According to the California Health Care Foundation (CHCF) and Edrington Health Consulting (EHC), Medi-Cal plans placing a greater focus on primary care can improve the quality of care and health equity in the Medi-Cal program.
A new study conducted by the 2 organizations found that there is significant variation in primary care spending across the different populations (adult, child, Affordable Care Act optional expansion, and seniors and people with disabilities) and 27 county-specific health plans observed for this study.
The average overall primary care spending percentage among the plans was 11.3%. According to the study, spending across the plans ranged from $8.85 per member per month (PMPM) to $61.24 PMPM, with an average of $28.50 PMPM.
The study also found that health plans that invested a higher percentage in primary care provided a higher quality of care for their members and were associated with higher scores in health plan performance on the National Committee for Quality Assurance (NCQA) Health Insurance Plan Ratings.
The plans that spent more on primary care were also associated with higher Aggregated Quality Factor Scores (AQFS), which include a measure of the health plan’s members who complete primary care services such as well-child visits, receive immunizations, control their diabetes, and receive recommended cancer screenings.
On 9 of the 11 clinical quality measures used to compute the AQFS in the Healthcare Effectiveness Data and Information Set (HEDIS) higher primary care spending percentage was associated with better performance.
The study also examined the relationship between a health plan’s primary care spending and total cost of care (its members’ utilization of acute hospital services or its members’ utilization of the emergency department), and found no association between them. However, the study did reveal an association between a higher primary care spending percentage and higher inpatient utilization for the population of older adults and people with disabilities.
CHCF and ECH stated that this data analysis can help guide efforts to further explore primary care spending in the Medi-Cal population, and encourage health plans to take action to increase primary care utilization and improve health outcomes for their members.
“These efforts take on particular urgency in light of the renewed focus on quality and primary care within Medi-Cal and statewide efforts to measure and promote sustained systemwide investment in primary care and behavioral health,” the study reads. “Better information about the benefits of investing in primary care, along with the best strategies for achieving desired quality, experience, utilization, and cost outcomes, can help guide and inform policy action.”