Online Program

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

Tuesday, November 3, 2015

Mari Taylan-Arcoleo, MPH, California Department of Health Care Services/ Office of Family Planning, Office of Family Planning, Sacramento, CA
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.

Learning Areas:

Administration, management, leadership
Provision of health care to the public

Learning Objectives:
Describe a Pay-For-Performance (P4P) concept/model for California's Family Planning, Access, Care and Treatment (Family PACT) program. Identify key components of the Family PACT program P4P model.

Keyword(s): Health Care Costs

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a graduate of the California DHCS Leadership Academy training program which focus on building skills in policy and fiscal analysis and measuring performance. I have presented this concept payment strategy as my Leadership project to Executive and Program staff. I have been with Office of Family Planning for over 18 years administering both prevention and clinical programs. My scientific interest and training are in health program planning, evaluation and policy development.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.