Six Major California Payers Agree to Join Value-Based Primary Care Initiative

Six Major California Payers Agree to Join Value-Based Primary Care Initiative   by Tim Casey   Six payers have signed a memorandum of understanding (MOU) to become the first members of the California Advanced Primary Care Initiative, a new program intended to expand the use of value-based primary care in the state. The initiative is in its early stages, according to participants in the program who spoke with AIS Health. But the agreement calls for the companies to work together to increase their investment in primary care, contract with providers in value-based arrangements, adopt measures that will be publicly released, and hold practices accountable for meeting benchmarks and reward them for strong performance Initiative marks first ‘voluntary effort’ The six organizations that signed the MOU are CVS Health Corp.’s Aetna; Blue Shield of California; Health Net, LLC, a Centene Corp. subsidiary; Oscar Health, Inc; UnitedHealthcare; and Adelade, a company that works with physician practices to create accountable care organizations (ACOs). They have agreed to work together on the initiative through at least 2025. The initiative is led by the Purchaser Business Group on Health (PBGH) and the Integrated Healthcare Association. Payers have collaborated before on quality improvement and data measurement initiatives, but not to this extent, according to Crystal Eubanks, PGBH’s senior director of care redesign and head of the CQC. “I think what makes this different is this is the first agreement of its kind with these elements in the nation,” Eubanks tells AIS Health. “In other states, the government regulators or the state purchasers told [the payers] they had to do it. This is the first time it was a voluntary effort, that they will do it before ever being required to. Payers applaud initiative “The second piece is it’s implementing it together,” Eubanks continues. The idea is because they share the delivery system, they can’t independently file for pieces of it. We have to come up with the same definitions, the same codes. It’s beyond collaboration. It’s this deeper level of working together and changing their business operations together.” Todd May, M.D., vice president and medical director of Health Net’s commercial business, tells AIS Health that the company has encouraged value-based care in California for several years. However, he writes that “this is a new approach that health plans are aligning around, intended to standardize how we pay primary care practices so that they can provide the best care possible for our members. While we have quality incentives for primary care physicians today, this goes a step further by restructuring how we pay for primary care in the future to achieve the best outcomes for our members.”   From Health Plan Weekly   Subscribers may read the in-depth article online. Learn more about subscribing to AIS Health's publications.