Advancing Health Equity Through Primary Care Policy in California

Mathematica and the California Health Care Foundation (CHCF) have published state policy recommendations and priorities to improve primary care access for all Californians.

The recommendations, developed by health equity and primary care experts, include expanding the pipeline and pathway programs in health professions to recruit and prepare students from historically and systematically excluded communities for careers in primary care. They also include supporting the role that community health workers play in primary care delivery to advance health equity and evaluating the design of health care benefits through an equity lens.

“Primary care is the foundation of our health care system, yet it faces underinvestment, workforce shortages, and barriers to access for too many communities across the country,” said Diane Rittenhouse, a senior fellow at Mathematica. “This report highlights realistic and attainable steps California can take to provide its residents with stronger, more equitable whole-person care. I look forward to seeing how California helps its primary care system live up to its potential and how other states and systems apply learnings within their own context.”

CHCF and Mathematica brought together 30 experts in September 2023 for the Summit on Primary Care Policy to Advance Health Equity. Their task was to build consensus around policy recommendations to strengthen primary care and eliminate health disparities—particularly in underserved communities. Those recommendations are now outlined in Advancing Health Equity Through Primary Care Policy in California. The report is part of CHCF’s ongoing effort to robustly incorporate primary care into health equity conversations in California.

As shared in the report, the summit participants identified three policies to strengthen primary care and advance health equity that were foundational to all others:

1. Sustainably increase Medi-Cal primary care provider payments to remove all financial disincentives to serving Californians with low incomes.
2. Increase the proportion of health care spending directed toward primary care to enable sustained, systemwide investment in primary care services and supports. Along with this investment, establish time-bound spending targets for payers, to ensure resources are sufficient to provide high-quality, equitable primary care for all Californians.
3. Create meaningful engagement of people with lived experiences of discrimination in all California state primary care policymaking and governance bodies. Including community experts helps identify barriers to health equity and generate solutions.

Summit participants also identified additional priority policy recommendations across the following areas of impact to put California on the right track to strengthen primary care and advance health equity: (1) engage and empower the community; (2) enhance education and training; (3) expand access; (4) improve data standards and sharing; and (5) design payment for equity.

"Improving our primary care system is an issue of justice—it is our first line of defense in the protection of our state's most vulnerable. Intentional advancement in primary care has the power to improve health outcomes for Latine and other systemically disenfranchised communities," said summit participant Dr. Seciah Aquino, executive director, Latino Coalition for a Healthy California. "The recommendations outlined in this report—from increasing workforce diversity to expanding access and improving quality of care—are necessary in the system transformation needed to achieve true health equity and help break the intergenerational poverty cycles that keep our communities from the health they deserve. Together, and in unity, we can build the sustainable movement needed to achieve this."

The Advancing Health Equity Through Primary Care Policy in California report concludes with a proposed approach to move the policy recommendations into action. There was broad support among many summit participants to start a task force on primary care and health equity, create a California state scorecard on primary care and health equity, and establish an office for primary care within the state government.

"Access to primary care has so much power to make a meaningful difference in people's lives and the overall health of our communities, so it was a real privilege to be involved in this summit that was focused on uplifting the importance of primary care,” said summit participant Brandon Bettencourt, director of quality and patient engagement, Chapa-De Indian Health. “There’s ample research out in the world that hints at solutions to strengthen primary care, and we were able to mine that evidence base to inform and put forth specific recommendations to set those solutions in motion.”

This paper is part of a broader body of CHCF research on the importance of primary care in California. Learn more at CHCF’s Primary Care Matters Resource Center.