California provider and five health plans adopt value-based primary care coalition

Photo: The Good Brigade/Getty Images

The Purchaser Business Group on Health has announced a new primary care agreement with five large payer organizations and with a provider serving California.

Aledade, a physician-led ACO, and insurers Aetna, Blue Shield of California, Health Net, Oscar and UnitedHealthcare have signed a memorandum of understanding in the California Advanced Primary Care Initiative. 

They have agreed to increase investment in and access to a value-based advanced primary care model that emphasizes comprehensive, person-focused care, integration of behavioral and physical health services and high-quality outcomes.

While providers have a choice whether to go with the value-based contracts, the payer alignment means there may be less options for non-value-based contracts. The alignment is intended to make it easier for providers to be more successful in value-based contracts and to make it more attractive for providers to choose this path, given the mutual financial sustainability among providers and plans, according to the Purchaser Business Group on Health.

The California Advanced Primary Care Initiative is jointly led by California Quality Collaborative, a program of the nonprofit coalition Purchaser Business Group on Health, and the Integrated Healthcare Association. Both convened the state's largest payers to collectively adopt a model to transform primary care statewide.

WHY THIS MATTERS

The initiative adopts an agreed-upon payment model for primary care providers. 

It standardizes the way payers finance, support and measure the delivery of advanced primary care through the adoption of a measure set jointly developed by the California Quality Collaborative and the Integrated Healthcare Association. The list of metrics enable purchasers, health plans and providers to identify primary care practices in a given market that are delivering the best results for patients, according to the Purchaser Business Group on Health.

The initiative also provides 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.

The collaboration is aimed at enabling primary care practices to transform to a high-performing, value-based care model that reduces costs and improves quality and equity. The organizations set increased primary care investment quantitative goals without increasing the total cost of care.

THE LARGER TREND

The announcement in the new primary care model comes on the heels of Amazon's $3.9 billion acquisition of One Medical and other recent investments in primary care by CVS, Walgreens and Walmart.

In June, the Department of Health and Human Services launched a $1 million primary care challenge to improve health outcomes by linking primary care to community supports that address inequities and the social determinants of health.

Primary care is a lever for better outcomes and decreased health inequities, according to Dr. Wayne Altman, chair of the Department of Family Medicine at Tufts Medical School.

However, primary care offices have struggled to remain open, he said in June, due to a shrinking workforce pipeline and declines in visits to PCPs and payment reimbursement. Altman said he believed current fee-for-service payments need to move towards models that better support independent practices, including the integration of behavioral health, which is not paid through a fee-for-service model.

The California Quality Collaborative and the Integrated Healthcare Association have been collaborating since 2019 to develop shared standards of advanced primary care. 

The Purchaser Business Group on Health is a nonprofit coalition representing nearly 40 private employers and public entities across the U.S. that collectively spend $350 billion annually purchasing healthcare services for more than 21 million Americans and their families. 

 ON THE RECORD

"This initiative reflects our understanding that the impact of any one payer alone is limited," said Peter Long, executive vice president of Strategy and Health Solutions for 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."

"As a practicing primary care doctor, I am especially heartened by the opportunity to better integrate behavioral and physical health, a key strategy for effectively addressing our behavioral health crisis." says Dr. Todd May, vice president and medical director of Health Net's commercial business.

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org