Medi-Cal Equity and Practice Transformation

Over the last couple of years, the COVID-19 Public Health Emergency (PHE) laid bare the disparities in health care in disadvantaged communities with preventive and routine care for chronic conditions was delayed in many cases. The California Department of Health Care Services (DHCS) has proposed a one-time investment for Equity and Practice Transformation of $700 million over five years, 2023 to 2027, to align with value-based models and advance equity, reduce care disparities, health and wellness. For comparison, California’s Health and Human Services Proposed budget for 2022-2023 is $217.5 billion (Budget Summary (ca.gov). This Practice Transformation funding is intended to complement California’s Medicaid waiver – California Advancing and Innovating Medi-Cal (CalAIM), which targets health care improvements to help address the complex challenges facing California’s most vulnerable residents.

The proposed Equity and Practice Transformation payments would help fund delivery system transformation to advance health equity in primary care, women and maternal, and behavioral health. The proposal includes $25 million to aid practices in developing and completing their grant applications.

$650 million is intended to support investment in provider infrastructures such as data exchange and analytics, practice transformation, and preparation for alternative reimbursement models. The funds would be available for care management systems, gap closures, identifying underutilizers, EHRs, telehealth, etc. While the complete grant designs are being developed, providers, community organizations, and health systems have the opportunity to plan for this transformational infusion, which will help the provider community increase its ability to deliver person-centered care while addressing long-standing gaps in the health care system.

DHCS has developed four workstreams:

• Maternity and early childhood health transformation to address disparities and outcomes for pregnant persons and infants
• Childhood and adolescent health transformation to address disparities and outcomes for school-aged children and adolescents
• Whole person, primary care transformation, targeting disparities and outcomes for all primary care patients and focused on social barriers to health
• Early childhood health for prevention and using evidence-based models of care to overcome social barriers to health

$200 million (of the $650 million) would support provider practices to adopt value-based and other payment models that improve health care quality while reducing costs. This funding targets area of the state that falls within the first and second quartiles of the Healthy Places Index (Healthy Place Index (HPI) (healthyplacesindex.org).

How we can help

Our team has have been collaborating with managed care plan leaders, health systems, SDOH vendors, and community providers through the final stages of CalAIM planning and early implementation across the state, including shaping infrastructure investment strategies for one of the state’s largest Medicaid providers. While this additional funding will be critical to providers looking to engage in CalAIM, this infrastructure development will benefit all lines of business as the system and providers move towards more integrated models of care inclusive of community-based organizations within each region and more sustainable sources of revenue under value-based arrangements.

How we can help you:

• COPE Health Solutions provides strategic planning and value based payment roadmap solutions, is proficient in developing needs assessments, and is experienced in developing grant proposals and completing the grant application.
• COPE Health Solutions’ Analytics for Risk Contracting (ARC) cloud platform incorporates and synthesizes data from a medical group, IPA/CIN, or health system, including claims, EHR, pharmacy, lab, ADT, social barriers to health/SDoH, biometrics, etc. We benchmark communities’ health outcomes and document where improvements need to occur.
• Advanced API-based solutions push the right analytics and risk stratification outputs, including prioritized gap closure actions, into the EHR and the physician workflow.
• COPE Health Solutions differentiates itself by its ability to assist clients with implementation and project management.
• We have proven workforce development solutions that can accelerate readiness for new graduates and rapidly close gaps in recruiting, training and retention for all roles in the ambulatory space.

To help you with Medi-Cal Equity and Practice Transformation, please contact info@copehealthsolutions.com.