Summary
Summary: California has promoted value-based care in its public hospitals under a Section 1115 Medicaid Waiver called Public Hospital Redesign and Incentives in Medi-Cal (PRIME), a waiver overseen by California’s Department of Health Care Services (DHCS). PRIME required public hospitals to significantly transform their outpatient care delivery to receive payment for improved performance.
Fifty-four public hospitals in California — including 17 designated public hospitals (DPHs) and 35 district and municipal hospitals (DMPHs) — implemented PRIME to achieve five overarching goals designed to improve care delivery, cultural competence, and patient health outcomes, as well as to move public hospitals towards value-based care.
Nadereh Pourat, associate center director of the UCLA Center for Health Policy Research and director of the center’s Health Economics and Evaluation Research Program, led a team of researchers who evaluated the PRIME program. This report, Final Summative Evaluation of PRIME, is the third in a series of reports based on their findings.
In the initial Interim Evaluation of PRIME report, Pourat and the research team evaluated the PRIME program (i.e., following evidence-based guidelines), promoting better care outcomes (i.e., offering increased screening for cancer and tobacco use), and tracking better health (i.e., improvement of hypertension and diabetes control).
In the subsequent Preliminary Summative Evaluation pf PRIME, report, Pourat and team evaluated PRIME metric progression, challenges and successes, and plans for sustainability at the end of PRIME implementation.
Findings: The Final Summative Evaluation of PRIME report shows that PRIME hospitals:
- Reduced hospitalizations (2.33 fewer per 1,000 patients per year among DPHs) and emergency department visits (6.32 fewer per 1,000 patients per year among DPHs;15.36 fewer per 1,000 patients per year among DMPHs) for PRIME patients compared with patients of other providers.
- Reduced Medi-Cal payments per patient per year ($836 less among DMPHs; $865 less among DPHs).
- Used innovative approaches and modifications to implement PRIME projects, mitigating COVID-19 pandemic disruptions.
- Improved public hospitals’ ability to participate in managed care value-based payments.
The findings of this evaluation highlight the importance of federal funding for initiating and promoting progress in quality improvement projects and can be used to inform federal and state Medicaid policies to promote better care, better health, and lower costs.
*The report is currently with the Centers for Medicare & Medicaid Services (CMS) for review. A final version will be posted once it has been approved.
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