Pioneering in Population Health: Insights from Covered California’s Innovative Program

In February 2025, Covered California—the nation’s largest state-based Marketplace with a strong track record of innovation—launched three groundbreaking Population Health Investments (PopHIs, pronounced “Poppys”). These PopHI programs address members’ underlying needs—food insecurity, financial insecurity and access to preventive care—to advance health equity and improve outcomes. Other marketplaces, payers and employers can read here to learn more about how these programs were designed to consider related transformation efforts within their own markets.

Population Health Investment Programs

When Covered California had the opportunity to invest funds owed by its Qualified Health Plan (QHP) Issuers under a new financial accountability program, it created and launched three targeted initiatives that direct those dollars to support its members and the providers that care for them:

1. Grocery Support Program: The “Beyond Covered by Covered California: Grocery Support Program” assists members with chronic health conditions and financial challenges access nutritious food to improve food security and health outcomes. Eligible members—those with household income up to 250% of the federal poverty level, a chronic condition and food insecurity—who consent to enroll receive a reloadable debit card to purchase food. Benefits start at $80 per month for a household of one, increase with household size and cover fresh food, packaged food, baby food and non-alcoholic drinks.
2. Child Savings Account Program: The “Beyond Covered by Covered California: Child Savings Account Program” aims to improve well-child visits and childhood immunization rates while helping families invest in their child’s future. Eligible members are children under two years old who register for a , which requires being born in California. Families that consent to participate can earn up to $1,000 in their CalKIDS savings account based on the completion of nine steps, including $100 per primary care visit when certain vaccines are administered and $150 per flu shot.
3. Equity and Practice Transformation (EPT): Covered California supplemented Medi-Cal’s (California Medicaid) by accelerating population health management capabilities in primary care practices serving both Covered California and Medi-Cal enrollees. The 46 practices selected for Covered California’s additional investment receive enhanced technical assistance through the .

Below are core components of Covered California’s strategy to fund and design the PopHIs, which other marketplaces, payers and employers can take into account if launching a similar initiative.

Incentivizing Win-Win Quality Outcomes

Funds for the PopHIs—which totaled $15.8 million for its first year—were generated by another cutting-edge Covered California program—the Quality Transformation Initiative (QTI). The QTI program imposes direct and substantial financial incentives on plans by levying a percentage of their premium if they do not meet specified quality benchmarks (further described below). In the QTI’s first year, plans owe up to 0.8% of their premium, though the maximum penalty will increase to 4% of premium over time. Dr. Soni, Chief Medical Officer of Covered California, underscored that Covered California is “not actually looking to collect a bunch of money from plans. We just want the quality outcomes for folks.” In fact, Dr. Soni reported that many plans dramatically improved their performance against the quality benchmarks in just one year (from the baseline measure year to when the QTI program started).

Cross-Payer Collaboration on Quality Measures

Covered California conditions plans’ QTI payments based on their performance against quality measures related to controlling high blood pressure, comprehensive diabetes care (HbA1c control), colorectal cancer screening, and childhood immunization status. These quality measures were selected due to: (a) their ability to reduce morbidity and improve mortality, (b) the significant disparities in their outcomes across subpopulations, and (c) they align with the priorities of California’s two other major public purchasers: the Department of Health Care Services (DHCS), which administers Medi-Cal, and CalPERS, which provides health benefits to state employees and retirees—together leveraging the market power of purchasers that cover over 45% of all Californians.

Guiding Principles for PopHI Selection

To guide the selection of PopHI programs, Covered California first established criteria against which to assess each potential program, determining that PopHI programs must:

1. Align with Covered California’s guiding principles, to: improve health equity by targeting geographic regions or communities with the greatest health and quality gaps; lead to measurable improvements in quality and member outcomes related to QTI core measure performance; be evidence-based; and, advance quality in underfunded areas.
2. Be responsive to population needs  
3. Be feasible to implement on the desired scale and timeline and be measurable through data-driven evaluation.

Stakeholder Engagement for PopHI Design and Selection

Covered California underwent 14 months of stakeholder engagement to: ensure the PopHIs were responsive to population needs; assemble a prioritized list of PopHIs; and, thoughtfully design the selected programs. Covered California:

• Conducted qualitative and quantitative studies of member challenges achieving health and wellness using annual member surveys and direct outreach calls to members with chronic conditions
• Interviewed QHP Issuers, consumer advocates and providers who care for high volumes of its members to understand their barriers in delivering high quality care.
• Executed a Geographical Information System mapping project to identify environmental and geographic drivers of health.
• Solicited written comments and facilitated nine public meetings across its existing Plan Management Advisory Group and newly-established 12-person “PopHI Advisory Council.” The latter included a Covered California member as well as representatives from QHP Issuers, DHCS, CalPERS, California providers and other thought leaders.

Member-Centric Outreach and Enrollment

To ensure that available funds reached those in need, Covered California designed an equitable, member-centric outreach and enrollment approach for its member-facing Grocery Support and Child Savings Account programs. Key strategies include the following:

• Covered California started with its own data to determine which members met most or all PopHI eligibility criteria and proactively outreached to just those members across multiple communication modalities (email, text, and phone calls to either cell phones or landlines).
• Covered California considered linguistic preferences, leveraging its data on members’ preferred language and communication modalities to tailor outreach, which was translated by native speakers into the five most common languages spoken by members.
• To manage potentially higher demand than available funds and reduce the need to turn members away, Covered California organized its list of potentially eligible members into multiple cohorts and conducted outreach on a rolling basis, allowing time for each group to respond before inviting the next. A schedule of automated reminders across members’ available communication modalities reminded and encouraged members who did not immediately apply.
• Covered California prioritized initial outreach to members that reported only having a landline phone (i.e., no cell phone or email address) to provide additional time to members with lower digital literacy to enroll.
• A call center with live support assisted any member with questions about the program, including with use of the digital platform—which leveraged AI-enabled translation in members’ preferred languages.

Looking Ahead

Through creativity, partnerships, and a member-first mindset, Covered California launched innovative programs that invest in members’ upstream needs with funds from underperforming Issuers. Notably, Covered California is evaluating the impact of these programs to ensure not only that the PopHIs continue to evolve based on evaluation findings but to inform other Marketplaces’ and payers’ programs. Other marketplaces, payers and employers across the country can build on this model to create their own customized programs that meet their members’ needs—improving quality of care and members’ health outcomes while reducing health disparities.

KFF, “”, Table 1, “Marketplace Plan Selections, 2020 and 2024,” May 16, 2024.

Household income and size as determined at time of Covered California application

As identified through Covered California claims analysis

As assessed through member response to the two-question Hunger Vital Sign screening tool.

 California Kids Investment and Development Savings (CalKIDS) Program is a state-administered children's savings account program designed to help families save for their children's future education expenses.

Amico, P. et al, “,” Health Affairs Scholar, Volume 2, Issue 5, May 2024, qxae052. See also: National Quality Forum, “,” May 30, 2024.

Manatt calculation of 2024 enrollment from “California Public Purchaser Contract Provisions on Primary Care: Multi-Payer Alignment Drives Investment,”