Commercial	San Francisco Bay Area	Cigna Collaborative Care Program
Cigna Collaborative Accountable Care (CAC) Program - Healthcare Partners Medical Group	Commercial	Southern California	Cigna Collaborative Care Program
Enhanced Personal Health Care Program - California	Commercial	20 counties	Anthem - Enhanced Personal Health Care
Hill Physicians Medical Group and BCBS of California ACO	Commercial	San Francisco Bay Area; the Silicon Valley; the Sacramento area; Los Angeles, Orange and San Diego counties; the Inland Empire and the San Joaquin Valley	Blue Cross Blue Shield Value-Based Care Program

State Legislation

Legislation	Status	Year
Chapter 346, Session Laws of Colorado 2007 This law established that all enrollees in the California Bridge to Reform Demonstration must be assigned to a medical home.	Expired	2010
California - AB-2895 Primary Care Spending Transparency Act This bill, the Primary Care Spending Transparency Act, would require a health care service plan or health insurer that reports rate information, as specified, to annually report the percentage of expenses the health care service plan or health insurer allocated to primary care, among other things. The bill would require the Department of Managed Health Care and the Department of Insurance to annually compile and post a report with that information on their Internet Web sites, beginning January 1, 2020, and would require the departments to include their reports as discussion items at specified public meetings. The bill would require the Department of Managed Health Care and the Department of Insurance to convene the Primary Care Payment Reform Collaborative no later than January 1, 2020, to propose revisions to the types of primary care data collected from health care service plans and health insurers, as well as to advise and assist in developing specified best practices.	Expired	2018
AB 1130 Establishes the Office of Health Care Affordability (office) within the Office of Statewide Health Planning and Development (OSHPD). The office shall measure and promote a sustained systemwide investment in primary care and behavioral health. In furtherance of this goal, the office shall measure the percentage of total healthcare expenditures allocated to primary care and behavioral health and set spending benchmarks. Spending benchmarks for primary care shall consider current and historic underfunding of primary care services.. Establishes, within the office, the Health Care Affordability Advisory Board (board) and sets forth the composition and duties of the board, as defined, which includes "Measure and promote sustained systemwide investment in primary care and behavioral health". The office will also begin tracking the percentage of healthcare expenditures allocated to primary and behavioral healthcare. It will also help clarify and define what professionals are considered primary care. A version of this legislation was enacted as part of the 2022 budget.	Enacted as part of another bill	2022
SB 184 This 2022 California Health and Human Services Budget bill established the California Office of Health Care Affordability, required ongoing reporting, and established a process to set targets for primary care spend in the state.	Enacted	2022