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

Monarch Healthcare - CMS Pioneer ACO

Monarch HealthCare is contracted with more than 2,300 independent, private-practice physicians who provide health care for approximately 176,000 Orange County residents.  Recognized by health plans and business groups for providing high quality care and excellent service, Monarch HealthCare is operated by physicians who have demonstrated their commitment to advancing medical excellence and exemplifying the “patient-first” philosophy of healthcare in their communities. Under the Pioneer ACO Model, Monarch is required to meet quality standards based upon, among other measures, patient outcome

Heritage California ACO - CMS Pioneer ACO

Heritage California ACO is operated by the Heritage Provider Network (HPN) family of organizations which is comprised of Heritage Provider Network, Inc. and its ten affiliated Medical Groups and Independent Physician Associations. Through the Pioneer ACO Model, HCACO will work with CMS to provide Medicare beneficiaries with higher quality care, while reducing growth in Medicare expenditures through enhanced care coordination.

Brown & Toland Physicians - CMS Pioneer ACO

Through the Pioneer ACO Model, Brown & Toland Physicians will work with CMS to provide Medicare beneficiaries with higher quality care, while reducing growth in Medicare expenditures through enhanced care coordination. Currently, about 190 physicians, located in San Francisco and the East Bay, are providing care for the more than 18,000 Medicare beneficiaries in Brown & Toland's Pioneer ACO.

CMS State Innovation Model Design Award - California

On April 1, 2013, the State of California was awarded a State Innovation Model (SIM) Design Grant from the federal Center for Medicare and Medicaid Innovation (CMMI). The grant is supporting California to develop a State Health Care Innovation Plan (Innovation Plan), which will form the basis of a forthcoming application for a three-year State Innovation Model Testing grant.

Online Mental Health Services Program - HealthLinkNow Patient Centered Medical Home

In 2012, HealthLinkNow earned a CMS Health Care Innovation Award for $7,700,000 (to be distributed over three years) to provide online mental health services in Montana and Wyoming where there is a severe shortage of psychiatrists and other mental health providers. HealthLinkNow is partnering with a number of local provider groups and health networks to provide mental health and substance abuse services where geography and lack of psychiatrists and psychologists complicate access.

Delivery of Behavioral Health Services in Primary Care Using Telehealth

Children's Discovery and Innovation Institute at Mattel Children's Hospital UCLA  has been funded to integrate developmental, behavioral, and mental health services into pediatric primary care using a telehealth model that will be tested with children in low income, urban communities. A patient-centered model for telehealth has the potential to transform DB/MH services by integrating them into primary care.

California Health Care Coverage Initiative (HCCI) - Bridge to Reform

The medical home is a central component of California's proposed delivery system reform efforts under the Section 1115 Waiver proposal. California envisions that, by 2014, it will significantly expand access to medical homes and care coordination to populations that are currently served in the unmanaged fee-for-service system.

Anthem Blue Cross ACO Initiative

Anthem Blue Cross has expanded its ACO model and network with the introduction of a program focused on enhanced care coordination in collaboration with well organized, high quality provider organizations in California. This program is specifically designed to help improve the health of members affected by chronic conditions and improve the value of the care delivered. The new program will be available to fully insured PPO members at no additional cost, with self-funded offerings to follow.

Hill Physicians Medical Group and BCBS of California ACO

Hill Physicians Medical Group has launched 3 ACO collaborations. Beginning as a pilot in 2009, an ACO was formed between Hill Physicians, Blue Shield of California and Dignity Health for the CalPERS population in Sacramento. The integrated health care delivery model aligned incentives among the health plan, hospital system, and medical group with the goal of keeping healthcare premium costs flat.

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