California Health Care Coverage Initiative (HCCI) - Bridge to Reform

Program Location: 
Sacramento, CA
Payer Type: 
California Medicaid

Reported Outcomes


The medical home is a central component of California's proposed delivery system reform efforts under the Section 1115 Waiver proposal. California envisions that, by 2014, it will significantly expand access to medical homes and care coordination to populations that are currently served in the unmanaged fee-for-service system. Members will choose a single provider or community health center to serve as their medical home provider who will be responsible for providing and coordinating care. The medical home provider will offer care management and member supports including disease and medical management and community-based care coordination.

The existing Bridge to Reform 1115 Waiver expires on October 31, 2015. DHCS will seek approval of the new Waiver by November 2015.

Payment Model: 

California seeks the opportunity to pilot methods of incorporating value based purchasing into safety net provider-based coverage through the Health Care Coverage Initiative (HCCIs). The State will develop methods of creating incentives for providers to improve process and health outcomes; patient and provider satisfaction; and greater integration and efficiencies. The value-based purchasing component will be developed and implemented by the end of waiver year 1.

Fewer ED / Hospital Visits: 

Health Affairs (July 2015) evaluation of 49,000 program enrollees in Orange County from 2007-2010

  • among enrollees who saw their assigned primary care providers:
    • percentage of patients with 2 or more annual ED visits decreased from 4.11% (before intervention)  to 3.13% (after intervention)
    • percentage of patients with 2 or more annual hospitalizations decreased from 1.37% to 1.17%
    • had a 2.1% higher probability of NO ED visits
    • had a 1.7% higher probability of NO hospitalizations
Improved Access: 

Health Affairs (July 2015) evaluation of 49,000 program enrollees in Orange County from 2007-2010

  • enrollees were much more adherent to their designated primary care providers after intervention (69.6% vs. 31.4%)
  • after the program intervention, enrollees had a 41.8% higher probability of always seeing the same primary care provider
Other Outcomes: 
  • DPHs achieved 97 percent of 3,764 milestones across all projects
Last updated April 2019
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