PRIMEd for Innovation: California’s Public Hospitals Work to Improve Quality and Health Outcomes

Since 2015, Harbage Consulting has supported the California Department of Health Care Services (DHCS) with the planning and execution of Learning Collaboratives for California’s Public Hospital Redesign and Incentives in Medi-Cal (PRIME) Program. The hospitals and health systems participating in PRIME (PRIME entities) are working to maximize health care value by using evidence-based quality improvement methods and preparing to take on risk through alternative payment models by 2020. The PRIME program is part of the Medi-Cal 2020 Section 1115 waiver and is authorized through December 31, 2020.

Like other Delivery System Reform Incentive Payment (DSRIP) programs, PRIME is rooted in a “pay for performance” model, where health systems selected from 19 clinical projects – like patient safety, ambulatory care redesign, non-malignant pain management, and improving peri-natal care –  and are now responsible for reporting on a series of detailed performance metrics related to the projects.  Their success in achieving the goals and outcomes for the projects governs the amount of federal Medicaid funding they receive.

PRIMEd Learning Collaboratives

The PRIMEd Learning Collaboratives are designed to provide the 52 PRIME entities with technical assistance and shared learning opportunities that help them achieve their goals. In addition, Harbage Consulting has assisted DHCS by hosting several in-person convenings for the 200 health system staff that are responsible for PRIME.

The first round of conferences, held in the spring and fall of 2017, focused largely on implementation planning and strategies for effective patient engagement. The 2018 PRIMEd Learning Collaboratives Conference focused on quality improvement (QI), in alignment with the overarching theme of the learning collaborative activities for the year.

The conference included a variety of formats tailored to meet the interests of participants.  We offered individualized office-hour sessions with DHCS and national subject-matter experts in quality improvement, health disparities, maternal and child health, and tobacco cessation, and convened additional topic-specific workgroup discussions around mental health, obesity prevention, and care transitions.

Some of the topics discussed during the pre-conference activities included:

• Increasing exclusive breast milk feeding rates among African American mothers;

• Addressing the rise of vaping in communities;

• Developing partnerships in the community;

• Optimizing real-time data collection; and

• Improving performance on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) questions related to transitions of care.

2018 PRIMEd Conference Highlights

Highlights from the full-day conference include:

• Donald Goldmann, MD, Chief Scientific Officer, Emeritus, and Senior Fellow at the Institute for Healthcare Improvement presented on strategies to implement, scale up, and sustain evidence-based initiatives, inspiring attendees to address their QI projects with a new mindset.

• Marlies Perez, Chief of the DHCS Substance Use Disorder Compliance Division described the state's approach to combatting the opioid epidemic in California and encouraged the PRIME entities to leverage the new opportunities available through California’s MAT Expansion project to increase access and availability to substance use treatment.

• Leaders from delivery system transformation programs in New York, Massachusetts, and California shared their experiences and lessons learned regarding the transition to value-based purchasing and integrating quality improvement efforts into their organizations’ operations and cultures over time.

• During breakout sessions, the PRIME Entities presented on specific QI efforts around the following topics:

  • Effectively communicating data to internal and external partners;

  • Best practices for integrating QI into hospital workflows;

  • Identifying health disparities and achieving health equity;

  • Quality improvement and innovations in care delivery; and

  • Implementing strategies for obesity prevention.

• After a day of focused learning, the conference concluded with an inspirational panel, focused on patient empowerment, led by Rohan Radhakrishna, MD, Chair of Family and Adult Medicine at Contra Costa Health Services. Dr. Radhakrishna and his staff spoke to the importance of empowering patients to engage in and take control of their care.

The conference left the PRIME entities with a more complete understanding of the return on investment that quality improvement efforts can yield more broadly and in the context of PRIME specifically — including how to identify what successful QI projects look like, how to sustain QI efforts, and how to assess the impact they can have on clients and the health care system as a whole.  Stay tuned for additional resources on how PRIME is progressing in 2019.

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Authors

Lucy Pagel [Director]

Megan Thomas [Managing Principal]