The California Department of Health Care Services (DHCS) is implementing a one-time $700 million dollar primary care provider practice transformation program for Medi-Cal providers. The program is focused on advancing health equity and reducing COVID-19 driven care disparities, and will invest in upstream care models and partnerships to address health and wellness and fund practice transformation to align with value-based payment models.
The program is aligned with the goals of the DHCS Comprehensive Quality Strategy and Equity Roadmap, and will provide funding to primary care practices (pediatrics, family practice, adult medicine primary care, primary care OB/GYN, and behavioral health providers in primary care settings). This initiative will better serve the state’s diverse Medi-cal enrollee population and focus on advancing DHCS’ equity goals in the “50 by 2025: Bold Goals” Initiative.
The program will be allocated in three separate pathways:
1/ EPT Provider Directed Payment Program
This pathway will provide $650 million over 5 years to primary care practices to support delivery transformation specifically for practices that provide primary care pediatrics, family medicine, internal medicine, primary care OB/GYN services, or behavioral health services that are integrated in a primary care setting to Medi-Cal members.
$200 million of the $650 million will be dedicated to value-based care, including practice infrastructure such as electronic health record systems, data collection, recording capabilities, improved data exchange and implementing care management systems.
The web-based application for this program is due on October 23, 2023 at 11:59 pm. See the Provider Directed Payment Program Application Instructions document for more details.
2/ Medi-Cal Managed Care Plan (MCP) Initial Provider Planning Incentive Payments
This pathway will provide $25 million over 1 year to MCPs to identify and aid small to medium sized independent practices as they develop practice transformation plans.
Interested small to medium sized independent practices should contact a contracted MCP. Completion of a standardized practice assessment tool, the pmhCAT, is required for practices.
3/ The Statewide Learning Collaborative
This pathway will provide $25 million over 5 years to participants in the Provider Directed Payment Program in implementing practice transformation activities, sharing and spreading best practices, practice coaching activities, and achievement of stated quality and equity goals.
The structure of the program is still being determined. As of 10/03/2023, there are no contractors in place for this component of EPT.
These pathways are a significant investment in California’s primary care system and have the potential to make a real difference in the lives of Medi-Cal enrollees. The program offers incentives to primary care providers by providing funding to support practice transformation and align with value-based payment models. The program can help improve access to quality care, reduce health disparities and achieve better health outcomes for all.