Through a facilitated panel discussion, leaders from state public purchaser organizations serving over 3 million Californians (Covered California and the California Public Employees Retirement System [CalPERS]) and a provider organization with over 100,000 board-certified family physicians (the American Board of Family Medicine [ABFM]), will describe how the three organizations are collaborating to hold health plans accountable for member outcomes in a new way that centers on the provider and patient relationship. Covered California and CalPERS have aligned their quality programs to focus on a narrow and meaningful set of quality measures. 

These measures are evidence-based, disparities sensitive, and have real impacts on health outcomes – diabetes control, blood pressure control, cancer screening, childhood vaccination rates [1,2]. Recognizing the central role that the primary care provider and team have on prevention of disease and chronic condition management, Covered California and CalPERS have partnered with ABFM to bring evidence and an aligned approach to measuring and incentivizing continuity of care to discussions and programs with their health plans. Along with being a medical certifying board, ABFM is also the developer of the continuity of care measure. There is a robust body of evidence that shows that continuity of care, defined as a continuous relationship with a primary care clinician, improves health outcomes, increases patient and physician satisfaction, and reduces healthcare costs [3,4]. Throughout the collaboration, ABFM conducted comprehensive analytics to reveal critical patterns and insights to drive informed decision-making, assisted with the development of contract requirements, and provided technical support. In March of 2025, this collaboration culminated in a groundbreaking summit that brought together clinical leaders from various California health plans to discuss three topics: Continuity of Care, Access and Affordability, and Vaccine Hesitancy. 

The continuity of care portion of the agenda sought to respond to health plan concerns about their ability to influence provider continuity of care and devise actionable solutions. During the presentation portion, ABFM shared new state-specific data that directly responded to health plan concerns and a data simulation that demonstrated that even slight changes in performance at the patient level could greatly impact physician continuity of care. The in-person setting allowed health plan attendees to ask questions and share additional feedback with both the developer and payers (i.e., Covered CA and CalPERS) of the continuity measure throughout the presentation and day. After the presentation portion, the attendees were divided into small groups to brainstorm how health plans and payers could support health systems and clinicians in accomplishing continuity of care, resulting in over two dozen proposed solutions. In today’s primary care landscape, it’s critical that we come together in new and different ways across the healthcare industry to align on tactical solutions that support relationship-based primary care. Primary care is the backbone of the healthcare system, and high quality, continuous care drives better outcomes and health that we all want for our patients and members. 

This panel will illustrate how a new approach to co-opetition and cross-sector collaboration was successful and could be applied to other quality improvement efforts. References 1. California Public Employees' Retirement System. CalPERS driving improvements in healthcare quality: Alignment, measure set, and incentives. https://www.calpers.ca.gov/calpers-driving-improvements-in-healthcare-quality-alignment-measure-set-and-incentives. Accessed April 9, 202 2. Covered California. Quality Transformation Initiative. https://hbex.coveredca.com/stakeholders/plan-management/qti/. Accessed April 9, 2025. 3. Bazemore A, Petterson S, Peterson LE, Bruno R, Chung Y, Phillips RL. Higher Primary Care Physician Continuity is Associated With Lower Costs and Hospitalizations. Ann Fam Med. 2018;16(6):492-497) 4. Bazemore A, Merenstein Z, Handler L, Saultz JW. The Impact of Interpersonal Continuity of Primary Care on Health Care Costs and Use: A Critical Review. The Annals of Family Medicine 2023;21(3): 274-279. DOI: 10.1370/afm.2961