States focus on primary care models to increase access

Balancing the needs of patients seeking affordable healthcare with the market demands of insurers is challenging. Add to that the continuing debate over the Affordable Care Act (ACA) and the emphasis on value-based care and the situation becomes even more complicated. At the recent Patient-Centered Primary Care Collaborative Fall Conference, presenters discussed the strategies used “in states that make primary care the foundation for increasing access to care.”

One of the most significant challenges is that the uninsured regularly use the emergency room as their regular healthcare facility, whether seeing a physician there for a major injury or for routine care that should be part of a primary care physician visit. This practice results in increased costs and inconsistent care. As Peter Lee, J.D., executive director of Covered California, stated at the conference, “We have to change the culture by moving their normal point of care.”

Lee also discussed ways in which California is able to maintain “a balance between affordable plans for consumers and a market that insurers want to be in.” Covered California “requires participating plans to address four priorities:

  • promotion of primary care,
  • health disparities,
  • coordinated care and
  • a move away from strict fee-for-service payment.

Another example of a state increasing access to primary care is the patient-centered medical home (PCMH) model implemented by Oregon in 2009, and to which it moved 75 percent of its residents. There are now “630 PCMH practices statewide, and 80 percent of residents obtain care in one of these practices.”

Evan Saulino, M.D., Ph.D., a family physician who serves as clinical adviser for Oregon’s Patient-Centered Primary Care Home program, stated at the conference that Oregon’s “medical home model saved $240 million in health costs in its first three years.” Dr. Saulino also noted that “there are some things that both parties can agree upon across the political spectrum, and primary care transformation is one of them.”