Three California health plans are partnering on a statewide shared value-based payment (VBP) model that will include 10 provider organizations representing over 100 sites of care. The health plans—Aetna, Blue Shield of California, and Health Net—are participating in the California Advanced Primary Care Initiative’s Payment Model Demonstration Project, which is led by the California Quality Collaborative (CQC) and the Integrated Healthcare Association (IHA).
The model was announced on January 30, 2025, and is designed to scale across the state and beyond. The project is prioritizing participation by small independent practices. The goal is to address disparities in primary care payment, promote health equity, and improve population health in California. The shared model is initially anticipated to affect about 17,000 Californians. By adopting a single VBP model, the health plans, CQC, and IHA believe the streamlined approach will reduce the administrative burden of VBP on practices and allow primary care practices and professionals to focus more on care delivery.
The Payment Model Demonstration Project is part of a broader California Advanced Primary Care Initiative to strengthen primary care, described in a memorandum of understanding (MOU) signed by health plans in July 2022. This MOU has four focus areas, all of which are embodied in a demonstration project that launched in January 2025:
- Practice Transformation: The participating health plans will fund technical assistance provided by CQC to primary care practices working to implement clinical and business processes for success in the shared VBP models. The technical assistance will focus on closing care gaps, improving use of patient data, strengthening population health management, adjusting workflows, and achieving targeted goals set by each practice. In a related project, payers will explore shared opportunities to promote clinical models and business processes that help primary care practices provide screening, diagnosis, and treatment for mild-to-moderate behavioral health needs and get reimbursed for those services.
- Investment: The participating health plans will collaboratively set quantitative increased primary care investment goals without increasing the total cost of care.
- Payment: The participating health plans will adopt an agreed-upon VBP model for primary care provider organizations that offers flexibility, supports team-based care delivery, and incentivizes promptly delivering correct care. The VBP model has no downside risk and includes population health payments and incentives for strong performance and improvement on a common Advanced Primary Care (APC) measure set jointly developed by CQC and IHA. The goal is to ensure prospective payments are sufficient to cover the cost of infrastructure changes to support health equity and adjustment for social risk.
- Transparency: The participating health plans will report primary care investment, adoption of value-based payment models that support the delivery of advanced primary care, and performance on the APC measure set. IHA selected Cozeva to serve as the common reporting platform for the initiative and demonstration project. Through Cozeva, the participating practices will be able to view data across plans for actionable insights related to performance to help close care gaps and better manage their panels.
CQC is a program of the Purchaser Business Group on Health. CQC collaborates with health plans, provider organizations, and purchasers to drive system-wide transformation and promote high-value, consumer-centered care.
IHA is a facilitator for solving industry-wide challenges that impede the delivery of high-value care. It provides insights and tools to simplify how the industry works together. It convenes boards and programs for cross-industry leaders to discuss the future of health care.
The full text of the memorandum of understanding was posted on February 5, 2025, by California Quality Collaborative. A free copy is available online at https://www.calquality.org/wp-content/uploads/2025/02/California-Advanced-Primary-Care-Initiative-MOU_Feb2025.pdf (accessed April 3, 2025).
For more information, contact:
- Anna Elgart, Senior Manager of Communications, California Quality Collaborative, Purchaser Business Group on Health, 1611 Telegraph Avenue, Suite 210, Oakland, California 94612; 415-615-6322; Email: aelgart@pbgh.org; https://www.pbgh.org/
- Ashley Burkett, Senior Director, Marketing and Communications, Integrated Healthcare Association, 180 Grand Avenue, Suite 1365, Oakland, California 94612; 510-208-1740; Fax: 510-444-5842; Email: press@iha.org; Website: https://www.iha.org/contact/
August 2025 00US25EUA0023