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 Outcomes
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

State Legislation

Legislation Status Year
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
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

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

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