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CMA comments on proposed Medi-Cal value-based payment measures

April 29, 2019
Area(s) of Interest: Access to Care Public Payors 


In his proposed budget for the 2019-2020 fiscal year, Governor Newsom announced plans for a value-based payment (VBP) program that would provide incentive payments to Medi-Cal managed care providers for meeting specific measures aimed at improving care for certain high-cost or high-need populations. 

The California Department of Health Care Services (DHCS) has released proposed measures for the VBP program, which would be funded with $180 million annually in Proposition 56 tobacco tax funds.

The program would provide risk-based incentive payments targeted at physicians that meet specific achievement on metrics targeting areas such as behavioral health integration, chronic disease management, prenatal/post-partum care and early childhood prevention. 

The California Medical Association (CMA) is supportive of the overall direction of the VBP program, as it will help ensure increased access to important primary and preventive services for Medi-Cal beneficiaries. CMA is pleased with the clinical measures selected by DHCS and with the agency’s plan to use existing encounter data rather than requiring physicians to complete additional reporting.

CMA strongly supports the use of existing data sources when evaluating physician participation in this program and urges that any assessment of the proposed measures be done through existing encounter data. 

CMA submitted comments urging DHCS to minimize additional administrative burdens on physicians and expressed strong opposition to any measures that require increased manual review of medical records by physicians, their staff or external auditors. 

CMA also emphasized that to have a meaningful impact on physician behavior, the value-based payments must be distributed in a timely and transparent manner. Payment to physicians should occur as soon as goals are met to increase the affiliation between incentives and behavior. 

CMA has also offered suggestions to ensure the program’s success and looks forward to continuing to work closely with DHCS as the value-based payments are implemented.

Read CMA’s comments to DHCS here.

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