Promote High Value System Performance

OHCA promotes high value system performance through its work in five focus areas: (1) primary care investment, (2) behavioral health investment, (3) alternative payment model (APM) adoption goals and standards, (4) quality and equity performance and (5) workforce stability. 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. 

Health System Performance Branch Updates#

Alternative Payment Model Standards and Adoption Goals

• The Office of Health Care Affordability has announced its proposed Alternative Payment Model (APM) Standards and Adoption Goal recommendation. 
• Read about the proposed APM recommendation: OHCA Recommendations to Board – Proposed APM Standards and Goal Revised June 2024
• Notice of Publication and Public Meeting- APM Standards and Goal Recommendations 

Workforce Stability Standards 

• The Office has announced its proposed Workforce Stability Standards recommendations. 
• Read about the proposed Workforce Stability Standards: OHCA Recommendation to Board- Proposed Workforce Stability Standards 
• Notice of Publication and Public Meeting- Proposed Workforce Stability Standards Recommendations 

Primary Care Investment Benchmark 

• The Office has announced its proposed Primary Care Investment Benchmark recommendation. 
• Read about the proposed Primary Care Investment Benchmark: OHCA Recommendation to Board- Primary Care Investment Benchmark 
• Notice of Publication and Public Meeting- Proposed Primary Care Investment Benchmark 

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.

Focus Areas#

Primary Care and Behavioral Health Investment  

OHCA is responsible for setting statewide investment benchmarks for primary care and behavioral health, and for monitoring the impact of spending growth targets on health care workforce stability.  

OHCA recently presented draft proposals for a technical definition of primary care, and for statewide primary care investment benchmarks, to the Health Care Affordability Advisory Committee in March 2024. These draft proposals were informed by input from the public Investment and Payment Workgroup. Over the next several months we will revise these proposals based on further stakeholder and public input, in preparation for adoption of a primary care investment benchmark by the Health Care Affordability Board in July 2024.   

OHCA will begin its work to develop a technical definition of behavioral health spending and a behavioral health investment benchmark, with input from the Investment and Payment Workgroup, in summer 2024. 

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. 

Recently, OHCA presented its proposed Alternative Payment Model (APM) Standards and Adoption Goal recommendation to the Health Care Affordability Board. These recommendations have been shaped through extensive discussions within the Investment and Payment Workgroup, sibling departments, as well as feedback from the Health Care Affordability Advisory Committee, the Health Care Affordability Board, and additional stakeholders. After incorporating further input from stakeholders, OHCA will present final APM recommendations to the Health Care Affordability Board for adoption by the end of June. For more information, please refer to the Notice of Publication and Public Meeting regarding the APM Standards and Goal Recommendations. The proposed APM recommendation document is available here. 

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 state sibling 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 

In the area of workforce stability, OHCA has developed a draft set of standards for health care entities to adopt and a set of metrics to monitor the health care workforce over time. These draft standards and metrics were developed in consultation with content experts and a broad range of stakeholders. Draft standards were presented to the Health Care Affordability Advisory Committee for feedback in March 2024, and to the Health Care Affordability Board in April 2024. After incorporating further input from stakeholders and the public, we will adopt final workforce stability standards in consultation with the Board in June 2024.   

Statutes & Regulations#

Primary Care and Behavioral Health Investments

Alternative Payment Models

Quality and Equity Performance

Health Care Workforce Stability