Focusing on Primary Care

For too long, the quality of health care has depended on where patients live, how much money they make, and even the color of their skin.1 In California there are significant health disparities by race and ethnicity, geography, income and education levels, sexual orientation, and gender identity.2 Health care is fragmented and favors treatment over prevention. It doesn’t have to be this way.

Decades of research have shown that increased investments in primary care lead to higher-quality and more equitable care as well as lower costs. Yet the US, on average, spends only about five cents of every health care dollar on primary care, or about one-third of what other high-income countries spend.3

A healthier future for all Californians can be built by reorienting health care back to patients and their relationship with primary care providers, who include physicians, nurse practitioners, and physician assistants that provide comprehensive, generalist care. Primary care providers administer critical first-line care for physical and behavioral health needs. Supported by teams that include community health workers, nurses, behavioral health staff, and others, they help patients diagnose symptoms, prevent disease, manage chronic illness, and overcome social stressors that impact health, such as violence or food insecurity. They also help coordinate care, such as testing and specialist care.

Strengthening primary care means more Californians will have access to a care team in their community who knows them and can advocate for their health in our health care system.

Now a coalition of California health care stakeholders is working to make that happen. Recognizing that changes to our health care system demand partnership, the California Health Care Foundation (CHCF) has brought together public and private health care purchasers, policymakers, analysis and improvement specialists, consumer advocacy organizations, and funders on primary care investment strategies and activities within the Primary Care Investment Coordinating Group of California (PICG). Since spring 2021, this group has worked to:

  • Support California-focused research to inform changes in health care policy and industry practices
  • Identify priorities for measuring, reporting, and assessing the results of primary care spending
  • Align primary care investment activities and efforts across the state

Shared Commitment to Shift Health Care Priorities

Notably, the state’s major health care purchasers who are part of the PICG have committed to advance these shared principles within their organizations, which provide health coverage for millions of Californians. The shared commitment signals a major shift in priorities for health care in California.


PICG Members

Palav Babaria, MD, Chief Quality Officer and Deputy Director of Quality and Population Health Management, California Department of Health Care Services

Rachel Block, Program Officer, Milbank Memorial Fund

Alice Hm. Chen, MD, MPH, Chief Medical Officer, Covered California

Crystal Eubanks, MS, Senior Director, Care Redesign and the California Quality Collaborative, Purchaser Business Group on Health

Julia Logan, MD, Chief Medical Officer, California Public Employees’ Retirement System

Elizabeth Mitchell, President and CEO, Purchaser Business Group on Health

Vishaal Pegany, MPH, MPP, Assistant Secretary, California Health and Human Services Agency

Kathryn E. Phillips, MPH, Senior Program Officer, California Health Care Foundation

Rachel Reid, MD, MS, Physician Policy Researcher, RAND Corporation

Lisa Dulsky Watkins, MD, Director, Multipayer Primary Care Network, Milbank Memorial Fund

Anthony Wright, Executive Director, Health Access California

Dolores Yanagihara, MPH, Vice President, Strategic Initiatives, Integrated Healthcare Association

Staff: Jill Yegian, PhD, Yegian Health Insights, Project Director; Lance Lang, MD, Clinical Advisor

Filling the California Research Gap: New and Upcoming Studies

CHCF commissioned a national scan of how other states are taking action to increase investment in primary care. This can inform California stakeholders as they consider ways to share information on primary care investment and allocate resources to assure high-quality primary care for all.

In addition, CHCF commissioned a series of reports that examine the current level of investment in primary care in California’s commercial health care market as well as in Medi-Cal. This important new research can help direct new investments that measurably improve primary care, with a first-ever comprehensive data set and findings for the state.

Finally, CHCF’s annual health policy poll examined how the health care experiences of insured respondents who report having a primary care provider differ from those of insured respondents without one. Respondents with a primary care provider (compared to those without) reported fewer negative experiences with health care providers, were more likely to engage in healthy behaviors and prioritize preventive care, and were less likely to skip recommended care due to care.


  1. Miranda Dietz et al., Undocumented Californians Projected to Remain the Largest Group of Uninsured in the State in 2022, UC Berkeley Labor Center, April 13, 2021.
  2. Let’s Get Healthy California Task Force Final Report (PDF), State of California, December 19, 2012, 3–4.
  3. Linda McCauley et al., eds., Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care, National Academies Press, 2021.