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San Francisco Health Network outlines plan to implement Medi-Cal waivers, warns data work is central
Summary
San Francisco Health Network staff told the Health Commission they have named project leads and are building data teams to implement statewide Medi-Cal waiver programs (PRIME and the Global Payment Program), but stressed that defining 57 metrics and capturing "nontraditional" visits in electronic records are major challenges.
San Francisco Health Network leaders told the Health Commission that implementing the state—s new Medi-Cal waiver programs will require intensive data work and system changes to capture previously uncounted services.
Hallie Hanna, director of primary care, said the network is preparing to implement PRIME (Public Hospital Redesign and Incentives in Medi-Cal) and the Global Payment Program (GPP). The programs aim to align payment with population-health outcomes rather than volume of visits, Hanna said, and will require the network to report on dozens of new metrics and to claim points for nontraditional services the network previously did not bill for.
Hanna said PRIME includes seven required projects and that the network selected three optional projects for local focus: the Million Hearts cardiovascular initiative, an integrated chronic non-malignant pain program based at a new pain clinic in Anesthesiology at Zuckerberg San Francisco General, and a pharmacy-led project targeting high-cost medications. She said there are 57 PRIME metrics that teams must define, measure and report.
Commissioners pressed staff on how many metrics are predetermined by the state and which require local definitions. Hanna said some measures are standard (for example, HEDIS items), but PRIME often changes denominators (the definition of the population counted) and requires novel data elements that the network does not currently capture in its electronic health records.
The Global Payment Program will use a point system to credit nontraditional encounters, Hanna said. These include documented nurse visits, telephone contacts, health coaching, group visits, home visits and other previously non-billable services. Hanna explained the program—s scoring approach and said outpatient services will receive relatively more points over time as the state emphasizes prevention and primary care.
Hanna named Patrick O as the PRIME project lead, identified Alice Chen as executive sponsor, and said a clinical co-lead, Reena Gupta, will join in July. She described active work to build project teams, data-analytic capacity and standardized EMR documentation to support reporting. Hanna said the network is roughly 94% of the way to a short-term GPP target for primary care measures this year, pending state validation.
Commissioners and staff also discussed workforce implications, with Hanna and commissioners describing training for medical assistants, nurses and health coaches to support team-based care and better chronic disease management. Several commissioners asked for follow-up reports that show the financial and clinical impacts, and requested that the network present an integrated summary of all Medi-Cal waiver elements (PRIME, GPP, whole-person care and dental) in a future full commission update.
The Health Commission did not take formal action on the waivers at this meeting; staff said a more in-depth report on whole-person care and other waiver components will come to the commission in August.
