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Research Questions

  1. Did the GPP allow PHCS to build or strengthen primary care, data collection and integration, and care coordination to deliver care to the remaining uninsured?
  2. Across the majority of PHCS, did the utilization of non-inpatient non-emergent services increase?

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.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Changes in PHCS Infrastructure and Care Processes

  • Chapter Three

    Changes in Utilization of Health Care Services

  • Chapter Four

    The Foundation to Deliver Care to the Remaining Uninsured: Changes in Uninsured Served, Payments, and Costs During the GPP

  • Chapter Five

    The Foundation to Deliver Care to the Remaining Uninsured: Perspectives from the Participating PHCS

  • Chapter Six

    Conclusion

  • Appendix A

    Evaluation Methods

  • Appendix B

    Supplemental Data Exhibits

  • Appendix C

    California's GPP: Midpoint Evaluation Survey

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

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

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