The Global Payment Program (GPP) seeks to improve health care for California's uninsured by using federal funds to make prospective payments to public health care systems for providing inpatient, outpatient, and nontraditional services. This report presents the final evaluation of the program. Through the GPP, public health care systems have put in place a variety of strategies and offered a wider range of services during its first three years.

Evaluation of California's Global Payment Program

Final Report

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

ResearchPublished Aug 22, 2019

There are approximately 2.8 million remaining uninsured individuals in California and they often have limited access to cost-effective preventive care and mental health services. To address this issue, 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. California developed a system of points to provide a value for each service and to track service use relative to each PHCS's budget. 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.

This report documents findings of the final evaluation of the GPP. Through the GPP, PHCSs have put in place a variety of strategies and offered a wider range of services to improve care for the uninsured in California. Utilization of outpatient, non-emergency services increased over the three-year period, while emergency room services and inpatient days decreased. Non-traditional service utilization increased in different ways across PHCSs, indicating that the PHCSs were able to tailor their services to the needs of their patient populations.

Key Takeaways

PHCSs have strengthened infrastructure to support the goals of the GPP

  • PHCSs implemented broad health system improvement strategies to further GPP goals and changed their provision of services, suggesting that the GPP is a foundation for improving care for the uninsured.
  • As PHCSs gained familiarity with the GPP, they appear to be individualizing the services they provide to their own settings.
  • PHCSs indicated that the strategies they are adopting to build their infrastructures and the services they are delivering are having a positive impact on GPP outcomes.

PHCSs are prioritizing expanded use of outpatient and non-traditional services

  • The number of points earned for outpatient non-emergent services increased by 12 percent, points for inpatient medical and surgical services decreased by 15 percent, and points earned for ER visits decreased by 14 percent.
  • The use of non-traditional services as a share of all outpatient and residential services increased from 12.9 percent to 17.3 percent — a 4.4-percentage point increase. Use of non-traditional services was concentrated in a small number of services (particularly Registered Nurse–only visits, eConsults, and case management) but increased slightly overall.
  • Use of all outpatient mental health and substance use services decreased and inpatient behavioral health utilization increased. Despite these unexpected trends, there were favorable reductions in the use of mental health emergency room and crisis stabilization services.
  • Uninsured costs increased from the baseline year to year 1, but then decreased slightly between year 1 and year 2. Per capita uninsured costs increased slightly between year 1 and year 2.

Topics

Document Details

Citation

Chicago Manual of Style

Timbie, Justin W., Maria DeYoreo, Jodi L. Liu, Denise D. Quigley, Lesley Baseman, Mary Ellen Slaughter, Alina I. Palimaru, and Katherine L. Kahn, Evaluation of California's Global Payment Program: Final Report. Santa Monica, CA: RAND Corporation, 2019. https://www.rand.org/pubs/research_reports/RR3080.html.
BibTeX RIS

The research described in this report was sponsored by the California Department of Health Care Services and conducted with the Payment, Cost, and Coverage Program within RAND Health Care.

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.