The California Department of Health Care Services (DHCS) has released information on a one-time $700 million provider practice transformation program to advance health equity and reduce COVID-19-driven care disparities. The California Medical Association (CMA) heavily advocated for this funding during the budget process. 

The Equity and Practice Transformation (EPT) Payments Program, which was announced last week, will invest in upstream care models and partnerships to address health and wellness by funding practice transformation. DHCS has published guidance for Medi-Cal managed care plans and provider groups interested in the program.

The program’s funds will be allocated in three separate pathways throughout the phases of the program. Currently, applications are only being accepted for the Medi-Cal Managed Care Plan (MCP) Initial Provider Planning Incentive Payments.

​​Medi-Cal Managed​ Care Plan Initial Provider Planning Incentive Payments: $25 million is available over one year to incentivize MCPs to identify and work with small-to medium-sized independent practices using standardized assessment tools as they develop practice transformation plans and applications to the larger EPT Provider Directed Payment Program. Interested small-to medium-sized independent practices (with one to 50 physicians) should contact a contracted MCP if they are interested in this program. Completion of a standardized practice assessment tool, called the pmhCAT, is a required activity for practices. Eligibility guidelines for provider participants can be found on pg. 6 of DHCS’s guidance.  

EPT Provider Directed P​ayment Program: $650 million ($325 million General Fund) is available over five years to support delivery system transformation, specifically targeting primary care practices that provide pediatrics, family medicine, internal medicine, OB/GYN or behavioral health services that are integrated in a primary care setting to Medi-Cal members. $200 million of the $650 million will be dedicated to preparing practices for value-based care. This includes implementing practice infrastructure, such as electronic health record systems, data collection, recording capabilities, improved data exchange, and implementation of care management systems. The web-based application for this program is forthcoming and will be due in Q3 2023.

The Statewide Le​arning Collaborative: $25 million is available over five years to support participants in the Provider Directed Payment Program in implementation of practice transformation activities, sharing and spread of best practices, practice coaching activities, and achievement of stated quality and equity goals.

To align with DHCS’s Comprehensive Quality Strategy and Equity Roadmap, the funds will pay for delivery system transformation payments to primary care practices (pediatrics, family practice, adult medicine, OB/GYN, and behavioral health providers in primary care settings) focused on advancing DCHS’s equity goals outlined in the “50 by 2025: Bold Goals” Initiative, which includes the following:

• Close racial/ethnic disparities in well-child visits and immunizations by 50%
• Close maternity care disparity for Black and Native American persons by 50%
• Improve maternal and adolescent depression screening by 50%
• Improve follow-up for mental health and substance use disorder by 50%
• Ensure all health plans exceed the 50th percentile for all children’s preventive care measures

CMA Physician Services, the practice transformation arm of CMA, has information and resources to help practices apply for and implement these grants. Contact CMA Physician Services at physicianservices@cmadocs.org or visit cmadocs.org/practice-transformation for more information.

Resources

• Payment Process and Procedures Guideline​
• phmCAT Tool