September 30, 2021

Covered California, CalPERS and Purchaser Business Group on Health to Launch Sweeping Quality Improvement Project to Modernize Primary Care for Californians

Covered California and CalPERS Will Pilot a Set of Performance Measures to Emphasize Patient Experience and Outcomes of Care in 2022 Health Plan Contracts to Encourage High-Quality, High-Value Primary Care

Covered California, the California Public Employees’ Retirement System (CalPERS) and the Purchaser Business Group on Health (PBGH) are partnering to launch a pilot program to promote improvement in primary care which will benefit all Californians.

The partnership includes introducing a set of performance measures that reflect a shared standard of Advanced Primary Care as defined by PBGH’s California Quality Collaborative (CQC), a health care improvement program dedicated to helping care teams gain the expertise, infrastructure and tools needed to advance patient-centered care. The measures focused on health outcomes, patient safety and patient experience are designed to encourage high-quality, high-value primary care statewide starting January 2022.

Advanced primary care places patients at the center of every interaction and prioritizes access to high-quality primary care to promote continuity of care and to prevent higher acuity, costlier care which makes for a healthier California.

Purchasers are seeking to transition to an approach that recognizes the outcomes and experience of the care patients receive as a way of identifying high-quality primary care. To support the transition, PBGH’s California Quality Collaborative has defined a set of specific measures to improve the delivery of primary care services through a one-of-a kind multi-stakeholder process that includes input from purchasers, health plans, providers and patients.

“Large employers and public health care purchasers want to know they are paying for high-quality health care,” said Elizabeth Mitchell, President and CEO of PBGH. “We need an approach to primary care that ensures excellent patient outcomes and quality-of-care. This pilot affords us an opportunity to demonstrate that kind of approach can work.”

Covered California provides coverage for 1.6 million Californians and will contract with 12 health plans in 2022. Covered California is piloting the measure set to build on current health plan contract requirements to support advanced primary care, including ensuring all patients have access to a primary care provider and implementing alternative payment models for primary care. Informed by the results of the pilot, Covered California intends to incorporate the measure set into all health plan contracts to increase advanced primary care practices within all health plan networks.

“Raising the bar on the quality of care delivered not only leads to better outcomes for Californians, it also continues our mission to address the underlying costs of care, and making coverage more affordable to everyone,” said Dr. Alice Chen, Covered California’s Chief Medical Officer. “Covered California is committed to going beyond just getting people health care coverage — we want to make sure consumers are getting the quality care they need – and that starts with high-performing primary care.”

CalPERS provides health benefits for 1.5 million California public employees, retirees and their families. CalPERS will pilot the measure set in its 2022 health plan contracts to assess the use of advanced primary care practices by plan networks and providers. This pilot period will inform future requirements for health plans to address the variation in performance of their contracted primary care practices.

“As the largest purchaser of public employee benefits in California, CalPERS has long advocated that patient-centered primary care is vital in the delivery of exceptional health care for our members,” said Dr. Julia Logan, CalPERS Chief Medical Officer. “We look forward to piloting this measure set in our contracts to drive higher quality health care that improves our members’ experience.”

Performance across the suite of measures will allow purchasers and patients to identify practices delivering advanced primary care and strengthen the development and implementation of alternate payment models. Successful incorporation of the measures into Covered California and CalPERS contracts are expected to elevate the standard of primary care in the state of California and provide a model for other large health care purchasers.

Read more about the how CQC defined the standards for advanced primary care here.

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About Covered California

Covered California is the state’s health insurance marketplace, where Californians can find affordable, high-quality insurance from top insurance companies. Covered California is the only place where individuals who qualify can get financial assistance on a sliding scale to reduce premium costs. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Depending on their income, some consumers may qualify for the low-cost or no-cost Medi-Cal program.

Covered California is an independent part of the state government whose job is to make the health insurance marketplace work for California’s consumers. It is overseen by a five-member board appointed by the governor and the Legislature. For more information about Covered California, please visit www.CoveredCA.com.

About CalPERS

For more than eight decades, CalPERS has built retirement and health security for state, school, and public agency members who invest their lifework in public service. Our pension fund serves more than 2 million members in the CalPERS retirement system and administers benefits for more than 1.5 million members and their families in our health program, making us the largest defined-benefit public pension in the U.S. CalPERS’ total fund market value currently stands at approximately $489 billion. For more information, visit www.calpers.ca.gov.

About Purchaser Business Group on Health (PBGH)

PBGH is a nonprofit coalition representing nearly 40 private employers and public entities across the U.S. that collectively spend $100 billion annually purchasing health care services for more than 15 million Americans and their families. In partnership with large employers and other health care purchasers, PBGH initiatives are designed to test innovative operational programs and scale successful approaches that lower health care costs and increase quality across the U.S.

PBGH created the California Quality Collaborative (CQC), a health care improvement program dedicated to helping care teams gain the expertise, infrastructure and tools they need to advance care quality, be patient-centered, improve efficiency and thrive in today’s rapidly changing environment. For more information about CQC, visit www.pbgh.org/program/california-quality-collaborative.