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SFHN reports strong first-year PRIME progress; cautions that measures reset and continuous work is needed
Summary
San Francisco Health Network leaders told commissioners the PRIME Medicaid waiver work yielded substantial gains — including tobacco outreach and improved race/ethnicity/language data — and said they expect to receive full year-one payments pending final data, while warning that measures reset July 1 and require further continuous improvement.
San Francisco Health Network leaders presented a year-one PRIME update and a broader True North scorecard, saying the network achieved meaningful results on several measures and is preparing to meet an expanded set of performance requirements.
"So we're actually going to get a 100% of our payments this first year," Dr. Alice Chen, the network's chief medical officer, told commissioners while also cautioning that metrics reset on July 1 and the network must continue to improve to keep payments in future years.
Dr. Chen described PRIME as part of the state's 1115 Medicaid waiver and said the program includes 57 measures across mandatory and optional projects, with 15 measures moving to pay-for-performance this year and 29 new measures coming in the next cycle. She and Roland Pickens, director of the San Francisco Health Network, said the work required deep data mapping and workflow changes across primary care, specialty and behavioral health settings.
As examples of operational results, presenters cited tobacco outreach work that led to more than 1,000 patient calls over six months, a 27 percent contact rate and 41 percent of those contacted accepting counseling; they also described changes to race, ethnicity and language data collection that produced a 54 percent capture rate against a 20 percent target for a specific measure. Pickens emphasized that the decision to move to an enterprise EHR and the department's lean process work are critical to sustaining gains across divisions with varying data maturity.
Commissioners asked how the network will sustain year-one results given added measures and data requirements; presenters said teams have already identified measures at risk, will continue lean training and will rely on the impending enterprise EHR to standardize data collection and reporting. Presenters noted that only 20 of the 49 True North metrics had usable data for the year, and that 16 metrics were on target while 13 were off target, highlighting uneven progress across service lines.
The commission did not take a formal vote on PRIME at the meeting; staff said regular quarterly updates will continue and promised additional collateral on rebranding and scorecards.
