Value-Based Care
Transforming Medi-Cal through Value-Based Care
California’s public health care systems have been at the forefront of Medi-Cal transformation for more than a decade, helping design and implement programs that improve care quality, expand access and better address the needs of patients with complex medical and social needs.
Through initiatives such as Whole Person Care, CalAIM and other delivery system reforms, public health care systems have helped shift Medi-Cal toward more coordinated, community-based and person-centered care.
Today, CAPH works with state partners, health plans and public health care systems to advance value-based care models that:
- improve quality and health outcomes
- strengthen equity in care delivery
- support care coordination for high-need populations
- expand access to behavioral health and community-based services
- align financing with quality and patient outcomes
Key Areas
Learn more about public health care system’s role in Medi-Cal transformation in the key areas below:
CalAIM
California Advancing and Innovating Medi-Cal (CalAIM)
CalAIM is California’s multi-year Medi-Cal transformation initiative designed to improve care coordination, expand community-based services and better integrate physical health, behavioral health and social supports. California has applied to renew the Section 1115 waiver supporting key CalAIM initiatives and broader safety-net transformation efforts statewide. Renewal would support ongoing efforts to advance more coordinated, community-based and whole-person care for high-need populations across California’s Medi-Cal program.
Through programs such as Enhanced Care Management and Community Supports, CalAIM enables public health care systems and their partners to deliver more coordinated, patient-centered care for Medi-Cal’s highest-need patients, including individuals experiencing homelessness, severe mental illness, substance use disorders and other complex medical and social challenges. Early results show the program is delivering measurable improvements for patients and proving cost-effective in key areas.
CAPH works with state partners, health plans and member systems to support CalAIM implementation, elevate system challenges and advocate for policies and financing structures that strengthen access to coordinated care for Medi-Cal patients statewide.
Global Payment Program
Redesigning care for uninsured Californians
The Global Payment Program (GPP) is one of several programs included in California’s Section 1115 CalAIM waiver renewal application. GPP restructures financing for uninsured care to expand access to outpatient, primary and preventive services. By shifting incentives away from avoidable emergency and inpatient care, GPP supports public health care systems in delivering higher-value care for uninsured patients.
Through GPP, public health care systems have expanded outpatient access, strengthened care coordination and developed more flexible, community-based models of care. An independent review confirmed measurable improvements, with outpatient visits increasing and emergency and inpatient care declining.
Quality Incentive Program
Advancing quality and equity in Medi-Cal care
The Quality Incentive Program (QIP) is California’s largest value-based directed payment program for public health care systems. QIP ties funding to performance across approximately 40 quality and equity measures related to preventive care, chronic disease management, behavioral health, maternal health and care coordination for Medi-Cal patients.
QIP enables public health care systems to redesign how care is delivered. Systems use the program’s structure to strengthen data and reporting capabilities, develop new patient engagement strategies, expand care coordination, build workforce capacity and address disparities in outcomes by race, ethnicity and other factors. The program also requires systems to improve equity on specific measures and report performance data stratified by race and ethnicity, making equity an operational priority.
By tying funding to quality and equity outcomes, QIP supports public health care systems’ ongoing investments in care delivery, workforce capacity, data infrastructure and long-term quality improvement efforts. By tying funding to quality and equity outcomes, QIP supports ongoing investment in care delivery, workforce and infrastructure across the safety net.
CAPH works with state partners and public health care systems to support QIP implementation and advocate for program structures that improve patient outcomes while remaining operationally feasible and sustainable for public health care systems.