Looking back on 2024, we’re proud of the strides we’ve made to advance data sharing, payment innovation, and behavioral health—particularly as they collectively apply to primary care, the backbone of high-quality health care.

Access to primary care leads to better health outcomes. Trusted and consistent patient-provider relationships support fewer days hospitalized, fewer preventable hospital admissions, fewer in-hospital deaths, and lower total costs. Yet, primary care is in crisis. Nearly 100 million Americans, about a third of the population, do not have ongoing access to this form of care. 

In the past year, we’ve launched pilot programs, influenced policy, and driven awareness to achieve both incremental progress and proof-of-concept milestones, making affordable, effective care more accessible across California. Here's a closer look at how these initiatives are reshaping health care and setting the foundation for future advancements.

Pioneering a Multi-Payer Pilot Program for Primary Care

Blue Shield is one of the foundational contributors to and leaders of the California Advanced Primary Care Initiative, run by Purchaser Business Group on Health’s (PBGH) California Quality Collaborative (CQC) and the Integrated Healthcare Association’s (IHA). The goal of this work is to achieve a high-performing, value-based care model that reduces costs and improves quality and equity in primary care.   This collaborative effort has focused on quality measures and payment models to help optimize primary care providers’ expertise and impact. This year, we have moved from research to the implementation of a groundbreaking pilot involving 12 primary care practices and three payers covering thousands of lives. 

This pilot, to be rolled out in 2025, is unique in that practices will operate under a unified set of quality measures and incentives, fostering consistency and shared goals. Through a common dashboard, participants will be able to access data from all payers in one place, reducing administrative burden while empowering practices to focus on delivering quality care.—a first in advanced primary care pilots nationwide. 

Elevating Industry Alignment In the State and Across the Nation

This year, we had the privilege of presenting our work at several esteemed forums, influencing policy, and sharing these important initiatives and perspectives through multiple op-eds. Here are some of the biggest milestones we’ve achieved:

  • Driving industry-wide value-based care payment models: Blue Shield continued to participate in the Health Care Transformation Task Force (Task Force), a coalition of top payers, providers, purchasers, and patient organizations committed to achieving 75% of their respective business in value-based payment models by the end of 2025. This appointment strengthens Blue Shield’s leadership in value-based payment innovation, particularly in supporting primary care.

  • Underscoring the link between data and value-based care: At ViVE 2024, we joined industry peers on a panel focused on highlighting synergies between primary care in the commercial and Medi-Cal spaces. The conversation, featuring health equity leaders, focused on leveraging data to unlock financial success in value-based care, emphasizing the role of trust between payers and providers in achieving these goals. 

  • Engagement with the National Academies of Sciences, Engineering, and Medicine (NASEM) Standing Committee on Primary Care: Blue Shield shared its primary care insights and experiences with NASEM, helping highlight the importance of robust primary care in improving health care outcomes and reducing overall spending. Watch the full video to hear from speakers across the nation as they discuss the challenges and opportunities in advancing federal primary care policy. 

  • Meetings with key policymakers: Our team, alongside Blue Shield leaders, engages with key policymakers– including members of the House Ways & Means Committee, Congressman Ami Bera’s office, and Senators Whitehouse and Cassidy–to advocate for primary care investment and payment reform, with a focus on supporting independent practices.

  • Advising California’s Office of Health Care Affordability. Blue Shield continues to collaborate with California leaders and remains dedicated to improving healthcare affordability and effectiveness. 

  • Support for the Pay PCPs Act: During our meetings with Senate representatives, we endorsed the Pay PCPs Act and its associated Request for Information, which proposes a "hybrid" payment model for primary care physicians, similar to the one used by Blue Shield of California, to ensure stable funding and improve care quality. 

  • Climate-Conscious Care Panels: We participated in discussions on the intersection of payment innovation and climate change, underscoring the role insurers can play in advancing sustainable healthcare practices. Blue Shield of California is one of only a handful of payer plans globally working to reduce our emissions by committing to the global Science Based Targets initiative (SBTi) through action on climate change. 

  • Published op-eds to drive awareness of critical issues: Our leadership team shared insights on the power of balancing innovation and equity with the California Health Report; discussed the need to recognize and close gaps in care in partnership with industry peers in Fierce Healthcare; and highlighted the role of co-opetition in achieving transformation with the Game-Changing Women of Healthcare Podcast. 

We’re grateful for a transformative year and look forward to continuing the essential work to deliver sustainable and scalable solutions through co-opetitive and innovative collaborations in 2025.