To advance data sharing and the implementation of the Data Exchange Framework (DxF), multiple Medi-Cal Managed Care Plans (MCPs) in California have implemented health information exchange (HIE) incentive programs. In order to meet the goals of the DxF to enable seamless, real-time data sharing in California, provider organizations should be supported in their efforts to exchange data. Direct incentive payment programs are a proven strategy to increase participation in technology system implementation and encourage dedication from key stakeholders to implement data exchange practices that benefit whole-person care.
MCP incentive programs are one tangible method of advancing statewide data sharing in California’s Medi-Cal program. As more MCPs implement incentive programs to meet their DxF obligations related to provider adoption, C4BH will update this page and catalog the varying programs.
| Managed Care Plan | Incentive Program | Details |
| Health Net | HIE Grant Program (2022-2024)
Awarded 23 recipients (10 hospitals, 12 SNFs, and 1 ambulatory clinic), $500K disbursed as of Jan 2024 |
Grant funds available for new HIE connections made in 2024 to increase quality medical record data and encourage HIE connectivity to support the DxF |
| Inland Empire Health Plan | 2024 Global Quality P4P Program – Manifest Medex (MX)
Achievements per Milestone: Milestones 1-3: receive an additional $0.25 to their 2024 Quality PMPM (per member per month). Milestone 4: additional $0.50 to Quality PMPM Milestone 5: reporting measure for 2024 performance year |
Milestone 1: Connect with Manifest Medex (MX)
Milestone 2: Stay connected with MX Milestone 3: Improve data quality – reporting minimum data requirements Milestone 4: Improve data quality – reporting clinical data elements Milestone 5: Improve data quality – behavioral health data elements |
| L.A. Care | One time HIE adoption incentive:
P4P incentives:
|
Tier 1 Measures:
Tier 2 Measures:
|
| Partnership Health Plan | Hospital, Primary Care, and Enhanced Care Management Quality Improvement Programs
Eligible for payments are based on a sliding scale of criteria that the hospital must implement |
Hospitals eligible must:
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| Health Plan of San Joaquin / Mountain Valley Health Plan | HIE Grants Incentive Program: $8.775M
Offered to these connections: – Excel – Basic HIE – Expanded HIE – Enhanced HIE – ADT Data – HEDIS DAV Certification |
Requirements:
– Sign the CalHHS DSA – Sign Health Plan DSA / MOU / BAA as applicable – Data Sharing in various forms depending on connection (Excel template, basic data sharing, expanded data sharing, enhanced data sharing, HEDIS DAV file certification) |
At our August 8th C4BH meeting, we welcomed Dr. Jeff Ribordy, Northwest Region Medical Director from Partnership Health Plan and Saikiran Vodela, Program Manager for Health Information Ecosystems at L.A. Care, to speak on their respective HIE Incentive Programs.
Partnership Health Plan
Partnership Health Plan is working to enhance the quality and efficiency of healthcare services across 24 counties in California, serving 900,000 Medi-Cal members as of July 2024. Through the Hospital Quality Improvement Program (HQIP), substantial financial incentives are offered to hospitals that meet performance targets in areas such as readmissions, clinical quality, and patient safety.
Hospitals are encouraged to perform the following for financial incentive:
- Integrate with a community Health Information Exchange (HIE);
- Facilitate admit, discharge, and transfer (ADT) data using PointClickCare;
- Actively link to one of national HIE networks.
By doing so, organizations are compensated on a sliding scale based on engagement levels with the preferences Partnership has outlined. Additional financial compensation can be received by various Quality Improvement Programs under primary care, enhanced care management (ECM), palliative care, and perinatal care.
L.A. Care
Covering Los Angeles County, L.A. Care encourages its provider networks to be connected to both regional networks, LANES and eConnect, and the national network, PointClickCare. The health plan offers two financial incentives:
- One time HIE adoption incentive of $4.9M to provide necessary seed funding to cover the first year subscription and implementation cost for hospitals, skilled nursing facilities (SNFs), federally qualified health centers (FQHCs), and small or solo providers.
- Pay for Performance (P4P) incentives of $9M per year allocated to hospitals, SNFs, FQHCs, small or solo practices, and independent physician associations.
Milestones that L.A. Care tracks include:
- Sign Data Sharing Agreement (DSA)
- Sign the DxF participation agreement with either LANES or Collective Medical Technology
- Send ADT and Continuity of Care Document (CCD) data to LANES or PointClickCare
- Receive ADT and CCD data from LANES and PointClickCare
If you or your organization has MCP-related incentive information to add to this page, please contact info@connectingforbetter health.com.
