The California capitated-delegated “model” of physician groups that accept the financial risk and responsibility to provide medically-necessary patient care under an accountable budget is now decades old. With over 180 California-based members, this is the heart of the APG membership. In some respects, the legislative and regulatory structure that our members operate under is becoming increasingly rigid and outdated. Our California advocacy is focused on streamlining quality measurement, simplifying the administrative compliance processes across the multi-payer spectrum, and accelerating the transition from fee-for-service provider payment to capitated, accountable models.
This work involves interaction with the state legislature, regulatory agencies and departments as well as other stakeholders. Our current goals involve expansion of the capitated provider payment model into the 8 million life self-funded employer plan market, improving the performance of our members that serve the 13 million life Medi-Cal system, enabling the Covered California exchange to migrate its coverage plans from fragmented provider networks to integrated health models, and to support the continued expansion of affordable coverage to all California residents.
Most recently, APG advocacy succeeded in the creation of the California Provider Directory Utility – a single online portal that eliminates cumbersome, duplicative administrative compliance activity on the part of our member organizations and increases the accuracy of health plan provider listings, so that Californians will enjoy easier, quicker access to physician services.