​California is in the midst of promoting value-based care in its public hospitals under a Section 1115 Medicaid Waiver called Public Hospital Redesign and Incentives in Medi-Cal (PRIME), a waiver overseen by California’s Department of Health Care Services (DHCS). PRIME requires public hospitals to significantly transform their outpatient care delivery, intensify efforts to manage high-risk or high-cost populations, and promote efficient use of resources in outpatient and inpatient settings with the ultimate goals of better care, better health, and lower costs for Medi-Cal and statewide. A total of 54 public hospitals across California have participated in PRIME and have collectively implemented as many as 18 projects and reported on a total of 103  performance metrics.

The interim evaluation of PRIME led by Center’s Associate Director Nadereh Pourat has examined how PRIME projects were implemented by participating hospitals, the challenges they encountered and strategies they used to overcome them, and early outcomes of their efforts. Overall, the results indicated establishment of needed infrastructures such as health information technology and protocols, delivery of care according to evidence-based guidelines, and regular monitoring of efforts to ensure these efforts led to the desired results. Examples of better care outcomes included increased screening for depression and follow up, tobacco assessment and counseling, colorectal cancer screening, and high blood pressure screening and follow up. Examples of improvements in better health included increased number of patients with hypertension control, reduced number of patients whose diabetes was not under control.