CA Payers Ink Pact to Expand Advanced Primary Care

Health plans pledged to standardize finance, support and metrics for the delivery of advanced primary care.

Six of California's largest health insurance companies have signed a memorandum of understanding to expand investment and improve access to advanced primary care.

The first-of-its-kind California Advanced Primary Care Initiative -- led by California Quality Collaborative, a program of the nonprofit Purchaser Business Group on Health, and the Integrated Healthcare Association -- aims to enable primary care providers to transform to a high-performing, value-based care model that reduces costs and improves quality and equity.

The six payers that signed the MOU -- Aetna, Aledade, Blue Shield of California, Health Net, Oscar, and UnitedHealthcare – have pledged to standardize finance, support and metrics for the delivery of advanced primary care.

"This initiative reflects our understanding that the impact of any one payer alone is limited," says Peter Long, executive vice president of Strategy and Health Solutions at Blue Shield of California. "That’s why Blue Shield is committed to partnering with our peer payers and providers to scale delivery of high-quality primary care across the state. Ultimately, we know this is what is best for our members, and we all must work together to make this vision a reality."

Under the MOU, the payers identified four areas of focus, including:

* Transparency: Report primary care investment and adoption of value-based payment models that support the delivery of advanced primary care and performance on the advanced primary care measure set jointly developed by CQC and IHA.

* Payment: Adopt an agreed upon value-based payment model for primary care providers that offers flexibility, supports team-based care delivery and incentivizes the right care at the right time.

* Investment: Collaboratively set increased primary care investment quantitative goals without increasing the total cost of care.

* Practice Transformation: Provide technical assistance to primary care practices to implement clinical and business models for success in value-based payment models, integration of behavioral health and reduction of disparities.

"Primary care is the heart of all healthcare," says Jeff Hermosillo, California Market President, Aetna. "This innovative initiative will help ensure accessible, affordable and high-quality primary care to improve the well-being of all Californians. Working together with our peers, providers, plan sponsors and members, we are committed to primary care that makes a difference in people's lives."

CQC and IHA have been collaborating since 2019 to develop shared standards of advanced primary care, including common definitions of practice attributes, a performance measure set, methods to identify quality at the practice level and a value-based primary care payment model.