Can the California Family PACT program warrant its own Value Based Purchasing/Pay-for-Performance efforts?

The California Department of Health Care Services (DHCS), Office of Family Planning administers the Family PACT program.  The program’s payment system is Fee-For-Service. The State’s Family PACT program is an area where the Department can work closely with providers to maintain safety-net family planning services for those who remain uninsured in California and provide an opportunity to link quality of care and value by controlling cost using a Pay-for-Performance (P4P) design.

The three key components of the P4P model design are: 

• Key Metric:  Contraceptive Use and Pregnancy Intention 

• Infrastructure to Collect Data:  Eligibility and Claims Data

• Incentives:  Two-Part Payment System

The adoption of a quality measure related to contraception and pregnancy intention, using key questions that can be adapted from the California Maternal and Infant Health Assessment study asks questions related to fertility decisions, such as, “I’m not planning a pregnancy in the next year, but plan to get pregnant sometime in the future” and incorporating these questions during annual eligibility determination together with the type of contraception used in claims data reports would support quality of service to payment.  The payment formulary would draw upon experience and planning with Medi-Cal managed care plans and other health plans could support a two-part payment system composed of an upfront annual coordinated-care fee and a financial bonus based on pregnancy intention outcome.  Improving contraceptive use and mistimed pregnancy would improve health outcomes and save millions of dollars in public assistance expenses in the new ACA landscape.