At a Glance
IMPACT-CA is a multi-year, phased initiative to strengthen primary care delivery and advance value-based payment in California. It brings together three synergistic strategies — a value-based payment model, a High-Value Care Hub, and Accountable Care Entities — into a single, practical pathway for implementation and scale.
The Gap Between Policy and Practice
California has set ambitious goals to reduce health cost growth by increasing primary care spend and value-based contracting, which together aim to reduce total cost of care and improve health outcomes. But there is a significant gap between policy and practice.
In the California safety net, many existing “value-based” arrangements do not effectively link quality and cost or provide meaningful incentives at the practice level to change how care is delivered. Practices struggle to maintain their workforce, remain financially solvent, and meet the many needs of their most vulnerable patients. Practices, plans, and purchasers face a fragmented payment environment with inconsistent contracting and support structures, and limited infrastructure to support the shift from volume to value.
This is where IMPACT-CA comes in.
IMPACT-CA Goals
IMPACT-CA is designed to strengthen primary care by increasing investment in evidence-based advanced primary care and aligning payment, implementation support, and organizational capabilities. Together, these strategies aim to improve patient outcomes and experience, support practice sustainability, and contribute to lower total cost of care over time
Three Synergistic Strategies
Value-Based Payment Model A progressive pathway with three stages practices may advance through, with support from the High-Value Care Hub:
- Advanced Primary Care (APC) Payment — base rate + Population Health Management (PHM) payment + potential add-on payments + Pay-for-Performance (P4P) incentives, beginning in Year 1 to help practices build and sustain Advanced Primary Care delivery.
- Shared Savings — mature APC practices, organized through primary care–led entities, may participate in standard shared savings contracts across Medi-Cal plans starting in Year 3.
- Shared Risk — practices with sufficient capabilities, reserves, and infrastructure may take on downside risk starting in Year 4.
High-Value Care Hub A shared statewide infrastructure to support practices, plans, and purchasers to implement all three payment models and the care transformation that results in high-value care and improved outcomes. The Hub includes enablement support for data and technology, practice transformation, shared workforce and operational services, data platforms, and contracting and legal expertise. Rather than creating a new standalone technical assistance organization, the Hub partners with and leverages the expertise of high-quality technical assistance organizations and subject matter experts across California.
Accountable Care Entities (ACEs) A structure designed to enable primary care practices to participate in shared savings and shared risk contracts. An ACE must be primary care led and provider governed, pass the majority of savings through to participating practices, and not assume delegation or financial responsibility for health plan functions.
The Challenge and the Opportunity
PHLC operates at the nexus of all three major segments of the system — purchasers, plans, and providers — and understands the pressures shaping California’s affordability goals:
- OHCA has set ambitious primary care investment targets, value-based contracting targets, and overall cost growth reduction goals beginning in 2026.
- Health plans are juggling increased quality and cost accountability while responding to HR-1–driven membership and revenue losses.
- Providers face growing operational and financial strain from workforce shortages, rising labor costs, regulatory demands, and stagnant reimbursement.
- Standardization and shared infrastructure across plans and regions are needed to reduce administrative burden and strengthen investment in advanced primary care.
Building on the success of prior large-scale primary care investments — including the Equity and Practice Transformation (EPT) Program — DHCS partnered with PHLC to develop a statewide primary care value strategy for Medi-Cal. Co-designed with a multi-stakeholder statewide Value-Based Payment (VBP) Workgroup, this effort resulted in IMPACT-CA. Unlike many initiatives that address payment, practice transformation, and infrastructure separately, IMPACT-CA integrates these elements into a single, practical pathway.
While initially rooted in Medi-Cal, the models are designed to be adaptable across health plans and other lines of business over time.
Who Is Involved
IMPACT-CA is in its final stages of collaborative design through an established, multi-stakeholder VBP Workgroup. The workgroup includes state agencies (DHCS, OHCA, Covered CA), plans, providers, associations, and academic and technical partners, with PHLC serving as facilitator of VBP model development, regional implementation and the High-Value Care Hub. PHLC is now working with purchasers, funders, and the VBP Workgroup to plan for implementation. Moving from design to action will require commitment and investment from all key stakeholders.
Partner With Us
PHLC welcomes opportunities to collaborate with health plans, provider organizations, purchasers, employers, foundations, policymakers, and other organizations committed to advancing value-based payment and strengthening primary care.
📩 Contact us at info@pophealthlc.org to learn more about IMPACT-CA and opportunities to partner.