A Healthier Bottom Line: How California is Reinvesting in Residents
Facing a surge in funds due to improvements in health plan performance, covered California, the state’s health insurance marketplace, embarked on a groundbreaking venture: redistributing those funds directly to improve the health and well-being of its 1.8 million members. Calling itself the initiative “PopHI,” which stands for “Population Health Investments.” This innovative program tackles the root causes of poor health and inequity, placing a strong emphasis on social and environmental factors influencing health outcomes.
The journey began in 2023 after Covered California unveiled a Quality Transformation Initiative (QTI). This program required insurance plans to meet minimum standards for crucial healthcare aspects such as managing chronic conditions like diabetes and getting children vaccinated. Plans falling short faced financial penalties, creating an unexpected revenue stream for Covered California.
“It became clear that simply returning those funds to the insurance companies didn’t address the underlying systemic issues contributing to the penalties in the first place,” said Dr. Monica Soni, Covered California’s chief medical officer.
This sparked a collaborative journey. Covered California embarked on extensive outreach, collecting valuable input from plan members, healthcare providers, and consumer advocates. Their voices helped shape three impactful programs launching in February 2025.
Targeting Root Causes with Direct Support
The first program tackles a pressing need: food insecurity, particularly prevalent among individuals with chronic conditions. These individuals often find themselves in the complex position of being too affluent to qualify for CalFresh benefits, despite facing high healthcare expenses and limited access to affordable, nutritious food.
Covered California members with household incomes below 250% of the federal poverty level will receive at least $960 annually to use for groceries. This direct financial support, dispersed monthly or as a lump sum, will harness the power of the federal Supplemental Nutrition Assistance Program (SNAP).
A second program addresses another critical aspect of preventative care: early childhood vaccinations and well-child visits. Recognizing the importance of early intervention, families with children under two years old will earn up to $1,000 in rewards for completing recommended check-ups and vaccinations. These funds are directly deposited into each child’s CalKIDS college savings account, encouraging both childhood health and financial access to post-secondary education, highlighting a powerful connection between health and long-term economic well-being.
The final element focuses on bolstering primary care delivery.
Around 50 small, often independent, primary care practices serving covered California enrollees will receive limited technical assistance aimed at improving care delivery, advocating for quality and accessible care addressing health disparities. This aligns with the state’s broader strategy to support providers caring for low-income Californians.
Wider Impact, Lasting Change
Covered California leadership believes the impact will extend far beyond the program participants. “It’s a pioneering approach that aligns with other innovative efforts in public health funding, similar to the way states have used tobacco settlement monies and taxes on sugary drinks to fund programs that promote community health,” Dr.
Soni commented, adding that the projected impact transcends financial incentives.
“If we don’t collect a single dollar, it’s still a win,” Dr. Soni emphasized. “It demonstrates that we’ve moved the bar higher, pushing for better quality
across all 1.8 million of our members.” Dr. Soni vig
The PopHI initiative holds promise not only for covered California enrollees but also for similar programs across the nation. Research teams at UCLA and UCSF are dedicated to rigorously evaluating the program’s effectiveness.
If successful
How does Covered California’s PopHI initiative address the social determinants of health?
## A Healthier Bottom Line: Interview with Dr. Monica Soni
**Interviewer:** Dr. Soni, thank you for joining us today. Covered California’s new PopHI initiative is making headlines. Can you tell our viewers what it’s all about?
**Dr. Soni:** Certainly! PopHI, or Population Health Investments, is our innovative approach to addressing the root causes of poor health and inequities among our 1.8 million members. We’re taking a portion of funds generated through our Quality Transformation Initiative (QTI) and reinvesting it directly back into our communities.
**Interviewer:** The QTI aims to improve healthcare quality. How does that tie into PopHI?
**Dr. Soni:** The QTI sets minimum standards for important healthcare aspects like managing chronic conditions and childhood vaccinations. When plans don’t meet those standards, they face penalties. Initially, we considered returning those funds to the insurance companies. However, we realized this wouldn’t address the systemic issues contributing to those penalties in the first place. That’s how PopHI was born.
**Interviewer:** So PopHI tackles those systemic issues directly?
**Dr. Soni:** Exactly. We listened closely to our members, healthcare providers, and advocates. Through extensive outreach, we learned about critical needs like food insecurity and access to preventative care. The result? Three impactful programs launching in February 2025.
**Interviewer:** Can you give us some examples?
**Dr. Soni:** Absolutely! One program will provide direct financial support for groceries to members with household incomes below 250% of the federal poverty level. This addresses the issue of food insecurity, particularly prevalent amongst those with chronic conditions.
Another program focuses on early childhood vaccinations and well-child visits, emphasizing the importance of prevention.
**Interviewer:** These programs sound crucial. What message do you want to leave our viewers with?
**Dr. Soni:** At Covered California, we believe healthcare is more than just medical treatment. It’s about addressing the broader social and environmental factors that influence health outcomes. PopHI is a testament to our commitment to building a healthier California for everyone. [[1](https://hbex.coveredca.com/stakeholders/PopHI_Advisory_Council_Scope_and_Member_Expectations_V2_Final.pdf)]
