Sep 7, 2018
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.
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.
Changes in PHCS Infrastructure
Changes in Utilization of Health Care Services to the Uninsured
Changes in Payments and Costs During the GPP
How Health Systems Use Strategies and Services to Respond to GPP Incentives
Conclusions and Implications
Supplemental Data Exhibits
California's Global Payment Program (GPP): Final Evaluation Survey
Additional Exhibits Regarding the Association Between Survey-Reported Strategy Use and GPP Outcomes