Members of the Primary Care Investment Coordinating Group (PICG) convened by CHCF have committed to increasing access to high-quality primary care. Implementing wide-reaching change in the state’s massive health care system will take time and partnership. There are several initiatives in California helping to push the industry toward a greater focus on primary care. Here are some examples:
- In California, pending legislation, AB 1130, to create a new Office of Health Care Affordability (OHCA) in California includes a provision to measure, report, and increase primary care spending.
- Blue Shield of California adopted a primary care pay-for-value hybrid payment model (PDF) in 2021, beginning with its preferred provider organization products.
- Focus on primary care and preventive services is a theme in the 2022 Comprehensive Quality Strategy released by the California Department of Health Care Services (DHCS), which manages Medi-Cal (California’s Medicaid program). Additionally, DHCS is planning to launch an alternative payment method for Federally Qualified Health Centers.
- The California Quality Collaborative (CQC), a program of the Purchaser Business Group on Health (PBGH) and the Integrated Healthcare Association (IHA), have been working with system partners since 2019 to develop shared standards of advanced primary care, including common definitions of primary care practice attributes (PDF), a performance measure set (PDF), practice attribution methods, and a value-based hybrid payment model.1
- In 2022, Covered California and CalPERS (California Public Employees’ Retirement System) are requiring contracting health plans to participate in a pilot project conducted by CQC and IHA to measure advanced primary care based on the standard measure set. The results of the pilot will inform future contractual requirements related to primary care.2
- Covered California’s 2023 contract with participating health plans (PDF) includes a requirement to measure and report on primary care payment.3
- Beginning this year, CalPERS is requiring PPOs to match members with primary care providers to improve care quality while reducing care costs.
- Medi-Cal’s CalAIM is a multiyear initiative to move to a whole-person, population-health approach to care delivery. It includes key roles for primary care to help identify and address patients’ needs, including physical, behavioral, and social needs, and connect them to appropriate services.4
- PBGH created the Health Value Index, a set of key performance indicators that reflects the priorities of its large-employer and public-purchaser members in communicating with contracted health plans. The focused measure set includes primary care spending as a percentage of the total cost of care.
- PBGH has incorporated the shared attributes and measure set into its Employer Health Plan Common Purchasing Agreement for Advanced Primary Care (PDF), outlining eight principles that purchasers can incorporate into their contracts with health plans.5
- Advanced Primary Care: Defining a Shared Standard (PDF), Pacific Business Group on Health (PBGH), last modified April 2022; and Advanced Primary Care Measure Set: Alignment with Attributes (PDF), PBGH, accessed February 6, 2022.
- David Raths, “Covered California Health Plans Piloting Advanced Primary Care Measures,” Healthcare Innovation, January 13, 2022.
- Attachment 7 to Covered California 2023-2035 Covered California for Small Business Qualified Health Plan Issuer Contract: Quality, Equity, and Delivery System Transformation Requirements and Improvement Strategy (PDF), Covered California, accessed February 15, 2022; and Alternative Payment Model (APM) Framework, Health Care Payment Learning & Action Network, July 11, 2017.
- “CalAIM: Our Journey to a Healthier California for All,” California Dept. of Health Care Services, accessed February 4, 2022.
- Employer Health Plan Common Purchasing Agreement for Advanced Primary Care (PDF), PBGH, accessed February 4, 2022.