Primary Care Spending Linked to Care Quality, Plan Ratings

Plans that spend more for primary care are more likely to get better ratings from NCQA.

A first-of-its-kind study involving 5.4 million Medi-Cal managed care enrollees -- nearly half of the state’s Medicaid plan members – links higher spending for primary care with better care quality, patient experience, and plan ratings.

"Increasing emphasis on primary care in Medi-Cal is essential to improving health and well-being and reducing health disparities," says Kathryn E. Phillips, senior program officer at the California Health Care Foundation, which commissioned the study. "This study provides an important baseline for understanding how greater investment in primary care can improve performance."

The study by Edrington Health Consulting found that plans that spent more for primary care were more likely to get a better rating from the National Committee for Quality Assurance. The study examined 13 Medi-Cal managed care plans and found wide variation in primary care spending, from $8.85 to $61.24 per member per month, or roughly 11% of healthcare dollars spent on primary care, with a range from 5% to 19%. 

When specific quality metrics were studied, plans with a higher percentage of spending on primary care performed better on nine of 11 measures. Three of these measures met criteria for statistical significance and align with state priorities: receipt of recommended cancer screenings and two measures of management of medications for depression.

The findings come just weeks after California established a new Office of Health Care Affordability to measure and promote a greater role for primary care in the state's healthcare delivery system.

Beginning in 2024, the California Department of Health Care Services will require all Medi-Cal managed care plans to report on primary care expenditures for the plan's more than 10.8 million enrollees.

"DHCS is committed to reducing the stark racial and ethnic disparities in access to primary care. These include maternity outcomes and children's preventive services, as well as improving maternal and adolescent depression screenings," says Palav Babaria, MD, CQO CDHCS. "This study will serve as a benchmark among Medi-Cal managed care plans as we seek to achieve these and other bold goals."