California’s Public Hospitals are Improving Quality and Health Outcomes through PRIME

By Trish Violett, Junior Policy Consultant and Megan Thomas, Director, Quality Initiatives

Over the past four years, the 52 hospitals and health systems participating in the California Public Hospital Redesign and Incentives in Medi-Cal (PRIME) program have been working to improve care delivery and maximize health care value through a “pay-for-performance” model. The PRIME hospitals are using evidence-based quality improvement methods to achieve designated goals and outcomes on select clinical projects and associated performance metrics.

Recent data, presented by DHCS at the 2019 PRIMEd Conference, demonstrates the PRIME program’s role in accelerating progress on improving access to care and health outcomes in California. For example, the PRIME entities have made steady improvements in increasing patients’ access to primary and preventive care services, such as breast-and-cervical cancer screening, as well as behavioral health services, including screening for clinical depression and follow-up.

The outcomes have been significant. To date, DHCS reports that efforts underway through PRIME have directly impacted an estimated 1.37 million patient lives across the state. Between July 2018 and June 2019, approximately 84 percent of PRIME targets were fully achieved, resulting in $5.32 billion in incentive payments to participating entities.

PRIME quality improvement activities are currently funded through June 30, 2020. As PRIME is part of the Medi-Cal 2020 Section 1115 waiver, which expires on December 31, 2020, California is pursuing a six-month extension to continue incentive funding through 2020.

PRIMEd Learning Collaboratives
Over the past four years, the PRIMEd Learning Collaboratives have supported the hospitals and health systems engaged in PRIME to achieve programmatic aims though shared learning and targeted technical assistance activities. The Learning Collaboratives operate in a spirit of active participation, partnership and innovative information exchange. Key activities include:

  • Topic-Specific Learning Collaboratives (TLCs) — Regular conference calls and in-person meetings among interested entities to discuss their improvement efforts on targeted topics, such as behavioral health and care transitions.
  • PRIMEd Webinars — Periodic web-based learning opportunities on quality improvement topics. For example, in 2019, the Learning Collaborative hosted a three-part webinar series on how entities can use telehealth to achieve PRIME goals.
  • Annual PRIMEd Conference — Each year DHCS and Harbage Consulting host an event where PRIME entities come together to network and learn from each other and subject matter experts.

Harbage Consulting has supported the California Department of Health Care Services (DHCS) in developing and implementing the PRIMEd Learning Collaboratives since 2016.

2019 PRIMEd Annual Conference
On October 30th, representatives from nearly 50 public hospitals and health systems gathered in Sacramento for the PRIMEd Learning Collaboratives Annual Conference. Now in its fourth year, the conference fosters shared learning and sustained momentum for improving health care delivery.

Like the 2018 conference, the 2019 PRIMEd conference was preceded by in-person meetings of the TLCs, and office hours with subject-matter experts in tobacco cessation and perinatal health. Highlights from the conference included:

  • Opening remarks from DHCS Acting Director Richard Figueroa and Medical Director Karen Mark, MD, PhD, who highlighted the current state of the PRIME program.
  • A presentation from the CA Quits Team about how PRIME entities can tackle the emerging vaping epidemic.
  • An overview of behavioral health care in California, and DHCS’ initiatives to improve and integrate behavioral health care, led by DHCS’ Deputy Director for Behavioral Health Kelly Pfeifer.
  • A presentation by BluePath Health and PRIME entities on using telehealth technology to help achieve and sustain the goals of PRIME.
  • Breakout sessions led by PRIME entities focused on chronic pain management, the use of care teams to improve patient outcomes, innovative approaches to address challenges in reporting and performance, and a forum for the smaller hospitals participating in PRIME.

The main highlight of the conference was a presentation on the new California Advancing and Innovating Medi-Cal (CalAIM) initiative by DHCS’s Senior Advisor for Health Care Programs, Jacey Cooper. Ms. Cooper provided an overview of the new, expansive initiative designed to improve the entire Medi-Cal continuum of care. One of the key goals of CalAIM is to improve quality outcomes and drive delivery system transformation through value-based initiatives, an objective familiar to the PRIME audience.

After attendees learned about CalAIM, the stage was set for discussions on the future of the PRIME program. Conference attendees learned more about the Quality Incentive Program (QIP), a pay-for-performance program for California’s public health care system. The QIP is currently structured to complement PRIME, and will evolve to incorporate the progress made through PRIME beyond the expiration of the Medi-Cal 2020 Section 1115 waiver. While some public hospitals are already participating in QIP, others will be participating in the program for the first time.

PRIMEd Learning Collaboratives in 2020
As PRIME enters its final year, a key focus of the Learning Collaboratives will be the sustainability of PRIME investments and looking to the future. The Learning Collaboratives are poised to help the hospitals and health systems as they transition from the PRIME program to QIP. Harbage Consulting is working with DHCS to develop a series of learning collaborative sessions to help smooth the transition to QIP and facilitate timely information sharing as the new version of California’s QIP program develops and is formalized.