Promote High Value System Performance
focus areas for promoting high value
OHCA promotes high value system performance through its work in five focus areas. Across all these areas, the goal is to reorient the health care system towards greater value, with the vision of creating a sustainable health care system that provides high-quality, equitable care to all Californians.
Primary Care Investment
- Define, measure and report on primary care spending
- Establish a benchmark for primary care investment
Behavioral Health Investment
- Define, measure, and report on behavioral health spending
- Establish a benchmark for behavioral health investment
APM Adoption
- Define, measure, and report on alternative payment model adoption
- Set standards for APMs to be used during contracting
- Establish APM adoption goals
Quality and Equity Performance
- Develop, adopt, and report performance on a single set of quality and health equity measures
Workforce Stability
- Develop and adopt standards to advance the stability of the health care workforce
- Monitor and report on workforce stability metrics
Recent Updates
Primary Care Investment Benchmark
- The Health Care Affordability Board approved primary care investment benchmarks in October 2024.
- Read about the OHCA Primary Care Investment Benchmark.
Alternative Payment Model Standards
- The Health Care Affordability Board approved Alternative Payment Model (APM) Standards and Adoption Goals in June 2024.
- Read about the OHCA APM Standards and Adoption Goals.
Expanded Non-Claims Payments Framework
- Read about the Expanded Non-Claims Payments Framework.
Workforce Stability Standards
- The Office adopted its initial set of Workforce Stability Standards in June 2024.
- Read about the OHCA Workforce Stability Standards.
OHCA Investment and Payment Workgroup
Health care experts and stakeholders participate in this monthly meeting to support the development of alternative payment model, primary care, and behavioral health standards and benchmarks.
Cost-Reducing Strategies
OHCA has collected examples of cost-reducing strategies that health plans, hospitals, and physician organizations are implementing to reduce cost while maintaining or improving quality in their care delivery systems.
Progress in Focus Areas
Primary Care and Behavioral Health Investment
OHCA is responsible for setting statewide investment benchmarks for primary care and behavioral health as a percent of total health care spending.
The Health Care Affordability Board approved primary care investment benchmarks in October 2024. These benchmarks, and the primary care spending definition, were developed with extensive input from the Investment and Payment Work Group, sibling state departments, the Health Care Affordability Advisory Committee, the Health Care Affordability Board, and public commenters.
OHCA began its work to develop a technical definition of behavioral health spending and a recommended behavioral health investment benchmark, with input from the Investment and Payment Workgroup, in July 2024 and plans to present a proposed behavioral health investment benchmark to the Health Care Affordability Board in spring 2025.
Alternative Payment Model Adoption
OHCA establishes a statewide goal for the adoption of alternative payment models (APMs) and monitors progress towards those goals. Additionally, OHCA is tasked with developing definitions and standards to support the adoption of APMs.
The Health Care Affordability Board approved Alternative Payment Model (APM) Standards and Adoption Goals in June 2024 to promote increased APM adoption. These standards and goals have been shaped through extensive discussions within the Investment and Payment Workgroup, sibling state departments, as well as feedback from the Health Care Affordability Advisory Committee, the Health Care Affordability Board, and additional stakeholders.
Over the next several months, OHCA will focus on data collection requirements and guidance for purposes of measuring progress towards the APM Adoption Goals.
Quality and Equity Performance
OHCA is responsible for developing, adopting, and reporting performance on a single set of measures for evaluating health care quality and equity across various health care entities. OHCA will align with existing quality and equity measurement programs across the California health care system. In Spring 2024, OHCA will begin gathering feedback on its proposal for quality and equity performance from sibling state departments and other partners and interested parties.
OHCA is also responsible for evaluating potential equity and quality adjustments that can be applied to the spending target or the health care entity’s performance against the target. OHCA is currently reviewing data on social drivers of health and methods for estimating payers’ and providers’ share of patients with higher levels of social risk as well as existing methods used nationwide for equity and quality adjustments.
Workforce Stability
OHCA is charged with monitoring the effects of cost targets on health care workforce stability, high-quality jobs, and training needs of health care workers, with the goal that workforce shortages do not undermine health care affordability, access, quality, equity and culturally and linguistically competent care. To achieve workforce stability in the context of spending targets, in June 2024, OHCA adopted its Workforce Stability Standards.
Over the next several months, OHCA will focus on exploring additional data collection opportunities and planning for future workforce stability reporting. OHCA will update the Health Care Affordability Advisory Committee and Board in Fall 2024 on its progress.