Workgroup recommends five access measures and core four quality metrics for 2026 primary care snapshot; avoidable ED metric deferred to 2027

The Department of Health Care Access and Information (HAI) Primary Care Snapshot workgroup on the 2026 indicator set recommended a concise package of access and quality metrics and asked members for additional feedback on data gaps and stratifications.

Miranda Wartz, HAI senior primary care specialist, presented five access indicators the team recommends for 2026: the Bice-Boxerman continuity index for patients with two or more visits; median miles traveled to in‑state primary care visits; primary care visits per 1,000 residents; the share of Californians with a usual source of care (using CHIS); and the share of adults reporting a routine checkup in the past 12 months (CHIS). Wartz said the snapshot will use the Healthcare Payments Database (HPD) for several measures and CHIS for patient‑reported items.

The workgroup singled out data limitations and trade-offs. Wartz noted that HPD covers roughly 82% of California’s population but “lacks complete race and ethnicity data and does not include uninsured or self‑insured populations,” and that some measures will need patient‑survey data to reflect the consumer experience. Alyssa Borders, a research scientist working with HPD, clarified the planned utilization metric: “the primary care visits per 10,000 people … is total visits regardless of how many distinct members,” and HPD will also report the percent of members with any primary care visit in the past year in upcoming public materials.

Members flagged measures they consider important but hard to capture. Diana Douglas of Health Access asked about wait times for new‑patient appointments and time to visit, saying the patient experience of wait time can drive use of urgent care and the emergency department. Wartz and Lindis said available administrative sources do not capture patient wait‑time experience reliably and that the team does not plan to include a wait‑time indicator in 2026. Several participants urged adding a measure for whether clinicians are accepting new patients; Dr. Bravo called that “a very simple indicator” with “profound implications” for true access, while some speakers cautioned about the administrative burden of frequent self‑reporting by individual practices.

On quality measures, HAI proposed five quality indicators for 2026 anchored by the rate of potentially preventable hospitalizations for chronic conditions using Agency for Healthcare Research and Quality/ARC methodology and patient discharge data. The workgroup recommended including the state’s “core four” quality measures — childhood immunization (CIS‑10), colorectal cancer screening, blood‑pressure control, and glycemic assessment for people with diabetes — because state departments already align on these measures for performance reporting.

HAI recommended deferring avoidable emergency‑department visits to 2027 to allow time to harmonize methodology and move reporting from HPD to patient discharge data (PDD), which HAI said offers more complete race/ethnicity coverage and includes uninsured and self‑insured populations. Wartz said social‑risk stratifications (for example the Healthy Places or Social Vulnerability Index) are being evaluated for inclusion in 2027.

Workgroup members also urged expanding the quality set over time to include adult immunizations and women’s preventive‑screening measures such as flu or Novavax vaccination rates, breast cancer screening and cervical cancer screening. Dr. Hong said adult immunizations “would be a really strong” addition to help prevent hospitalizations upstream; Lisa cautioned that vaccination rates reflect uptake as well as access and that distinguishing being offered a vaccine from taking it up is important for interpretation.

Next steps: HAI will use the feedback to refine the 2026 indicator list, develop technical specifications, continue coordination with other California state departments for data alignment, and invite asynchronous feedback to the project team by email. Updated calendar invites for rescheduled July and November workgroup meetings will be distributed.