Health Reform 2.0: Emerging Efforts on Value-Based Health Care in California
Last year, the Robert Wood Johnson Foundation launched a joint initiative with Community Catalyst called the Value Advocacy Project (VAP). The project is supporting consumer health advocacy organizations in six states in their non-lobbying advocacy efforts to pursue local and state policy and health system changes that increase the value of health care by improving health outcomes and lowering health care costs, especially for populations that have disproportionately poor outcomes. Building on the Center for Consumer Engagement in Health Innovation’s recently released Consumer Policy Platform for Health System Transformation, we will be highlighting our state partners working on issues outlined in the policy platform and encouraging them to share how their work can translate to advocates across the country.
Health Access, California Pan-Ethnic Health Network (CPEHN), Consumers Union and other consumer groups have teamed up in an effort to improve health and health equity for California consumers using the opportunities provided through our existing work on transparency, benefit design and Medi-Cal (Medicaid in California) reforms. The Medi-Cal program covers low-income individuals including families, seniors, persons with disabilities, children in foster care, pregnant women and childless adults with incomes below 138 percent of the federal poverty level. Through our Value-Based Health Care initiative, Health Access and CPEHN are building on the state’s success in implementing the Affordable Care Act (ACA) to ensure that reforms to our health care delivery system lead to better health and health care and improved health equity for all Californians. As one of the most diverse states in the country with strong market reforms, California’s progress in these areas could be a potential model for other states and nationally, as well.
California has come a long way in implementing and improving on the ACA through consumer protections, a robust exchange and a promising start on delivery system reforms (learn more here). Together with Medi-Cal, Covered California, the state’s ACA marketplace, has been successful in covering more than half of the uninsured and reducing premium costs. Going forward it plans to step up its “active purchaser” role to ensure enrollees are getting the right care at the right time and place through standardized benefit designs, delivery system reforms and transparency initiatives scaled for market-wide impact.
The state’s Medi-Cal 2020 waiver renewal also sets an ambitious agenda aimed at better care, lower costs and quality improvement – the “triple aim” – for beneficiaries. Approved on Dec. 30, 2015, Medi-Cal 2020 will bring a new emphasis on whole-person care and an enhanced focus on health disparities reduction. Additionally, county-level health systems will have incentives and resources to find efficiencies in delivering care and to reorient their indigent care programs to provide primary and preventive care outside of hospital systems (learn more here).
In California people of color, immigrants, Limited English Proficient (LEP) and LGBTQ communities face significant disparities that may impede the state’s ability to achieve the triple aim unless the reduction of health disparities is explicitly addressed (learn more here). The project therefore adds a fourth dimension to the triple aim, equity, to keep the focus of triple aim initiatives on opportunities to track and reduce disparities by race, ethnicity, income, sexual orientation, gender identity (SOGI) and other key demographics.
With that background, the project focuses on three key areas:
- Medi-Cal Reforms to Focus on Equity, Population Health and Consumer Engagement: We will use the implementation of Medi-Cal 2020, the recently renewed waiver, as a platform to advance equity, quality, coverage and improved outcomes. As the overwhelming majority of beneficiaries in Medi-Cal, communities of color have the most to gain from initiatives aimed at improving the quality of care, as long as there is an explicit, data-driven focus on reducing health disparities (see link). Diverse communities have a greater incidence of preventable illnesses, and social and environmental factors play a decisive role in determining who gets sick, who gets care and who benefits from treatment. As the single largest purchaser in the state, Medi-Cal should be a model for reducing disparities through data collection and meaningful use of data, population health measures and a patient centered medical home model of care. Additionally, just as the last Medi-Cal waiver connected uninsured patients to a medical home, we will work to ensure the new waiver facilitates access to comprehensive care for the remaining uninsured.
- Transparency: Advocates will help to shape and highlight state efforts to collect and analyze provider claims, consumer complaints information and other data to ensure that enrollees in Covered California, Medi-Cal and/or commercial coverage are getting the right care at the right time and place and that that care is equitable. The project will also focus on strengthening knowledge and access to consumer complaint mechanisms for diverse communities to ensure quality, equitable care is provided
- Value-Based Benefit Design (VBD): This initiative will provide data and evidence to refine and promote standardized benefit designs in and out of Covered California to simplify plan choices; limit cost sharing, for example by minimizing the use of co-insurance; track problems that result from excessive cost sharing or poorly designed transparency initiatives or wellness programs; and support consumer-friendly VBDs such as lower cost sharing for primary care with the goal of improving population health and eliminating disparities in health outcomes.
Through these team efforts, CPEHN and Health Access will learn what it takes to keep consumers – at the heart of delivery system reforms so the health care system works better for all – including communities of color and the remaining uninsured. As one of the largest, racially and ethnically diverse states, California’s success in advancing greater transparency and health equity through delivery system reforms could be a model for the rest of the nation.
Authors: Judi Hilman, Director of Special Projects and Cost/Quality Initiatives, Health Access, and
Cary Sanders, Director of Policy Analysis and Having Our Say, California Pan-Ethnic Health Network