California insurers launch primary care model

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Three California-based health plans – Aetna, Blue Shield of California and Health Net – have come together to implement a shared value-based payment model under the California Advanced Primary Care Initiative’s Payment Model Demonstration Project. 

Led by the California Quality Collaborative (CQC) and the Integrated Healthcare Association (IHA), the new payment model will span 11 provider organizations statewide, representing more than 100 care sites and a collective patient population of approximately 17,000.

The demonstration project prioritizes recruitment of small independent practices. The groups said it will target health equity, with a focus on improving population health.

“By co-investing in a unified value-based payment model, and providing technical assistance for practice transformation, we’re better supporting primary care practices in ways that can improve patient outcomes,” said Dr. Todd May, vice president and medical director for Commercial at Health Net. “And high-functioning primary care is the foundation of a high-quality and cost-effective health care system.”

WHAT’S THE IMPACT

Through the demonstration project, participating health plans will offer a common value-based payment model, which is designed to invest more revenue into the practices, rewarding improvement and strong performance on the Advanced Primary Care Measure Set. 

CQC is providing comprehensive technical assistance to help participating practices implement the new payment model, integrate behavioral and physical health services, improve care coordination and achieve better patient outcomes. IHA selected Cozeva to serve as the common reporting platform for the initiative.

Practices will be able to view data on their patients across plans for insights on how to close care gaps, officials said.

THE LARGER TREND

According to Purchaser Business Group on Health (PBGH), this approach – a single payment model implemented, coordinated and financed by the California health plans — helps reduce administrative burden on practices and shift focus to care delivery.

ON THE RECORD

“At Blue Shield of California, we believe payers must collaborate boldly on innovative payment models to advance primary care,” said Blue Shield of California Medical Director Dr. Nina Birnbaum. “Done right, this project will help clinicians connect with the joy of practice by aligning payment with what inspired them to pursue medicine in the first place – delivering quality-oriented, data-enabled, patient-centered care”

“This project is an opportunity for payers to collaborate in support of California primary care providers who play a vital role in our members’ care,” said Dr. Pegah Mehdizadeh, executive director, West Region and chief medical officer for Aetna California. “Aetna is committed to partnering with providers on value-based care arrangements like this one that empower and incentivize delivery of high-quality whole-person care and support our goal of helping members achieve better health.”

“By designing a common value-based payment model with guaranteed upfront payments and enhanced incentives for performance on disparity-sensitive measures, we’re helping practices focus on what matters most – delivering high-quality, equitable care,” said Dolores Yanagihara, general manager at IHA.

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.