Toby Douglas

Mr. Douglas is the chief deputy director of Health Care Programs in the California Department of Health Care Services. He has served as a senior manager for the Medi-Cal program since 2005.  As the administrator of health care programs, he manages a budget of over $37 billion, and a workforce of approximately 1,700 employees.  He is responsible for setting Medi-Cal policy, operation of the Medi-Cal payment systems, operation of the Medi-Cal field offices, and oversight of the Medi-Cal Managed Care program.  Mr. Douglas is also responsible for the Children’s Medical Services and Primary and Rural Health programs.  He plays a major role in formulating the health care program’s benefits and eligibility policies, and is responsible for overall coordination and direction of the healthcare delivery systems for over seven million beneficiaries, almost half of whom are children.   

With the newly created Department of Health Care Services in July 2007, Mr. Douglas served as the Deputy Director of Health Care Programs.  He served as the assistant deputy director for Medical Care Services for the California Department of Health Services since September 2005.  Before joining the State, Mr. Douglas was the deputy director of the San Mateo County Health Department, where he was responsible for the activities related to health access, policy, and planning.  Previously, Mr. Douglas was a research associate at the Urban Institute, a non-partisan, social policy research organization in Washington, DC.  

Mr. Douglas earned a master’s in public health and a master’s in public policy from the University of California, Berkeley.

Practicum Summary

Goal: Develop a strategic plan that transforms Medi-Cal into a value-based system that will lead to better quality, outcomes, and performance of the health care system.

Toby Douglas is working to ensure that both the Medi-Cal fee-for-service and managed care systems use performance incentive strategies to pay for outcomes, invest in prevention, align financing, and encourage providers to effectively use health information technology. With his senior staff, Mr. Douglas identified the California Children’s Services (CCS) program as the first area to implement a value-based approach within Medi-Cal. In collaboration with the CHCS and Professor Michael Porter of the Harvard Business School, Mr. Douglas and his team assessed the viability of incorporating value-based purchasing into various payment systems and are creating a plan for implementing these concepts into the CCS program for specific medical conditions. The strategic planning process is identifying the resources and program changes necessary to implement the value-based system, while engaging key stakeholders in the process. The plan developed for CCS will act as a roadmap for implementing value-based purchasing across the Medi-Cal system.