Investing in Primary Care: Why it Matters for Californians with Medi-Cal Coverage

Primary care is the only component of health care for which an increased supply is associated with better population health, longer lives, and improved health equity. Yet until now, few data were available on the level of primary care investment within Medi-Cal, the state’s health program for Californians with low incomes, which covers more than 13.4 million Californians, the vast majority of whom are people of color.

This first-of-its-kind study examines primary care spending by 13 Medi-Cal managed care plans in California, for 5.4 million members, and finds that greater investment in primary care is associated with better quality of care and a higher plan rating.

Given that Medi-Cal provided coverage for about one-third of Latinx Californians and 28% of Black Californians in 2019, the study points to an important opportunity to improve care quality in the Medi-Cal program and health equity for Californians through greater emphasis on primary care. Medi-Cal care quality remained stagnant at best in the decade leading up to 2019. A focus on primary care is an opportunity to move these measures in the right direction.

Key Findings

• The level of investment in primary care — defined as the percentage of a health plan’s overall spending dedicated to primary care services — varied widely among the 13 Medi-Cal managed care plans that participated in the study, with a low of 5% to a high of 19%. The average was roughly 11%.
• A significant statistical relationship was observed between plans with higher primary care spending percentages and those that scored higher on the Aggregated Quality Factor Score, a composite measure of overall care quality, which includes the percentage of plan members who complete well-child visits, receive immunizations, have control of their diabetes, and receive recommended cancer screenings, among other measures.
• When individual measures of quality were studied, a relationship was found between plans with a higher percentage of spending on primary care and better performance on 9 of 11 measures. Three of these measures met criteria for statistical significance.
• Plans that spend a higher percentage on primary care were more likely to get a better plan rating from the National Committee for Quality Assurance. NCQA evaluates health plans on the quality of care patients receive, measures of patient experience, and health plans’ efforts to keep improving.

The study was conducted by Edrington Consulting, Health Management Associates with support from the California Health Care Foundation.

This publication is part of a CHCF series on primary care investment in California. Learn more at the Primary Care Matters Resource Center.