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.

CHIPRA: 
No
MAPCP: 
No
Dual Eligible: 
Yes
2703 Health Home: 
No
CPCi: 
No
SIM Awards: 
Yes
PCMH in QHP: 
Yes
Legislative PCMH Initiative: 
Yes
Private Payer Program: 
Yes
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

Anthem ACOs Targeting Chronically-Ill PPO Population Improve Patient Health, Save $7.9 Million in 1 Year

Anthem Blue Cross (Anthem) announced today its Accountable Care Organizations (ACOs) under its Enhanced Personal Health Care Program, which targets PPO members with two or more chronic conditions to improve their overall health through enhanced care coordination, saved $7.9 million1 by improving total population health.

State legislation aims to improve access to mental health care

The San Diego health care community is known for innovation and collaboration. Programs such as the Low Income Health Program helped many sectors of the health care delivery system. For community health centers and clinics, the county incentivized the establishment of the patient-centered medical home model and provided performance payments for the care of individuals with chronic diseases.

News Author: 
Henry N. Tuttle

Bridging The Gap Between Behavioral And Primary Health Care For Low-Income Patients

Bridging the divide between behavioral and primary health care not only makes sense, it’s what patients want. Recent Blue Shield of California Foundation research reveals that low-income patients prefer to receive behavioral health services in the same setting as they receive their primary care. It also shows that a broad gap still exists between need and available treatment.

News Author: 
Rachel Wick

Future of dual eligible demonstrations questioned due to low enrollment

There are growing worries about the future of an ambitious federal demonstration aimed at improving coordination of care for millions of low-income and disabled Americans who are dually eligible for Medicaid and Medicare.

Health plan leaders and state officials expressed concern during a webinar event on April 16 that current federal-state demonstrations in 11 states may not yield the cost savings the Obama administration and the states hoped for – at least in the projected time frame.

News Author: 
Virgil Dickinson

AB 342, Medi-Cal Demonstration Project Waivers

This law established that all enrollees in the California Bridge to Reform Demonstration must be assigned to a medical home. 

California stumbles at shifting care for costly patients

lifornia's ambitious effort to save billions of dollars by changing how the state's costliest patients get treated is on the ropes.

The Obamacare program was designed to reduce medical costs by putting more of the nation's 11 million most challenging and expensive patients into tightly managed care.

News Author: 
Chad Terhune

12th Annual CAPG Healthcare Conference

2015-06-11 13:00 to 2015-06-14 11:00

We are in a historic period of healthcare reform that requires increased coordination, integration, and accountability among all healthcare sectors. The 2015 CAPG Healthcare Conference is designed to help you thrive in this new and challenging world.

Announcement Type: 

The mortal threat to Medicaid -- and how to fix it

That was the expiration day of a two-year bump in Medicaid reimbursements for primary care physicians seeing Medicaid patients. The raise, which was part of the Affordable Care Act, temporarily raised Medicaid rates to the level of Medicare reimbursements; the expiration means a drop averaging nearly 43% nationwide, according to calculations by the Urban Institute.

News Author: 
Michael Hiltzik

Coordinating All Resources Effectively (CARE) - California

Children’s National Health System has been named a recipient of a Center for Medicare & Medicaid Innovation (CMMI) award to improve health care delivery for children with complex medical needs.  The grant, aimed at advancing care coordination models, was awarded to the Children’s Hospital Association (CHA) and 10 pediatric hospital partners.

AAMC Project CORE: Coordinating Optimal Referral Experiences - California

The Association of American Medical Colleges received a CMS Health Care Innovation Award to fund scalability testing of an electronic consultation and referral system for implementation at five partner medical centers. The model, developed by the University of California San Francisco, aims to address gaps in primary care-specialty care communication and provide technology for non-face-to-face electronic consultation.

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