Public Hospital Redesign and Incentives in Medi-Cal (PRIME) is a pay-for-performance program in which California’s public health care systems and District and Municipal Hospitals are using evidence-based quality improvement methods to achieve ambitious performance targets and improve health outcomes for patients. All federal funding for this program is contingent on meeting these targets and demonstrating continued improvement. If all CAPH member systems meet all of their performance metrics over the 5 years of the program, they could earn a total of $3.26 billion in federal funds.
PRIME is a core programmatic element of California’s current Section 1115 Medicaid waiver, approved on December 31, 2015, known as MediCal 2020. PRIME is intended to complement other delivery system transformation efforts that are also focused on strengthening patient-centered primary and specialty outpatient care, improving care coordination, and providing the right care in the most appropriate settings.
Projects and Metrics
Under PRIME, each participating health care system can participate in as many as seventeen projects, which are focused on improvements in ambulatory care, behavioral health integration, high-risk populations, and efficiency. Public health care systems must select at least nine projects, six of which are required. Targets for these projects are largely based on state and national benchmarks.
Roughly 20% of targets are based on “innovative metrics” which have been created for the PRIME program. The establishment and testing of these metrics through the PRIME program will help support the advancement of new clinical care measures.
- See full PRIME projects list and an example project description and metrics
- Read more about the Medi-Cal 2020 waiver
- Read about PRIME’s predecessor, the 2010-2015 Delivery System Reform Incentive Program (DSRIP)
- See the State of California’s PRIME page which includes the Special Terms and Conditions of the waiver and relevant attachments
CAPH members can access more resources and technical assistance related to PRIME through SNI Link.