HCAI work group outlines primary care snapshot indicators, members flag data gaps on funds flow to practices

The Office of Healthcare Affordability (OCA), housed within the Department of Health Care Access and Information (HCAI), presented proposed measures for a statewide Primary Care Snapshot and sought work‑group feedback on a draft charter and indicator criteria.

Miranda Wirtz, senior primary care specialist at OCA, described three proposed investment indicators: primary care investment as a percent of total medical expense and per‑member per year, year‑to‑year change (2023→2024), and primary care investment broken down by claims and non‑claims payment categories. Wirtz said the snapshot will rely on existing state and national data and will not require new data collection. “We will ask work group members to take a brief survey to help us determine whether each indicator meets all of these criteria,” she said.

Why it matters: the snapshot aims to create a concise, trackable picture of the health of California’s primary care sector for purchasers, payers, providers, policymakers, consumer advocates and researchers. OCA intends to use the snapshot to monitor trends in investment, workforce, access, quality and equity and to move from a static report toward interactive dashboards over time.

Work‑group members broadly welcomed the indicators but pressed for clarification and additional baseline materials. Kevin Grumbach, a family physician at the University of California, San Francisco, cautioned that a high‑level snapshot will not substitute for a deeper evaluation of whether plan‑reported spending reaches frontline practices. “I think we’re gonna have to keep kind of deciding what’s our domain… and where do we need a much more labor‑intensive evaluation,” Grumbach said, urging the group to define boundaries between snapshot tracking and deeper evaluation.

Multiple members raised the same practical concern: OCA’s current data collection captures payments made by plans but generally lacks visibility into how those payments flow to provider organizations and individual practices. Debbie Lindes, healthcare delivery system group manager at OCA, said OCA sees what plans pay but not which provider organizations receive funds. She described provider‑level visibility as “a big data gap at present” and welcomed discussion on methods — such as attestations or additional reporting — that might help trace funds to frontline providers.

Data strategy and stratification: presenters proposed stratifying indicators by payment categories (claims vs. non‑claims), market and product type. Work‑group members asked whether stratification would align with how DHCS classifies spending; a consultant supporting the Delaware example noted that non‑claims totals often aggregate multiple distinct categories (incentives, capitation, care management fees) and said OCA’s expanded non‑claims framework collects granular category‑level data for reporting.

Scope boundaries and audiences: Miranda Wirtz clarified that the snapshot’s primary audience is technical stakeholders — purchasers, payers, providers, policymakers, advocates and researchers — rather than individual consumers, because the snapshot is meant to show sectorwide trends rather than provider‑level quality comparisons. Members recommended providing common foundational materials in advance so participants can evaluate indicators consistently.

Other substantive flags: members asked about specific topics the snapshot might capture or exclude. Debbie Lindes said OCA’s primary care definition includes the cost of administering vaccinations for all ages and that the 2026 data collection will add specific codes to capture Vaccines for Children (VFC) vaccine administration. Lindes also said OCA will exclude urgent care settings from the investment measure because those settings typically reflect episodic rather than continuity‑based primary care; other snapshot domains will include access measures that can capture usual source of care.

Next steps: OCA will send a post‑meeting survey collecting feedback on whether proposed indicators meet the evaluation criteria, requested charter comments by Jan. 28, and plans to finalize the charter at the March 11 work‑group meeting. OCA plans a static 2026 report and an interactive snapshot dashboard targeted for 2027. The agency will continue to seek data sources to fill gaps and may explore provider attestations or additional reporting to better trace funds flow.

The work group adjourned with requests for clearer baseline materials and a commitment from OCA to return with more detailed indicator proposals at the next meeting in March.