Promote High Value System Performance
focus areas for promoting high value
OHCA promotes high value system performance through its work in five focus areas. Across all these areas, the goal is to reorient the health care system towards greater value, with the vision of creating a sustainable health care system that provides high-quality, equitable care to all Californians.
Primary Care Investment
- Define, measure and report on primary care spending
- Establish a benchmark for primary care investment
Behavioral Health Investment
- Define, measure, and report on behavioral health spending
- Establish a benchmark for behavioral health investment
APM Adoption
- Define, measure, and report on alternative payment model adoption
- Set standards for APMs to be used during contracting
- Establish APM adoption goals
Quality and Equity Performance
- Develop, adopt, and report performance on a single set of quality and health equity measures
Workforce Stability
- Develop and adopt standards to advance the stability of the health care workforce
- Monitor and report on workforce stability metrics
Recent Updates
Quality and Equity Performance
- The Office adopted its Quality and Equity Measure Set in April 2025.
- Read about the OHCA Quality and Equity Measure Set.
Primary Care Investment Benchmark
- Read about the OHCA Primary Care Investment Benchmark, approved by the Health Care Affordability Board in October 2024.
- OHCA will collect data to measure primary care spending by health plans annually, beginning in September 2025.
Alternative Payment Model Standards
- Read about the OHCA APM Standards and Adoption Goals, approved by the Health Care Affordability Board in June 2024.
- OHCA will collect data to monitor APM adoption annually, beginning in September 2025.
OHCA Investment and Payment Workgroup
Health care experts and stakeholders participate in this monthly meeting to support the development of alternative payment model, primary care, and behavioral health standards and benchmarks.
Cost-Reducing Strategies
OHCA has collected examples of cost-reducing strategies that health plans, hospitals, and physician organizations are implementing to reduce cost while maintaining or improving quality in their care delivery systems.
Expanded Non-Claims Payments Framework
HCAI uses the Expanded Non-Claims Payments Framework to collect and categorize non-claims payments data to understand the purpose of payment and the level of risk assumed by the provider receiving the payment.
Progress in Focus Areas
Primary Care and Behavioral Health Investment
OHCA is responsible for setting statewide investment benchmarks for primary care and behavioral health as a percent of total health care spending and for monitoring progress toward those benchmarks.
The Health Care Affordability Board approved primary care investment benchmarks in October 2024. These benchmarks, and the primary care spending definition, were developed with extensive input from the Investment and Payment Workgroup, sibling state departments, the Health Care Affordability Advisory Committee, the Health Care Affordability Board, and public commenters. Data collection to measure primary care spending will begin in fall 2025. Additional details are outlined in the Total Health Care Expenditures Data Collection Emergency Regulations, approved on April 17, 2025.
OHCA began its work to develop a technical definition of behavioral health spending and a recommended behavioral health investment benchmark, with input from the Investment and Payment Workgroup, in July 2024 and plans to present a proposed behavioral health investment benchmark to the Health Care Affordability Board in summer 2025.
Alternative Payment Model Adoption
OHCA establishes a statewide goal for the adoption of alternative payment models (APMs) and monitors progress towards those goals. Additionally, OHCA is tasked with developing definitions and standards to support the adoption of APMs.
The Health Care Affordability Board approved Alternative Payment Model (APM) Standards and Adoption Goals in June 2024 to promote increased APM adoption. These standards and goals have been shaped through extensive discussions within the Investment and Payment Workgroup, sibling state departments, as well as feedback from the Health Care Affordability Advisory Committee, the Health Care Affordability Board, and additional stakeholders. Data collection to monitor APM adoption will begin in fall 2025. Additional details are outlined in the Total Health Care Expenditures Data Collection Emergency Regulations, approved on April 17, 2025.
Quality and Equity Performance
OHCA is responsible for developing, adopting, and reporting performance on a single set of measures for evaluating health care quality and equity across various health care entities. OHCA will align with existing quality and equity measurement programs across the California health care system.
To promote high quality and more equitable health care for all Californians, OHCA adopted its Quality and Equity Measure Set in April 2025.
OHCA is also responsible for evaluating potential equity and quality adjustments that can be applied to the spending targets or the health care entity’s performance against the targets. OHCA is currently assessing existing methods used nationwide and their potential impact.
Workforce Stability
OHCA is charged with monitoring the effects of cost targets on health care workforce stability, high-quality jobs, and training needs of health care workers, with the goal that workforce shortages do not undermine health care affordability, access, quality, equity and culturally and linguistically competent care. To achieve workforce stability in the context of spending targets, in June 2024, OHCA adopted its Workforce Stability Standards.
Currently, OHCA is exploring additional data collection opportunities and planning for future workforce stability reporting. OHCA will update the Health Care Affordability Advisory Committee and Board in fall 2025 on its progress.