Skip to main content

Pressure on Collaborative to Act Quickly to Adopt Federal Primary Care Reforms

A primary care collaborative created by legislation last July finally had its first meeting last week, convening competing providers and health insurers to agree on payment models that will invest more in primary care.
April 18, 2016

A new primary healthcare delivery reform collaborative that was convened this month by the Oregon Health Authority will have to act quickly if the state wants to join a national reform model that’s been implemented by the Affordable Care Act.

At just the first meeting of the primary healthcare collaborative, Dr. Glenn Rodriguez, the director of the family practice residency at Providence Health & Services in Milwaukie, pushed for a vote from the group to adopt the federal model, noting a deadline of June 1 to participate in the Comprehensive Primary Care Plus program.

“I’m interested in taking action to save primary care practices in this state,” Rodriguez pleaded with the group. “If we wait a year, there may be practices that don’t exist.”

But the conveners of the collaborative, including Dr. Evan Saulino, the clinical director of the state’s primary care home program and Chris DeMars, the director of systems innovation at the state’s Transformation Center, prodded the group to delay voting until next month to give other members of the group a chance to share their opinions about joining the federal program.

The primary healthcare collaborative is a large stakeholder group of providers, insurers, consumers and state bureaucrats created last year by Senate Bill 231 to help the state’s commercial insurance industry align its primary care reforms and create a standard for reimbursement different from fee-for-service.

The group has monthly meetings planned in Portland until September and will consider other statewide reforms besides the federal program, which offers hybrid payment models on two tracks, one for small doctors’ offices and the other for larger clinics.

SB 231 provoked some controversy before passage last July because it suspends state antitrust laws and actively encourages competing health insurers to work together to tailor their payment models. Sen. Chip Shields, D-Portland, objected to the antitrust suspension, arguing that the insurers could reform and work together without allowing providers to collude on rates.

But advocates of the collaborative said Oregon’s diverse health insurance market -- with as many as a dozen significant health insurers -- has created a situation where each company is going in different directions and several have been unwilling to reform their primary care models at all, creating the need for this collaborative where they could work together under guidance from the Oregon Health Authority.

Because billing is based on paying for tests and procedures when a patient gets sick, there is little incentive for primary care practices to look out for the whole health of their patients. Providing a means for reimbursement for health and not just sickness has been key to the reforms in Medicaid by the coordinated care organizations, and the collaborative seeks to apply similar solutions to the private insurance market, as well as encourage CCOs to adopt the best practices of their sister organizations.

With payment skewed toward more expensive specialty care, young physicians flock to the higher-paid specialties and insurers end up paying more as patients are passed up to these specialty providers.

Primary care proponents believe that if more money is invested in primary care, patients will stay healthier, and there will be less need for more expensive specialty care.

“There is no evidence that if you spend more on primary care that bad things happen,” said Saulino.

Christopher Koller, the president of Milbank Memorial Fund, which has worked on primary care reforms across state lines, showed anecdotally that Rhode Island -- which has a population roughly equivalent to the Portland metro area -- has slowed the growth in healthcare costs with its investment in primary care.

“Rhode Island had the lowest rates of healthcare premium rises in New England,” Koller said.

European countries, which have health insurance systems that proportionately spend much more on primary care, also have much better health outcomes than the United States.

Comments

Submitted by Jeremy Engdahl… on Tue, 04/19/2016 - 08:09 Permalink

This analysis on ACA marketplace rate changes shows that states with fewer carriers tended to have higher increases. http://bit.ly/1kljYnQ

Jeremy Engdahl Johnson