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.

CHIPRA: 
No
MAPCP: 
No
Dual Eligible: 
Yes
2703 Health Home: 
No
CPCi: 
No
SIM Awards: 
Yes
PCMH in QHP: 
Yes
Legislative PCMH Initiative: 
Yes
Private Payer Program: 
Yes
State Facts: 
Population:
38,114,300
Uninsured Population:
15%
Total Medicaid Spending FY 2013: 
$61.9 Billion 
Overweight/Obese Adults:
60.1%
Poor Mental Health among Adults: 
36.8%
Medicaid Expansion: 
Yes

MediConnect - Dual Eligible integrated care program

California signed a Memorandum of Understanding with CMS on 3/27/2013. The state Medi-Cal program and the federal Medicare program are partnering to launch a three-year project to promote coordinated health care delivery to seniors and people with disabilities who are dually eligible for both of the public health insurance programs, “dual eligible beneficiaries. ”The program will be called Cal MediConnect.

Cigna Accountable Care Organization - Santa Clara County IPA

Cigna and Santa Clara County IPA  (SCCIPA) have launched a collaborative accountable care  initiative to improve patient access to health care, enhance care coordination, and achieve the “triple aim” of improved health, affordability and patient experience. The program became effective October 1, 2013 and is Cigna's third accountable care initiative in the Bay Area.

Enhanced Personal Health Care Program - California

This Program empowers primary care physicians (PCPs) to engage in those comprehensive primary care functions that move us toward a coordinated, evidence-based care model that has the greatest impact on achieving the triple aim of improved quality, patient experience and affordability.  

The Doctor's Team Will See You Now

Why Visit One Doctor When Some Offices Offer a Medical Entourage?

A visit to the doctor may mean seeing someone else instead. An increasing number of practices are scrapping the traditional one-on-one doctor-patient relationship. Instead, patients are receiving care from a group of health professionals who divide up responsibilities that once would have largely been handled by the doctor in charge. While the supervising doctor still directly oversees patient care, other medical professionals—nurse practitioners, physician assistants and clinical pharmacists—are performing more functions.

News Author: 
Laura Landro

Central Valley Project To Improve Health Costs, Outcomes Appears To Be Paying Off

A pilot project to improve the management of chronic disease and reduce health care spending has resulted in nearly a million dollars in savings over 12 months for a Central Valley school district.

The Fresno Unified Joint Health Management Board worked with the California Academy of Family Physicians in late 2010 to launch a patient-centered medical home initiative with a primary care medical group, Community Medical Providers.

News Author: 
Alice Daniel

New Report Finds Medical Homes Are Reducing Health Care Costs, Utilization, and Improving Health

A review of the year’s academic and industry-generated PCMH evaluations finds significant impact across a number of clinical and financial outcomes.

Embargoed Until Monday, January 13th, 4PM

PCPCC: Michelle Shaljian, 347-754-1692, michelle@pcpcc.net

Milbank: Tara Strome, 212-355-8400, tstrome@milbank.org

New Report Finds Medical Homes Are Reducing Health Care Costs, Utilization, and Improving Health

Anthem Blue Cross Accountable Care Organizations See Major Improvement in Quality Measures in Program’s First Year

ACOs Performed 35% More Mammograms, Reduced Improper Bronchitis Treatment

Anthem Blue Cross and its Accountable Care Organization (ACO) partners showed across the board improvements in the treatment of patients in 2012, the first full year of Anthem’s program, including a 35 percent increase in the number of mammograms performed and a 44 percent increase in the appropriate prescribing of antibiotics for bronchitis treatment.

News Author: 
Darrel Ng

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