It Pays to Meet Pay-for-Performance Metrics

SCVMC earns $53 million by meeting Medi-Cal standards

California’s version of Medicaid, Medi-Cal, offers significant incentives to organizations who reach specific performance metrics. California-based safety net hospital Santa Clara Valley Medical Center found out just how beneficial it is to reach those goals this year when they surpassed 56 of Medi-Cal’s 58 pay-for-performance metrics, earning them roughly $53 million in payments from the California government and contributing to their recent Stage 7 recognition from HIMSS.

SCVMC used Epic to make many improvements to their workflows in order to meet these goals, which included ensuring appropriate treatment for several diseases, improving inpatient quality and readmission rates, and delivering innovative and nontraditional service. “We had to change from a reactive model of care to a proactive model where we identify which patients aren’t meeting the metrics,” said Dr. Jennifer Tong, SCVMC’s CMIO at the time.

One of SCVMC’s greatest accomplishments was reaching the 90th percentile nationally for readmission rates, which is 12.9%. “This is remarkably difficult for safety net hospitals like SCVMC to achieve,” said Dr. Philip Strong, SCVMC’s current CMIO.

Epic community members can read SCVMC’s Success at Seven newsletter here.