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 54 public hospitals to significantly transform their outpatient care delivery, receiving payment for improved performance.
The Interim Evaluation of PRIME Report, led by UCLA Center for Health Policy Research Associate Director Nadereh Pourat, PhD, indicated establishment of needed infrastructures for PRIME projects such as following evidence-based guidelines, better care outcomes such as increased screening for cancer and tobacco use, and better health such as hypertension and diabetes control.
In the Preliminary Summative Evaluation Report, Pourat and team have evaluated PRIME since the Interim Evaluation Report and near the end of PRIME implementation. The findings indicate that hospitals had:
- Completed most of their PRIME project goals, building on synergies between project goals and organizational mission and other quality improvement initiatives.
- Highlighted the high impact of PRIME on establishing data gathering and processing tools and promoting internal stakeholder engagement and data driven quality improvement.
- Significantly improved the majority of process and outcomes performance metrics up to the last year of the program and prior to the COVID-19 pandemic.
The final Summative Evaluation Report will be available later in 2021 and will examine the impact of COVID-19 on PRIME activities, and include a comprehensive assessment of PRIME’s impact on health care utilization of Medi-Cal enrollee populations that received services by participating hospitals.
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