Updates on the Value Based Payment Program

On Thursday, the California Department of Health Care Services (DHCS) held a meeting to discuss the final information and measures for the Value Based Payment (VBP) program through Medi-Cal managed care health plans (MCPs).

The program was part of Gov. Gavin Newsom’s proposed budget for 2019-20 and aims to provide incentive payments to managed care providers if they meet certain quality and efficiency measures. These measures seek to adjust disparities in specific targeted health areas.

 

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The recently passed final budget allocates $544.2 million ($250 million of Proposition 56 funds), with $70 million in Prop. 56 funds strictly for behavioral health integration, for the program. The VBP program will be executed for a minimum of three years in the managed care delivery system.

The incentive payments will be for physicians to work towards improvements in the following areas:

  • Prenatal/Post-Partum Care
  • Early Childhood Prevention
  • Chronic Disease Management
  • Behavioral Health Integration

 

“To address and consider health disparities, DHCS will pay an increased incentive amount for events tied to beneficiaries diagnosed as having a substance use disorder or serious mental illness, or who are homeless.”

 

Under the Prenatal/Post-Partum Care category, the quality measures include administration of prenatal pertussis vaccines, prenatal care visits, postpartum care visits, and postpartum birth control. The overall goal is to improve the quality of prenatal care and postpartum health to mothers and their babies.

 

According to the presentation, “DHCS understands that women may change providers and plans during a pregnancy. Therefore, the first visit that occurs in a specific plan will be paid. The intent is to encourage that visit to happen quickly to begin the prenatal relationship.”

 

Under the Early Childhood category, the measures include Well Child Visits in the first 15 months of life, Well Child Visits in the first 3-6 years of life, all childhood vaccines for two-year olds, blood lead screening, and dental fluoride varnish. This aims to increase the number of visits young children receive, improve vaccination rates, and treat elevated blood levels for young children.

Under the Chronic Disease Management, the measures include controlling high blood pressure, diabetes care, control of persistent asthma, tobacco use screening, adult influenza vaccine, and screening for clinical depression. This will improve the care of those with high blood pressure, diabetes, asthma, and those who are current smokers. This screening for clinical depression will lead to improved behavioral health care.

Under the Behavioral Health Integration category, the measures include management of depression medication, screening for unhealthy alcohol use, and allocating funds to entities with a three-year Behavioral Health Integration Project Plan. The goal is to identify what services would best fit the needs of those struggling with their mental health.

 

The presentation stated that there will be “Incentive payment to provider for beneficiaries 18 years and older with a diagnosis of major depression and treated with an anti-depressant medication who has remained on the anti-depressant medication for at least 12 weeks.”

 

These measures are set to start on July 1, 2019 and the Behavioral Health Integration Project Plan will be executed on January 1, 2020.

All payment methods and measure purposes are available in this document. There will be a technical specifications document that will include this information released next week.