California Health Plan Leaders Unite for the First Time to Launch New Payment Model Demonstration Project to Fortify Primary Care

Statewide Initiative integrates a unified value-based payment model to invest more in primary care, improve care quality and advance health equity across California

/EIN News/ -- Oakland, California, Jan. 30, 2025 (GLOBE NEWSWIRE) -- In an unprecedented collaboration, three leading California health plans — Aetna, Blue Shield of California and Health Net — have united to co-implement a shared value-based payment model under the California Advanced Primary Care Initiative’s Payment Model Demonstration Project. Led by the California Quality Collaborative (CQC) and the Integrated Healthcare Association (IHA), the new payment model will span 11 provider organizations statewide, representing over 100 care sites and a collective patient population of approximately 17,000. The demonstration project prioritized recruitment of small independent practices and will address long-standing disparities in primary care payment, promote health equity, and improve population health in California. It is designed to scale across the state and beyond.

"Participating in this project is crucial for us as a health plan because it aligns with our commitment to promoting healthcare excellence in California," said Todd May, MD, Vice President Medical Director for Commercial at Health Net. "By co-investing in a unified value-based payment model, and providing technical assistance for practice transformation, we’re better supporting primary care practices in ways that can improve patient outcomes. And high-functioning primary care is the foundation of a high-quality and cost-effective health care system.” 

Through the demonstration project, participating health plans will offer  a common value-based payment model, which is designed to invest more revenue into the practices, rewarding improvement and strong performance on the Advanced Primary Care Measure Set. This approach provides flexibility while ensuring a focus on meeting patients' needs with tailored, high-impact care.

CQC is providing comprehensive technical assistance to help participating practices implement the new payment model, integrate behavioral and physical health services, improve care coordination and achieve better patient outcomes. IHA selected Cozeva to serve as the common reporting platform for the initiative. Practices will be able to view data on their patients across plans for actionable insights related to performance to help close care gaps and better manage their patient panels.

“This project marks a significant step forward in our mission to elevate primary care across the delivery system,” said Crystal Eubanks, Executive Director at CQC and Vice President, Care Transformation at the Purchaser Business Group on Health. “Health plans are doing something that’s never been done before — they’re not just aligning payment models but co-implementing a unified one. They’re paying differently and paying more to help primary care practices deliver high-quality care while addressing cost and advancing equity across the state.”

Unlike other states that are working toward payer alignment, these California health plans have taken a step further by fully implementing, coordinating, financing and operationalizing a single payment model. This streamlined approach significantly reduces the administrative burden on practices, allowing them to focus more on care delivery.

"At Blue Shield of California, we believe payers must collaborate boldly on innovative payment models to advance primary care. Done right, this project will help clinicians connect with the joy of practice by aligning payment with what inspired them to pursue medicine in the first place — delivering quality-oriented, data-enabled, patient-centered care,” said Nina Birnbaum, MD, Medical Director, Blue Shield of California.

“This project is an opportunity for payers to collaborate in support of California primary care providers who play a vital role in our members’ care,” said Pegah Mehdizadeh, DO, Executive Director West Region and Chief Medical Officer for Aetna California. “Aetna is committed to partnering with providers on value-based care arrangements like this one that empower and incentivize delivery of high-quality whole-person care and support our goal of helping members achieve better health.”

The demonstration project reflects the growing momentum among California's health care stakeholders to align around a shared vision for advanced primary care that improves patient outcomes and reduces costs. “By designing a common value-based payment model with guaranteed upfront payments and enhanced incentives for performance on disparity-sensitive measures, we’re helping practices focus on what matters most — delivering high-quality, equitable care,” said Dolores Yanagihara, General Manager at IHA.

About California Quality Collaborative (CQC)

The California Quality Collaborative (CQC), a program of the Purchaser Business Group on Health, is dedicated to improving the quality and affordability of health care across California. CQC collaborates with health plans, providers, and purchasers to drive system-wide transformation and promote high-value, patient-centered care.

To learn more, visit www.calquality.org or contact cqcinfo@pbgh.org.

About Integrated Healthcare Association (IHA)

Integrated Healthcare Association (IHA) brings the healthcare community together to solve industry-wide challenges that stand in the way of high-value care. As a non-profit industry association, we use our decades of expertise, objective data, and unique role as a trusted facilitator to make the healthcare system work better for everyone. We provide insights that help the healthcare system continuously improve. We build new tools that simplify how the industry works together. And we provide a forum for cross-industry leaders – through our boards and programs – to have honest conversations that guide the future of healthcare.

For more information, please visit www.iha.org  or contact Ashley Burkett at press@iha.org.

Janet Cabibbo
                    California Quality Collaborative
                    415-615-6344
                    jcabibbo@pbgh.org