The Global Payment Program seeks to improve health care for California's uninsured by providing funds to cover both traditional and non-traditional services, settings, and providers. The 12 participating public health care systems seek to reduce the use of services in high-intensity settings by designing systems of care that emphasize primary care and supportive services. This is the report of the midpoint evaluation of the program.

Evaluation of the Global Payment Program

Midpoint Report

Justin W. Timbie, Jodi L. Liu, Maria DeYoreo, Denise D. Quigley, Mary Ellen Slaughter, Lesley Baseman, Katherine L. Kahn

ResearchPublished Sep 7, 2018

With approximately 2.8 million uninsured in California, who often have limited access to cost-effective preventive care and mental health services, California initiated the Global Payment Program (GPP), a pilot program included in the state's current Section 1115 demonstration waiver to support public health care system (PHCS) efforts to deliver more cost-effective and higher-value care to the state's uninsured.

The GPP seeks to improve care to the uninsured by providing GPP funds that can be used to pay for a broad set of services, including non-traditional services and services provided in non-traditional settings. The goal is to provide a flexible payment system that encourages the delivery of high-value services, particularly those in lower-intensity care settings to address the needs of PHCS patients. Progress in strengthening the delivery system for the uninsured over the five-year demonstration will be measured by documenting changes in PHCS infrastructure, staffing, and patient care, as well as changes in the cost and utilization of services.

This report documents findings of the midpoint evaluation of the GPP.

Key Findings

PHCS have built and strengthened primary care, data collection and integration, and care coordination

  • PHCS have adopted a broad set of health system improvement activities: improving data collection and tracking, coordination of care, access to care, staffing, team-based care, and changes to the delivery system.

The majority of PHCS improved the utilization of non-inpatient non-emergent services

  • For non–behavioral health services, use of outpatient non-emergent services, including non-traditional services, increased, while use of emergency room (ER) and inpatient services decreased overall.
  • For behavioral health services, outpatient mental health and substance abuse treatment services decreased, while mental health ER and crisis stabilization services and mental health inpatient service use increased overall.
  • The share of services that were non-traditional increased.

PHCS are putting a strong foundation in place to deliver care for the remaining uninsured

  • Although it is too early to determine whether PHCS are serving greater numbers of uninsured, they reported changing their mixes of services to emphasize providing non-traditional and preventive services to the uninsured.
  • In program year 1, PHCS provided $1.25 billion in uninsured services, a small increase from the prior year. Uninsured costs decreased for nine PHCS and increased for only three.
  • Federal payments to PHCS totaled $1.1 billion during program year 1 and covered 92.0 percent of uninsured uncompensated care costs of PHCS overall, which was an increase from the prior year. Federal payments covered the full cost of uninsured uncompensated care claimed by seven of the 12 PHCS.

Topics

Document Details

Citation

RAND Style Manual
Timbie, Justin W., Jodi L. Liu, Maria DeYoreo, Denise D. Quigley, Mary Ellen Slaughter, Lesley Baseman, and Katherine L. Kahn, Evaluation of the Global Payment Program: Midpoint Report, RAND Corporation, RR-2509-CDHCS, 2018. As of September 8, 2024: https://www.rand.org/pubs/research_reports/RR2509.html
Chicago Manual of Style
Timbie, Justin W., Jodi L. Liu, Maria DeYoreo, Denise D. Quigley, Mary Ellen Slaughter, Lesley Baseman, and Katherine L. Kahn, Evaluation of the Global Payment Program: Midpoint Report. Santa Monica, CA: RAND Corporation, 2018. https://www.rand.org/pubs/research_reports/RR2509.html.
BibTeX RIS

The research described in this report was sponsored by the California Department of Health Care Services and conducted by RAND Health.

This publication is part of the RAND research report series. Research reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND research reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited; linking directly to this product page is encouraged. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial purposes. For information on reprint and reuse permissions, please visit www.rand.org/pubs/permissions.

RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.