Moving Forward with Primary Care

A new focus on increasing primary care investment is taking root in California. The Primary Care Investment Coordinating Group of California (PICG) brings together public and private health care purchasers, policymakers, analysis and improvement specialists, consumer advocacy organizations, and funders on primary care investment strategies and activities. PICG members share the goal of promoting greater investments in primary care, standardizing payment models for broader health care system impact, and sharing data to spur accountability for improved patient health.

Notably, the state’s major health care purchasers who are part of the PICG have committed to advance these shared principles and recommend actions within their organizations, which provide health coverage for millions of Californians. For more background on the formation of the PICG and its guiding principles and recommended actions, download the fact sheet below.

Guiding Principles

• Access to high-quality primary care is critical for improving population health outcomes, reducing disparities, and slowing health care cost growth in California.
• Primary care is underresourced and requires greater investment.
• Payment for primary care should be sufficient to support the adoption and maintenance of advanced primary care attributes, including the ability to assess and address patients’ behavioral health and social needs.
• Payment for primary care should shift away from volume (fee-for-service) and toward value (prospective, outcome-based, population-based).
• Multipayer alignment on primary care investment, measurement, and value-based payment are essential to strengthening primary care in California.

Recommended Actions

1. Measure and report primary care spending. All payers should participate in measurement and public reporting on the percentage of total medical expenditures spent on primary care. Measurement of primary care spending, including non-claims spending, should be standardized to the extent feasible.
2. Set a target. A floor and/or target for primary care spending as a percentage of total medical care expenditures should be set to stimulate adequate investment in primary care services by all payers and plans.
3. Pay for advanced primary care. All payers should adopt payment models that support advanced primary care. Based on evidence of impact and aligning with the National Academies of Sciences, Engineering, and Medicine (NASEM) recommendations, priority should be given to models that include three components: payment for direct patient care using a mix of risk-adjusted capitation and fee-for-service, population-based payment to support population health management, and performance-based payment based on common measures.
4. Establish purchaser requirements. All purchasers should evaluate benefit design and provider networks, and incorporate contractual requirements such as primary care provider selection and matching, with the goal of creating and communicating a primary care–centric delivery system.
5. Track progress. The impact of increased primary care spending should be measured. California stakeholders should assemble, regularly compile, and disseminate an implementation scorecard to track progress and report on impact.

An example of PICG members taking the initiative on the Recommended Actions is evident in California Public Purchaser Contract Provisions on Primary Care: Multi-Payer Alignment Drives Investment (available as a Document Download below). California’s largest public purchasers collectively negotiate contracts with health plans to provide care to over 18 million Californians. Recent efforts to strengthen and align contract provisions related to primary care measurement, reporting, payment, and investment have resulted in virtually identical contract language in several key areas — representing tangible progress on Recommended Actions 1–4.