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Covered California Takes Lead in Value-Based Care, Votes to Ban Outlier Hospitals
AIS Health

The board of Covered California on April 7 approved a measure requiring participating health insurers to identify and exclude poorly performing hospitals from their networks by 2019. Experts say this is a “leading policy” that indicates where the industry is headed in its drive to cut cost and improve quality.

In Attachment 7 to Covered California’s contract with Qualified Health Plans, insurers will be required to work with the exchange “to identify areas of ‘outlier poor performance’ based on variation analysis. As part of this process, Covered California will engage experts in quality and cost variation and shall consult with Providers throughout California.”

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