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CalPERS: QAMS shows early improvement; staff outlines clinic plan and flags behavioral‑health access problems
Summary
CalPERS staff reported year‑one Quality Alignment Measure Set (QAMS) gains, roughly $7.3 million in plan paybacks, and plans to launch CalPERS‑run primary care clinics by early 2027; staff also warned provider directories contain ~40% invalid behavioral‑health listings and said access remains uneven.
Julia Logan, CalPERS’ chief clinical director, told the board that the inaugural year of CalPERS’ Quality Alignment Measure Set (QAMS) yielded measurable improvements on primary‑care‑oriented measures: blood‑pressure control and colorectal screening showed notable gains compared with national percentiles, and the plan required some paybacks due to penalties. Logan said about $64 million was at risk across three purchasers in year one; plans paid back approximately $7.3 million, which CalPERS will apply to reduce member premiums.
The QAMS program uses seven primary‑care‑focused measures aligned with Covered California and Medi‑Cal. Logan emphasized public reporting, contract levers and financial incentives as drivers of plan investment in quality and said NCQA accreditation remains a contractual floor. She described contract and monitoring levers including third‑party rate calculation (IHA) and plan corrective processes for plans failing benchmarks.
On access, staff outlined a primary‑care clinic initiative targeted at PPO members and access‑challenged geographies. CalPERS has been evaluating vendors and expects to bring a vendor recommendation to the September board meeting; the goal is to have a first pilot CalPERS clinic operational in early 2027, with potential expansion later in 2027–2028. The clinic model emphasizes integrated, relationship‑based primary care with warm handoffs to behavioral health and measures to avoid poaching local providers.
Lisa Albers summarized behavioral‑health findings: modest increases in prevalence of anxiety, depression and substance‑use disorders from 2021 to 2025; higher rates of telehealth use for behavioral health (a substantial fraction of outpatient visits are virtual); and indications of access pressures in some regions. Importantly, staff’s assessment of provider directories sampled across HMOs and PPOs found about 40% invalid listings (inaccurate or disconnected phone numbers, providers not in practice or not accepting the plan). Staff warned that inaccurate directories push members out of network and increase costs and frustration, and said the monitoring and remediation of directories is a key next step.
Logan and Albers described operational and oversight steps underway: targeted member and employer education, annual member surveys, an additional access survey focused on PPO service areas, a prior‑authorization deep dive with external consultants, tightened contract requirements for behavioral‑health access and provider directories, and a plan to develop internal dashboards to track behavioral‑health performance.
Quotes: "For the 1st year of the QAMS, approximately $64,000,000 was at risk...Our plans were required to pay back a total of $7,300,000," Logan said.
"Across all the plans for the providers that we sampled, we found approximately 40% invalid listings," Albers told the board.
Ending note: Staff will bring a vendor recommendation for primary‑care clinics in September, continue QAMS monitoring and public reporting, and pursue corrective contractual steps and data‑quality actions to improve behavioral‑health access and directory accuracy.
