Payment Model Demonstration Project Technical Assistance
January 19th, 2024
Providers contracting for any version of the California Advanced Primary Care Initiative’s common value-based payment model through the Payment Model Demonstration Project will engage in technical assistance to support performance improvement. Technical assistance services are provided by the California Quality Collaborative (CQC).
Technical assistance includes evidence-based support through a combination of on-demand virtual learning resources and personalized guidance from an improvement coach who interacts with practices via regular coaching sessions and remains available for questions and support throughout the project. Improvement coaches partner with practices to understand needs and opportunities, set goals, guide improvement efforts and track progress. In addition, participating practices will convene together every quarter to exchange learnings, provide peer support for overcoming challenges and celebrate achievements.
Curriculum
The foundation of the technical assistance program focuses on concepts from evidence-based frameworks and best practices, including:
- Model for Improvement
A widely used framework from the Institute for Healthcare Improvement for developing, testing and implementing changes leading to improvement.
- 10 Building Blocks of High-Performing Primary Care
A roadmap to identify foundational capabilities and implement building blocks, that include practice-level advanced primary care capabilities like engaged leadership, data-driven improvement, team-based care and population management. CQC has developed webinars on the 10 Building Blocks of Primary Care.
- Practice Transformation Initiative
An assessment, change package and curriculum developed by CQC and used across more than 2,000 California primary care practices to guide transformation efforts and improve care and health outcomes.
Participating Practices
Additional Support and Resources
In addition to learning practice-level change concepts, participants will have access to skill-building trainings such as improvement coaching, motivational interviewing and patient and family engagement techniques.
Advanced Primary Care Measurement Pilot
January 17th, 2024
Dates Active: 2022-2023
Together with IHA, PBGH brought together four large health care purchasers in California to pilot CQC’s set of practice-level performance measures that emphasize patient experience and outcomes. The Advanced Primary Care Measurement Pilot began in January 2022, and participating purchasers include Covered California, California Public Employees’ Retirement System (CalPERS), eBay and San Francisco Health Services System.
The information gained in the pilot can be used by purchasers and health plans to better connect patients to practices delivering the best primary care in the market and incentivize improvement for other providers, increasing the availability of Advanced Primary Care.
Payment Model Demonstration Project
January 17th, 2024
The Payment Model Demonstration Project will test a common value-based payment model with approximately 30 independent practices in California to strengthen primary care delivery. The overarching goal of the demonstration project is to provide additional resources for primary care providers, equipping them to deliver high-quality patient care and achieve better outcomes. These resources include helping to boost revenue, providing technical assistance and delivering data exchange and insights. Due to the variety of payers that practices contract with, implementing payment changes collectively has the potential to yield greater positive impact compared to individual plan-driven efforts.
As the next phase of the California Advanced Primary Care Initiative, the demonstration project is a collaboration of PBGH’s California Quality Collaborative (CQC) and the Integrated Healthcare Association (IHA), as well as three participating health plans – Aetna, Blue Shield of California and Health Net – beginning October 1, 2024 and ending December 31, 2025.
Barriers for Primary Care Practices
Primary care is the backbone of any high-performing health care delivery system, but it has been chronically underfunded, receiving approximately 4-7% of health care dollars while about 55% of health care visits take place in primary care settings.
The many barriers to the delivery of advanced primary care were underscored by pandemic burnout experienced by primary care providers. Small independent primary care practices, the primary focus of this demonstration project, are particularly affected by these barriers, which include misaligned payer incentives, minimal integration with other elements of care and the lack of necessary infrastructure, technology and workforce.
Common Value-Based Payment Model
Through the payment demonstration project, health plans will offer two similar versions of a value-based payment model. Practices may be paid under one or both depending on which health plans they contract with. Both value-based payment models invest more revenue into the practice and reward improvement and strong performance on the Advanced Primary Care Measure Set.
Hybrid Model:
- Monthly per member per month (capitated) payment
- Volume-based payment for specific pre-defined services (focusing on preventive care)
- Population health management payment to support practice improvements that will deliver better outcomes
- Incentives for strong performance on a common set of outcomes measures.
Fee-for-Service “Plus”:
- Volume-based payment for all services
- Population health management payment to support practice improvements that will deliver better outcomes
- Incentives for strong performance on a common set of outcomes measures.
Participating Practices
Support for Practices on How Best to Use the New Revenue
Focused support will be available to participating practices through a technical assistance program. The support will include regular one-on-one coaching to advise care teams on how to optimize their additional revenue for practice transformation.
Practices will have access to a common reporting platform to assess measure performance and progress across all participating health plans to reduce administrative burden. Plans will be trained on the platform as will the technical assistance coaches to manage troubleshooting and potential issues.
How Success Will Be Measured
Quantitative success will include return on investment for plans based on relative improvement on several key clinical and utilization measures, overall improvement on the Advanced Primary Care Measure Set for each practice and comparisons across practices, including the proportion of patients paid under each version of the value-based payment model and other variables.
Qualitative information on practice experience, engagement and impact is collected by technical assistance coaches to assess trends and make adjustments for future scaling of this multi-payer work. Information on the health plans’ experiences with multi-payer partnership is also collected with an eye toward learnings, improvement and future scaling.
View our complete introductory video series for an inside look at the Payment Model Demonstration Project
Supplier Innovation Summit
November 29th, 2023
Enhance your program by partnering with top-tier suppliers who offer innovative solutions tailored to the evolving needs of your workforce.
Service Details:
- Supplier Strategy:
- Craft an effective supplier strategy and structure that aligns with your employee benefits objectives and workforce preferences.
- Identify potential suppliers that meet these needs, and set up strong procurement and purchasing guidelines, along with measurement and accountability standards.
- Supplier Innovation Summit
- Plan and execute the summit, including format creation, agenda setting, and supplier vetting.
- Develop summit content, prepare suppliers, and lead the facilitation/moderation of the event.
- Conduct a post-event debrief, outlining actionable next steps.
PBGH Care Excellence Program
October 4th, 2023
The PBGH Care Excellence Program, an integral pillar of the PBGH System of Excellence, sets the gold standard in health care by rigorously evaluating and identifying top-tier primary care teams based on an employer and purchaser set of standards and shared quality metrics. Our mission is simple yet transformative: to make it easy for employers and purchasers to identify and partner with the highest quality healthcare, starting with advanced primary care.
The PBGH Care Excellence Program accomplishes for employees seeking top-notch health care what Michelin does for food enthusiasts. Created with input from employers, clinicians and technical experts, this program acknowledges the expertise and commitment of top-tier health care teams. PBGH is starting with primary care by utilizing the PBGH Advanced Primary Care Shared Standards to identify the best care for employees and their families. The Standards reflect patient and purchaser priorities by focusing on key attributes of quality, access, patient experience and care outcomes.
The PBGH Care Excellence award recognizes care teams and clinicians for the exceptional care they provide so that employers, employees and health plans know who meets these high standards. This program also enables entry into to the PBGH System of Excellence, a national group of vetted clinics that have received the PBGH Care Excellence award, which will be used by employers, purchasers and health plans.
Building on our 35 years of experience pioneering quality measurement and as an operating partner for the Employers’ Center of Excellence Network, one of the nation’s most successful employer-based health care initiatives, we have created a system that delivers whole-person health by providing access to top-quality specialty care connected to advanced primary care.
PBGH System of Excellence
The PBGH System of Excellence for advanced primary care with precision specialty referrals offers employers a way to supplement existing health plan offerings, making significant strides in both health improvement and total cost management.
Click here to learn more about the PBGH System of Excellence.
PBGH is building on its years of groundbreaking work to define and promote advanced primary care to improve health, well-being, prevention and early intervention. Our approach builds on our years of experience as an operating partner for the Employers’ Center of Excellence Network (ECEN) and takes it to its next evolution.
If you are interested in joining this work, contact Raymond Tsai.
Pharmacy Services
September 7th, 2023
In-depth description goes below
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nullam consequat diam sapien, quis tincidunt lectus sagittis in. Aliquam varius pulvinar varius. Fusce laoreet luctus ullamcorper. Nulla eu lorem malesuada, elementum magna nec, condimentum nulla. Donec est lorem, pellentesque quis dolor nec, malesuada finibus leo. Etiam at ex placerat, accumsan ligula non, lacinia metus. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nunc at tellus vehicula, rhoncus risus ac, elementum mauris. Donec id congue lacus.
Aenean magna felis, iaculis id pellentesque eget, finibus ac nisi. Donec commodo ac dui id laoreet. Cras vel enim eu risus consectetur congue. Morbi at nisi a magna vehicula faucibus quis non enim. Pellentesque hendrerit sodales nibh, id tempus mi molestie ut. Maecenas et pretium lorem, vitae volutpat ante. Vivamus ut lobortis eros, sit amet fermentum metus. Vestibulum scelerisque lectus odio, dictum finibus metus lacinia nec.
Direct Contracting Support
September 7th, 2023
Benefit from specialized expertise to develop and implement direct contracting strategies for better outcomes and lower total costs. Our comprehensive approach addresses all aspects of direct contracting, from assessing your unique needs to selecting partners and negotiating terms.
Service Details:
- Comprehensive Assessment and Strategy Development:
- Evaluate employee and employer priorities and goals.
- Assess quality and value of potential regional partners using public data.
- Select key metrics for quality, access, experience and cost performance, including payment rates and methods.
- Review data availability, existing contract terms and identify necessary implementation partners (e.g., independent TPAs, data vendors, actuaries).
- Consider regional regulatory requirements and necessary benefit incentive changes.
- Partner Selection and Contracting Process:
- Determine suitable payment models and rates.
- Draft contract standards and terms based on best practices among leading employers and purchasers.
- Conduct RFPs, data analyses and qualitative assessments to select optimal provider partners.
- Offer contract review and negotiation support.
- Implementation and Performance Monitoring:
- Develop an internal and employee communication plan.
- Establish a system for performance monitoring and transparent reporting.
- Conduct ongoing meetings with providers to monitor performance and adapt arrangements as needed.
Data Vendor Selection and Plan Management
September 7th, 2023
Get comprehensive, unconflicted assistance in the vetting and selection process of data vendors to optimize your health care spend.
Service Details:
- Facilitate independent selection of your data vendor, encompassing:
- Comprehensive request for proposal (RFP) services, which include establishing purchasing principles and guidelines, developing a selection rubric, managing the RFP process, coordinating finalist meetings and providing support for best and final offer and contract negotiations.
- Conduct thorough reviews of vendor service agreements to ensure alignment with your organizational needs and compliance standards.
- Undertake detailed review and benchmarking of vendor fees, assessing their reasonableness and verifying the completeness and compliance of disclosures.
- Develop and implement robust vendor performance standards, along with effective measurement systems to ensure continuous quality and service excellence.
Download Service Descriptions
Data Analyst Services
September 7th, 2023
Maximize available health and claims data to gain insights to ensure your vendors, providers and program effectiveness.
Service Details:
- Data analyst support to review your health and claims data, optimize savings and inform strategy and design.
- Review your contracts and agreement for optimal data access.
Download Service Descriptions
Expanded Quality Designations (beyond Advanced Primary Care)
September 7th, 2023
In-depth description goes below
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nullam consequat diam sapien, quis tincidunt lectus sagittis in. Aliquam varius pulvinar varius. Fusce laoreet luctus ullamcorper. Nulla eu lorem malesuada, elementum magna nec, condimentum nulla. Donec est lorem, pellentesque quis dolor nec, malesuada finibus leo. Etiam at ex placerat, accumsan ligula non, lacinia metus. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nunc at tellus vehicula, rhoncus risus ac, elementum mauris. Donec id congue lacus.
Aenean magna felis, iaculis id pellentesque eget, finibus ac nisi. Donec commodo ac dui id laoreet. Cras vel enim eu risus consectetur congue. Morbi at nisi a magna vehicula faucibus quis non enim. Pellentesque hendrerit sodales nibh, id tempus mi molestie ut. Maecenas et pretium lorem, vitae volutpat ante. Vivamus ut lobortis eros, sit amet fermentum metus. Vestibulum scelerisque lectus odio, dictum finibus metus lacinia nec.