Covered California’s Quality Transformation Initiative Boosts Health Outcomes and Equity

SACRAMENTO, Calif. — Covered California announced the results of its health plan accountability program, the Quality Transformation Initiative (QTI), at a board meeting. This program aims to improve health care and reduce disparities among its members. It was developed with input from consumer advocates, health care providers, and health insurance companies, in collaboration with the Department of Health Care Services and CalPERS.

The QTI introduces financial incentives for health insurance companies participating in Covered California. In its first year, companies faced penalties—up to 1% of premiums for not meeting specific health outcome measures. In future years, this penalty could rise to 4%. The outcomes include management of blood pressure and diabetes, colorectal cancer screening, and childhood immunizations.

Most health insurance companies improved year over year. Enrollees saw an increase in cancer screenings, vaccinations, and better management of chronic conditions. However, Covered California will collect over $15 million from companies that did not meet the program’s standards. These funds will be reinvested in health services for enrollees in 2025.

Dr. Monica Soni, chief medical officer of Covered California, expressed pride in the initiative, highlighting its focus on a small number of impactful health measures. Chronic condition management showed significant improvements, with blood pressure control increasing by 12% and diabetes management improving by 6%. Given that cardiovascular disease and diabetes are major health risks in California, these improvements are crucial.

Ten of the thirteen health plans increased their rates of colorectal cancer screening, averaging a 12% rise. Colorectal cancer is the second leading cause of cancer deaths in the U.S. However, childhood vaccination rates declined overall. Dr. Soni emphasized the need to reverse this trend, noting that immunizations prevent millions of diseases annually.

Jessica Altman, Executive Director of Covered California, pointed out that the initiative builds on the Affordable Care Act’s efforts to enhance equity in healthcare in the state.

For the 2024 plan year, the penalty for non-compliance increases to 2% of premiums. This will rise to 3% in 2025. Covered California expects that health insurance companies will continue to invest in improving outcomes.

Dr. Soni expressed optimism about the ongoing improvements, hoping that all Californians will receive the care they need.

Participating Health Insurers

The following health insurers participated in the Quality Transformation Initiative:

• PY2023: Anthem, Blue Shield of California, Balance by CCHP, Health Net, Kaiser Permanente, LA Care, Molina Healthcare, Sharp Health Plan, Valley Health Plan, Western Health Advantage
• PY2024: Anthem, Blue Shield of California, Balance by CCHP, Health Net, Kaiser Permanente, LA Care, Molina Healthcare, Sharp Health Plan, Valley Health Plan, Western Health Advantage
• PY2025: Aetna, Anthem, Blue Shield of California, Balance by CCHP, Health Net, Kaiser Permanente, LA Care, Molina Healthcare, Sharp Health Plan, Valley Health Plan, Western Health Advantage
• PY2026: Aetna, Anthem, Kaiser Permanente, Inland Empire Health Plan, LA Care, Molina Healthcare, Sharp Health Plan, Valley Health Plan  

About Covered California

Covered California is the state’s health insurance marketplace. It helps Californians find affordable, high-quality insurance. Individuals may qualify for financial assistance to reduce premium costs. Depending on income, some may also qualify for Medi-Cal, a low-cost or no-cost program. Covered California operates independently, overseen by a five-member board appointed by the governor and Legislature. Visit www.CoveredCA.com for more information.