This issue brief from the Insure the Uninsured Project focuses on the role of California’s health insurance marketplace, Covered California, in advancing health care payment and delivery system reform towards value-based payments. The issue brief makes the case that as an “active purchaser”, Covered California can use its contractual leverage with its qualified health plans (QHPs) to drive them towards value-based payments.
Covered California’s contracts with its QHPs already require the health plans to report their quality data, which is published by Covered California as part of the information consumers have available when they choose health plans in the marketplace. The health plans also must agree to promote the “triple aim” (increasing quality, reducing costs, and improving health outcomes), participate in one or more statewide and national collaborative quality initiatives, and report the share of providers participating and consumers served within quality initiatives.
The issue brief discusses potential ways that value-based payments can be implemented by Covered California, including pay-for-performance incentives, requiring medical homes or health homes, bundled payments for certain health care services, and reference pricing. Finally, the issue brief notes that Covered California could align its value-based payment strategies with other large purchasers in California, including the state’s Medicaid program, CalPERS (the state’s public retirement system), the University of California, and a number of larger employers based in California.