A wide range of initiatives in California are helping to push toward a greater focus on primary care. Here are some examples:
- The first public report on the Office of Health Care Affordability’s (OHCA) primary care benchmark is expected in Fall 2026, along with assessment of adoption of alternative payment models. OHCA shared a preview of aggregate findings in May with its Investment and Payment Workgroup; payer-specific findings on both primary care spending and adoption of APMs will be included in the Fall 2026report. Payers will be assessed against a statewide primary care investment benchmark of 15% of total medical expense (TME) allocated to primary care for all payers by 2034 and an annual improvement benchmark of 0.5-1 percentage point per year increase in primary care spending as a share of TME for each payer for years 2025-2033.
- In November 2025, CHCF sponsored a statewide convening on primary care investment implementation in collaboration with CalPERS, Covered California, the Department of Health Care Services (DHCS), the Office of Health Care Affordability (OHCA), and Purchasers Business Group on Health (PBGH). The event, Aligning for Impact: A Statewide Convening on Primary Care Investment Implementation, brought together 63 leaders representing health plans, provider organizations, purchasers, and national experts. The convening focused on identifying practical barriers to and actionable strategies for advancing primary care investment across payer types (e.g., commercial, Medi-Cal) in California. A CHCF issue brief, Payer Strategies for Primary Care Investment in California, highlights the key strategies considered and convening takeaways. To help health plans meet California’s primary care investment benchmark of 15% of total medical expenses (TME) by 2034, participants identified three priority levers: contracting approaches, network design and delegation structures, and practice capability and infrastructure support. Across all strategies, participants emphasized that effective implementation should meaningfully increase resources reaching primary care practices, ensure that funds flow to frontline clinical teams, allow participation across diverse practice types and sizes, and support team-based models of care delivery.
- Covered California is now reporting plan-specific data on primary care spending as a share of total medical expenditures, with data available for 2023 and 2024 in the Plan Reported Performance: Delivery System and Payment Strategies Domain. In 2024, median primary care spend across Qualified Health Plans was 4.6%, and primary care spend ranged from 0.36% (Chinese Community Health Plan HMO) to 8.35% (Inland Empire Health Plan HMO). Covered California’s definition of primary care spend aligns with OHCA’s definition, so median primary care spend will need to more than triple over the next 8 years to meet OHCA’s benchmark of 15%.
- Collectively, California’s public purchasers (DHCS, Covered California, and CalPERS) cover almost 45% of Californians, giving them significant influence over the coverage and care – including primary care – received by millions of residents. Clinical leaders from the three purchasers recently collaborated on a CHCF Expert Perspective: How California’s Public Purchasers Are Joining Forces to Strengthen Primary Care.” Among the key factors in the purchasers’ primary care efforts: aligned contracting strategies, accountability mechanisms, and support systems to drive real change while ensuring that providers—especially small and underresourced practices—support and tools needed to meet rising expectations.
- The Health Plan of San Mateo (HPSM), a Medi-Cal managed care plan operating as a county organized health system in the Bay Area, has made a five-year, $60 million commitment to primary care investment – allocating half of the total to capacity building and the other half to payment increases. Revitalizing Primary Care: Health Plan of San Mateo’s Investment Strategy, an issue brief published by the Milbank Memorial Fund, lays out the plan’s approach, including development of strategic pillars, stakeholder engagement, measures of success, and implementation to date.
- The Department of Health Care Access and Information has launched the Health of Primary Care in California Annual Snapshot. The first Snapshot report, a static report compiling data on primary care investment, workforce, access, quality, and equity, is expected in Fall 2026. The initial report will be static, with ongoing development of an interactive report for release in Fall 2027. An introductory brief provides an overview of the effort, which is being informed by a multistakeholder workgroup.
- PBGH has released the Virtual Advanced Primary Care Request for Information 2026, a tool to assess organizations interested in offering Advanced Primary Care services – including virtual-first or digitally enabled models – to PBGH’s employer members. The intent is to maintain consistent expectations across all models of care delivery. RFI builds on the Employer Health Plan Common Purchasing Agreement for Advanced Primary Care, which lays out eight core APC principles.
- First year results from the Department of Health Care Services’ $140 million investment in the Equity and Practice Transformation Payments Program were reported in a recent Health Affairs article. About 200 practices are participating in the initiative, which features flexible technical assistance, aligned payment, and shared measurement and data across health plans. Among the key findings: about two-thirds of participating practices improved on population health management capabilities, and more practices met operational targets for access, continuity, and empanelment. The Population Health Learning Center is serving as the program office for the program, leading the statewide learning collaborative and provision of technical assistance.
- Implementation of a multi-payer value-based payment model focused on primary care, the California Advanced Primary Care Initiative (CAPCI) is underway with about 100 practice participants through 2026. The payment model features three elements: direct services payment, population health payment, and performance incentive payment. Aetna, Blue Shield of California, and Health Net agreed to adopt the shared model in an initiative led by the California Quality Collaborative (CQC) and the Integrated Healthcare Association (IHA). The initiative uses a common reporting platform for all participating practices; a single sign-on for the data associated with all three participating plans simplifies reporting and enables access to updated information on project incentive payments.
- As part of its Future of Medi-Cal Commission, CHCF commissioned five “bold ideas” – one of which focuses on primary care. The Multipayer Primary Care Payment Reform Model would align California’s public purchasers – DHCS, Covered California, and CalPERS – on a shared primary care payment framework with four components: base payment, population health, complex care management, and quality and total cost of care incentives. Adoption of a shared payment framework would reduce fragmentation and complexity for providers if implemented across all purchasers. While much of the proposed model could be implemented under the purchasers’ existing authority, some aspects would require new legislation or federal approval.
- A recent regional market assessment of the Shasta and Lassen Counties in California’s rural north found severe primary care shortages, with significant access challenges and long waits to establish a primary care relationship. Notably, Medi-Cal members in the region often experience better access to primary care than commercially insured residents because of the strong presence of federally qualified health centers (FQHCs). Recognizing this capacity, CalPERS recently announced an agreement with Blue Shield of California and Shasta Community Health Center (SCHC), an FQHC, that expands access to SCHC providers for CalPERS members.
