A Technology Primer on the Public Hospital Redesign & Incentives in Medi-Cal (PRIME) Program

 

The Public Hospital Redesign and Incentives in Medi-Cal (PRIME) program builds on the success of the Delivery System Reform Incentive Payments (DSRIP) program in California. The initiative provides transition incentives for Alternative Payment Models (APMs), with a goal of tying 60% of payments to APMs for designated public hospital participants whereby Medi-Cal managed care beneficiaries receive their primary care.

 

According to CMS, PRIME Projects are designed to:

  1. Establish & improve hospital infrastructure to manage high-cost populations
  2. Expand capacity by enhancing efficiency and reducing unnecessary utilization
  3. Build capabilities to support the transition to value-based purchasing

 

PRIME Technology Strategy

Though the PRIME program is still in its infancy, California’s 17 Designated Public Hospitals (DPHs) and 37 District/Municipal Hospitals (DMPHs) that are participating in the program are reaching out to their technology partners to harness digital solutions already implemented in innovative ways. PRIME requires the DPHs and DMPHs to meet objective goals across 18 total projects, and technology can thankfully help both capture metrics as well as drive behavior changes that improve patient outcomes.

CipherHealth, a patient engagement technology company, has had several discussions with current clients throughout the state regarding the importance of patient engagement and data collection with PRIME. Our first takeaway is that the biggest technological area of need for our providers is focused around preventive care reminders and clinical assessments.

 

Preventative Care Reminders for PRIME

PRIME emphasizes the importance of preventative services and early detection and diagnosis of illness in the outpatient setting. Influenza immunizations, breast cancer screenings, cervical cancer screenings, and colorectal cancer screenings are examples of PRIME metrics in this domain.

Prioritizing preventative health for primary care patients requires the implementation of a systematic outreach strategy to remind paneled patients when they are due for an important screening, immunization, or visit. This type of outreach may not be highly prioritized in the day-to-day operations of a primary care practice.

Thus, most providers are considering preventative care reminder technology to address these care gaps in the primary care setting. For example, through CipherOutreach, reminders can be sent via an automated call and text technology platform  to inform patients that they are due for an important service and ask patients whether they would like to schedule their appointment at that time. The technology also serves as a workflow management software for staff to manage their panel of patients

 

Collecting Clinical Assessments for PRIME

In addition to large scale population outreach, PRIME participants are looking for ways to meet clinical assessment collection goals. The collection of clinical assessments is a critical component of PRIME’s projects, as the emphasis on behavioral health is expanding in the realm of population health.

For instance, Alcohol & Drug Misuse (SBIRT) and Screening for Depression & Follow-up each appear as project metrics over three times within the 18 PRIME projects. Another similar behavioral health metric is Depression Remission at 12 Months as demonstrated by a 12-month PH-9 score of less than 5. The question providers must address is how to collect and analyze these metrics. While the EMR is a strong starting point, robust collection and reporting of data is needed to successfully meet PRIME objectives.

Only a small percentage of patients covered by PRIME will have access to EMR patient portals which have low patient adoption rates. However, patient survey platforms like CipherKiosk provide an efficient and accessible survey that can be used to administer digital assessments at the point of care and report this information in real-time.

 

Readmission Reduction for PRIME

PRIME monitors the all-cause readmission rate in several of its projects. Fortunately, readmission reduction has been a key priority for many organizations since value-based payment modifiers were proposed. Most hospitals around the country, including those in California, are using outreach technology for post-discharge follow up after a hospital stay or ED visit in order to reduce readmissions. Anyone familiar with our story knows that all-cause readmissions has been at the forefront of our work since the company’s founding. Given the adoption of outreach technology, we believe many providers in California are well positioned in this area of PRIME.

 

Conclusion

PRIME has emphasized a new set of challenges and objectives to monitor and to meet. The solutions described above are just some initial examples of how technology can help meet the demands of a landscape shifting to alternative payment models. Nonetheless, early technology adoption is critical to the success of these initiatives, as we have observed with DSRIP and many other programs.

What are you doing to prepare for PRIME?

Elizabeth Lagone, MPH, is the Vice President of Government Programs at CipherHealth. Prior to her current role at CipherHealth, Lagone served as the Primary Care Strategy and Improvement Director for DSRIP Initiatives at One City Health, a subsidiary of NYC Health + Hospitals focused on population health, care management, and implementation of the state’s DSRIP program.