California’s bold Fairness and Follow Transformation (EPT) program, which helps 198 main care practices throughout 58 counties, is working to cut back disparities, improve knowledge capabilities, and put together practices for value-based funds. Throughout a Sept. 22 webinar, leaders of this system reported on among the milestones practices have achieved to this point.
Palav Babaria, M.D., M.H.S., chief high quality officer and deputy director of high quality and inhabitants well being administration on the California Division of Well being Care Providers (DHCS), mentioned the division sees this program as a important a part of its technique to enhance high quality and fairness for all Medi-Cal members.
She defined that the state launched the $140 million EPT program, which is slated to run from 2024 via 2027 with the aim of supporting main care practices, to advance fairness, scale back gaps in care and worsening high quality measures that developed because of the COVID-19 public well being emergency, to put money into upstream care fashions and to assist practices prepare for value-based fee methodologies.
The 198 main care practices taking part are working with 19 managed care plan sponsors.
Babaria added that the State Workplace of Well being Care Affordability (OCHA) has set a main care spending benchmark of 15% by 2034 on the well being plan stage, and it requires that the payers — if they aren’t already at that 15% goal — to make a 0.5 to 1% year-over-year enchancment. “Beginning in 2024 now we have additionally constructed language into our public purchaser contracts via MediCal, Lined California and CalPERS with reporting necessities round main care spend in these value-based contracts, and are at the moment working with OCHA to implement and align these necessities throughout the entire public purchasers,” she defined.
“Worth-based contracts permit us to tie extra of our spending to precise high quality and fairness outcomes,” Babaria mentioned. “OCHA has set targets for various traces of enterprise for what proportion of all contracts have to be in some kind of value-based fee association as a substitute of payment for service. In partnership with our different public purchasers, now we have began holding again cash for high quality targets. So Medi-Cal as of 2025 has a 1% withhold the place tons of of thousands and thousands of {dollars} of capitated funds are withheld from our plans except they obtain particular targets on high-priority high quality measures, which now we have aligned with Lined California and CalPERS.”
She added that additionally they know that a lot of what drives poor high quality and fairness outcomes is lack of applicable knowledge and knowledge sharing. “A number of these initiatives require the California Information Alternate Framework to take off, so most healthcare entities and plans have signed the info alternate framework settlement and are taking part in or onboarding to native well being data exchanges,” she mentioned.
“On the DHCS aspect, we required our plans to have knowledge sharing with a number of several types of native entities, together with county behavioral well being, public well being departments, et cetera. And we additionally required plans to start out utilizing ADT feeds. In 2025 via our inhabitants well being administration platform, Medi-Cal Join, the entire plans could have entry to member-level data, dashboards and danger stratification.”
DHCS has partnered with the nonprofit PopHealth Studying Heart to supply program oversight and technical help. “There’s loads of labor and redesign and workflow help and know-how that wants to enter supporting our practices to supply the very best care doable,” Babaria mentioned. “We’ve set this program up as a directed fee construction, so now we have milestones, and as practices attain particular interventions and milestones which are all evidence-based and on a roadmap to attending to a high-functioning, superior main care observe, they receives a commission for reaching these via their managed care plan companions.”
Shifting the needle with practices
Jennifer Sayles, M.D., M.P.H., is CEO of the PopHealth Studying Heart. Beforehand, she led the Division of Well being Care Providers/Kaiser Permanente/Neighborhood Well being Heart Inhabitants Well being Administration Initiative (PHMI), a program to develop and implement evidence-based fashions of care in inhabitants heath administration amongst group well being facilities. She additionally has served as chief medical officer at Inland Empire Well being Plan, chief inhabitants well being officer at LA County Division of Well being Providers, and medical director roles at LA Care and LA County Division of Public Well being.
“Shifting the needle requires focusing work throughout the suppliers, payers and purchasers, with actually aligning incentives, knowledge and operations to make issues occur,” Sayles mentioned. “From our perspective, it additionally requires stepping again and taking a relentlessly practice-centered strategy. So if our aim is to vary the care that sufferers and household obtain, then we have to actually step again into this practice-centered strategy. The remainder of the system wants to arrange round what is required on the bottom, to help practices to vary main care and attempt to step away from making practices concentrate on what all people else needs.”
Sayles defined that they began within the EPT program with constructing observe capabilities to seize the info wanted to grasp and outline disparities. “That’s one in all our main milestones within the first 12 months of this system,” she mentioned. “I’ll say that coming in, most practices didn’t enter this system capable of stratify by socio-demographic knowledge. We labored with them to seize the elements wanted to do that and to place it into motion. After six months of engaged on capturing socio-demographic knowledge and studying to stratify HEDIS-like measures, we had 75% of practices efficiently stratifying their measures and figuring out disparities that existed particularly of their observe inhabitants.”
She mentioned they’ve made a concerted effort to incorporate small practices which are usually unnoticed of bigger scale efforts like this. “We’re taking a look at small practices and what they have to be profitable on their inhabitants well being journey,” Sayles mentioned. “I believe that the parable that small practices cannot preserve tempo actually is not taking part in out on this program. So 61% of small practices in this system have achieved eight or extra of the ten complete milestones to this point, and that is in comparison with solely 55% of different practices.”
Summarizing, she mentioned that one 12 months into this system and its technical help mannequin they’re seeing important skill of practices to fulfill program milestones, statistically important enhancements and self-reported observe inhabitants well being administration capabilities in addition to significant enchancment in operational measures reminiscent of entry and continuity. “Additionally, we’re seeing these enhancements throughout all observe sorts, with notable enhancements in small practices.”
Shifting on to high quality measures, Sayles famous that at the moment in California, there actually isn’t any construction or constant methodology that’s used for practice-level efficiency measurement that makes use of payer knowledge, “and we all know that NCQA truly does not have practice-level benchmarks or specs but both. The result’s we see loads of variation throughout payers. On the upside, the Medi-Cal program has simply printed specs for practice-level measurement, and we on the EPT program, are going to be the primary to implement them in partnership with DHCS and the managed care plans.”
She added that their first spherical of managed care plan knowledge assortment on observe baseline efficiency in 2024 was difficult, “predominantly as a result of variation throughout plans that made aggregated outcomes fully unreliable. So we actually acquired a state of affairs of apples to oranges to bananas that we have to reconcile and enhance as we go ahead.”
