State Policy Updates

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Utah Issues Its First Primary Care Spending Report

The Utah Department of Health issued a primary care spending report using the state’s All Payer Claims Database (APCD). The report uses the Maine Quality Forum’s definition of primary care to calculate the total amount of spending on primary health care services as a percental of all healthcare expenditures. It found that primary care made up a combined 6.4% (narrow definition) and 8.5% (broad definition) of total expenditures in 2019. Primary care decreased from 2018 to 2019 for both Medicaid and commercial payers.

Oregon Value-based Payment Compact

Over 40 healthcare organizations—including several primary care providers—in Oregon signed a voluntary compact to advance the adoption of value-based payment (VBP) in the state. The groups committed to making a good-faith effort to “participate in and spread” VBPs, including moving from having 35% of all their payments be under advanced VBP models in 2021, to 70% by 2024. Read the principles that they signed on to. Their efforts corresponds with Oregon’s cost growth benchmark work that goes into effect this year.

Five States Join the Peterson-Milbank Program for Sustainable Health Care Costs

The Milbank Memorial Fund announced March 9, 2021, that Connecticut, Oregon, Nevada, New Jersey, and Washington have been selected to participate in the Peterson-Milbank Program for Sustainable Health Care Costs. With Peterson Center on Healthcare support, the Milbank Memorial Fund and Bailit Health will provide technical assistance to these five states as they set and implement healthcare cost growth targets. These targets are a first step toward making health care more affordable and transparent.

This program is just one Milbank Memorial Fund initiative that aims to empower and support state leaders in making health care more affordable for everyone.

“The Milbank Memorial Fund is excited to support these five leading states as they work with their stakeholders to set and implement a target and develop the data capacity necessary to identify and address the underlying causes of rising healthcare costs,” said Milbank Memorial Fund President Christopher F. Koller.

In the United States, healthcare costs have grown faster than the economy for decades. These rising costs are burdening states, employers, and families, as well as crowding out other critical priorities like education or housing. The COVID-19 pandemic has further stressed state, employer, and family budgets, and many states have a limited understanding of statewide healthcare spending and what is driving unsustainable increases.

“As we have seen across the nation and especially in our state’s ongoing battle with the pandemic, COVID-19 has not only devastated our economy, but it has turned gaps in coverage into chasms, especially for those who need it the most,” said Sara Cholhagian, executive director of Nevada’s Patient Protection Commission. “My hope is that this program will help our state address growth in healthcare spending across all populations.”

The Peterson-Milbank Program for Sustainable Health Care Costs supports state-led activities that engage cross-sector stakeholders, such as insurers, health providers, and employers, in designing, adopting, and implementing policies to measure total healthcare costs and set a statewide healthcare cost growth rate target so healthcare costs don’t outpace economic or income growth. The end goal is to stimulate data-driven systemwide action to address cost growth drivers and improve healthcare performance.

The approach is initially modeled on Massachusetts’s cost growth benchmark set in 2012. Since 2013, state spending growth has been, on average, lower than the benchmark and lower than the national rate of growth. In the commercial insurance sector, employers and individuals in Massachusetts spent about $7.2 billion less from 2013 to 2018 than they would have if the state’s spending growth had risen as fast as the national average.

To be selected, states had to demonstrate their leadership commitment — with a governor’s executive order or legislation establishing the target-setting process and resources to support it, as well as the appointment of a multi-stakeholder commission to oversee the work.

New England States Issue Regional PC Spend Report

A consortium of New England States, known as NESCSO, recently released a first-of-its-kind regional report on levels of primary care investment across six states. The analysis, based on administrative claims data for 7.2 million commercial, Medicaid and Medicare members across Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont, found that spending on primary care averaged 5.5% of overall healthcare costs. (Retail pharmacy is excluded from the denominator.) The data are largely in line with other studies of primary care spending levels, including PCC’s 2019 and 2020 evidence-based reports. Still, the NESCSO effort newly coordinates states to report on standard measures of primary care to allow for comparisons and regional benchmarking. It also attempts to capture non-fee-for-service spending, such as capitated payments and other investments, collected by states directly from payers.  
 

Delaware Sets Primary Care Investment Target

In December 2020, Delaware’s Office of Value-Based Health Care Delivery issued a new report on healthcare affordability standards that includes plans to “more than double primary care spending in the commercial fully insured market by 2025.” The office set a provisional target to increase investments in primary care by 1% to 1.5% of total cost of care each year until 2025, thus increasing primary care’s percentage of total spending from 5% in 2021 to between 9% and 11% by 2025. The report asserts that this will bring the state “to levels consistent with leading models of comprehensive primary care delivery nationally.”

Washington State Purchasers Issue Letter in Support of Efforts to Transform Primary Care

In a letter sent Jan. 26, the Washington Health Alliance (Alliance) and the Purchaser Business Group on Health, formerly Pacific Business Group on Health (PBGH), a PCC Executive Member, join with purchasers in expressing support for the state’s efforts to transform the delivery of primary care. The letter to the Washington State Health Care Authority (HCA), asks providers and health plans to “work together with those of us paying for health care services to generate new payment models that increase the proportion of health care spending on primary care.” Signers to the letter include employers and union trusts that collectively represent more than 350,000 individuals in Washington state. These purchasers include the Association of Washington Cities, King County, Puget Sound Energy, SEIU 775 Benefits Group, and the Washington Health Benefit Exchange.

The letter calls the transformation of primary care “the foundation upon which future success is built,” namely, achieving the “triple aim aspirations of health care—a better experience of care, healthier individuals and populations, and lower per capita cost of care.” Alliance Director of Performance Improvement and Innovation Karen Johnson said, “The health plans committed to working with HCA are to be commended for their leadership in collaborating to improve primary care in a manner that enables providers to focus on what is truly important – caring for patients.” Johnson added, “At the Alliance, we increasingly hear from our provider members about the need to eliminate unnecessary administrative tasks often associated with new payment models. When payers work together to align important aspects of their programs, such as common measures of success, providers are better able to focus on care delivery transformation and less on reporting on multiple measures in different formats.”

The HCA has been focused on the issue of improving primary care for more than a year. The purchaser letter follows the signing of a Memorandum of Understanding (MOU) last fall between insurance plans, the HCA, Governor Jay Inslee’s office, and the Washington State Medical Association to support the HCA’s Multi-Payer Primary Care Transformation Model. Under the MOU, insurers have committed to “use good faith efforts to contract with the practices participating in this initiative,” and medical practices “will be held accountable for meeting transformation and clinical quality metrics.” Amerigroup Washington, Community Health Plan of Washington, Coordinated Care, Kaiser Foundation Health Plan of Washington, Molina Healthcare, Premera Blue Cross, Regence BlueShield, and UnitedHealthcare have all agreed to the MOU.

Today, purchasers signing this letter will present their priorities to the HCA and health plans, specifically, that primary care be convenient and flexible, utilize a team-based approach, support patients with congoing and complex health conditions, and be culturally sensitive. In implementing new primary care payment models, the letter recommends that they be:

  • prospective rather than fee-for-service;
  • transparent in both the payment approach and amount;
  • consistent in the measures and methods used to measure performance;
  • effective in utilizing and sharing patient data to allow for optimal care for individuals and populations;
  • thoughtful in determining provider participation based on delivery of quality care; and
  • clear in identifying a patient’s primary care provider.

In addition to the HCA, the letter is being sent to leaders representing all health plans in the state, as well as the Washington Academy of Family Physicians, Washington Association for Community Health, Washington Chapter of American Academy of Pediatrics, Washington Chapter of American College of Physicians, Washington State Hospital Association, Washington State Medical Association.

PCPCC Commends Delaware for Expanding the Membership of the State’s Primary Care Reform Collaborative

The Patient-Centered Primary Care Collaborative (PCPCC) is pleased to report that Governor John Carny (D) signed Delaware Senate Bill 116  on August 7, 2019. 

This legislation expands the membership of the State’s Primary Care Reform Collaborative, creates the Office of Value-Based Health Care Delivery within the Department of Insurance, and compels the Collaborative to set a target for primary care investment by 2025

Delaware joins a growing number of states – Colorado, Oregon, Rhode Island, Vermont, Washington and West Virginia – who have passed legislation or enacted executive orders to report and/or set targets for investment into primary care.

“PCPCC is enthusiastic to see another state demonstrate its commitment to investing in primary care” said Ann Greiner, President and CEO, PCPCC, “The involvement of the Insurance Commissioner on the Primary Care Reform Collaborative gives that group added clout.  That said, we urge DE leaders to move more quickly in setting a target for primary care investment.  More investment in primary care can improve population health and help to reduce costs.”

The PCPCC is committed to working with more states on this vital issue and are gratified by the other states that passed legislation in 2019, including:

  • In Colorado, HB 19-1233Investments in Primary Care to Reduce Health Costs sets targets for investment in primary care and establishes a state-run primary care payment reform collaborative.
  • In Vermont, S.53 will analyze spending with the intent of increasing the proportion of healthcare spending allocated to primary care.
  • In 2019, Washington state appropriated $110,000 for fiscal year 2020 that is provided solely for the office of financial management to determine annual primary care medical expenditures in Washington, by insurance carrier in total and as a percentage of total medical expenditure. 

“Governor Carny and the legislators from Delaware have taken a great step forward towards providing higher quality care for their constituents.”

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About the Patient-Centered Primary Care Collaborative
Founded in 2006, the Patient-Centered Primary Care Collaborative (PCPCC) is a not-for-profit, multi-stakeholder membership organization dedicated to advancing an effective and efficient health system built on a strong foundation of primary care and the patient-centered medical home. Representing a broad group of public and private organizations, PCPCC’s mission is to unify and engage diverse stakeholders in promoting policies and sharing best practices that support growth of high-performing primary care and achieve the “Quadruple Aim:” better care, better health, lower costs, and greater joy for clinicians and staff in delivery of care.

PCPCC Applauds Colorado and Vermont for Laws that will Measure and Increase Primary Care Investment

The Patient-Centered Primary Care Collaborative (PCPCC) applauds Colorado Governor Jared Polis and Vermont Governor Phil Scott for signing into law legislation in their respective states that will enhance primary care services and payment.

The separate bills approved by each state’s legislature have a similar goal: strengthening primary care access and capability in ways that will benefit all patients. Both bills align with PCPCC’s advocacy efforts to increase primary care investment in order to realize the kind of care envisioned by the Shared Principles, care that improves population health and helps to curbs costs.

Colorado and Vermont are part of a growing movement among states—Oregon, Delaware, and Rhode Island have already enacted changes – and proposals are being considered in several other states to drive more resources into primary care services.

“PCPCC is excited to see Colorado and Vermont join the ranks of states that have made primary care investment a top priority, and we look forward to working with other state leaders on similar initiatives,” said Ann Greiner, PCPCC President and CEO. “The bills that Govs. Polis and Scott have signed into law will transform their healthcare systems in ways that will better provide high-value, relationship-based care that keeps people healthy instead of waiting until they get sick. We are committed to begin and continue work with more states on these vital issues and applaud the leadership shown by Colorado and Vermont.”

In Colorado, HB 19-1233, Investments in Primary Care to Reduce Health Costs sets targets for investment in primary care and establishes a state-run primary care payment reform collaborative.

“We were pleased to see a diverse set of stakeholders come together in Colorado to support strong primary care in our state,” said John Cawley, MD Colorado Academy of Family Physicians President. “The legislation that Governor Polis has signed into law demonstrates that ensuring access to affordable, quality primary care services is a bipartisan priority for all Coloradans, one that voters, clinicians, hospitals, health plans, and other interested parties agree on.”

In Vermont, S.53 will analyze spending with the intent of increasing the proportion of healthcare spending allocated to primary care.

 “This is a significant step that builds on Vermont’s already extensive primary care infrastructure,” said Susan Barrett, Executive Director of the Green Mountain Care Board. “The legislation signed into law by Governor Scott aligns with the focus of the Green Mountain Care Board to increase access to primary care and reduce health care costs for all Vermonters.”

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About the Patient-Centered Primary Care Collaborative

Founded in 2006, the Patient-Centered Primary Care Collaborative (PCPCC) is a not-for-profit, multi-stakeholder membership organization dedicated to advancing an effective and efficient health system built on a strong foundation of primary care and the patient-centered medical home. Representing a broad group of public and private organizations, PCPCC’s mission is to unify and engage diverse stakeholders in promoting policies and sharing best practices that support growth of high-performing primary care and achieve the “Quadruple Aim:” better care, better health, lower costs, and greater joy for clinicians and staff in delivery of care.

 

PCPCC Applauds Delaware Report Recommending Increased Investment in Primary Care

Washington, DC -- The Patient-Centered Primary Care Collaborative (PCPCC) applauds Delaware’s Primary Care Reform Collaborative (Collaborative) for its recommendations to invest more in primary care to meet the medical, behavioral, and social determinants of health of Delaware’s diverse patient population. These recommendations, if adopted, have the potential to help transform the health care system in Delaware and enhance value.

The Collaborative suggests the following recommendations:  
  • Delaware should incrementally increase primary care spending to eventually account for 12 percent of total health care spending.
  • The increase in primary care spending should include an upfront investment in infrastructure, increase the use of health information technology, support team-based care, and grow value-based incentive payments.
  • This mandate does not call for an increase in Delaware’s total health care spending and thus may result in constraints on increases for other health care costs.
  • Enforcement will occur through legislative statute or a regulatory enforcement authority, either in a new or existing agency.
  • The Collaborative will continue to work with stakeholders to enhance participation in value-based payment models, further initiatives to increase and sustain primary care workforce, and integrate Women’s Health and Behavioral Health within a primary care team model.
“The Collaborative's recommendations underscore Delaware's leadership in strengthening primary care,” said Ann Greiner, president and Chief Executive Officer of the PCPCC. “Research shows that advanced primary care reduces unnecessary specialist referrals, hospitalizations, and emergency room visits with better health outcomes for patients.”

“We know to improve health care in Delaware we must improve our system of primary care,” said Dr. Kara Odom Walker, Cabinet Secretary for the Delaware Department of Health and Social Services. “In order to strengthen our primary care workforce, we must invest in that care and find ways to incentivize front-line providers to perform as coordinated teams that are ultimately accountable for population health.”

The Collaborative consists of diverse state leaders and aims to develop annual recommendations to strengthen primary care in Delaware by collecting input from stakeholders in both the health care and patient communities, as well as from other model states. The Collaborative was created in August 2018 after Governor John Carney Jr. signed into law Senate Bill 227, legislation designed to strengthen primary care services and payment.
 
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The Patient-Centered Primary Care Collaborative
Founded in 2006, the Patient-Centered Primary Care Collaborative (PCPCC) is a not-for-profit multi-stakeholder membership organization dedicated to advancing an effective and efficient health system built on a strong foundation of primary care and the patient-centered medical home. Representing a broad group of public and private organizations, PCPCC’s mission is to unify and engage diverse stakeholders in promoting policies and sharing best practices that support growth of high-performing primary care and achieve the “Quadruple Aim”: better care, better health, lower costs, and greater joy for clinicians and staff in delivery of care.
 
PCPCC is and will position itself as an advocacy organization—a coalition that serves as a “driver of change,” educating and advocating for ideas, concepts, policies, and programs that advance the goals of high-performing primary care as the foundation of our health care system. For more information about PCPCC, visit www.pcpcc.org

For more information on nationwide primary care investment efforts, visit www.pcpcc.org/primary-care-investment

MEDIA CONTACT
Allison Gross
(202) 417-2075 
[email protected]

PCPCC Applauds Delaware Law to Strengthen Primary Care

For Immediate Release: CONTACT: Allison Gross; (202) 417-2075; [email protected] 

Washington, DC (August 29, 2018) - The Patient-Centered Primary Care Collaborative (PCPCC) applauds Delaware Governor John Carney Jr. for signing into law Senate Bill 227, legislation designed to strengthen primary care services and payment.

SB 227 is directly in line with PCPCC’s legislative efforts to increase primary care investment in order to realize the kind of care envisioned by the Shared Principles. “Research shows that greater investment in primary care improves population health and helps to curb costs, said PCPCC’s President and Chief Executive Officer, Ann Greiner. “SB 227 pushes Delaware to the leading edge of healthcare reform and should serve as a beacon to primary care efforts nationwide.”

The law promotes the use of primary care through several approaches, including mandating that payers reimburse primary care physicians and other front-line practitioners for chronic care management and primary care at no less than the physician Medicare rate for the next three years; requiring payers to participate in the Delaware Health Care Claims Database; and creating the Primary Care Reform Collaborative (the Collaborative) under the Health Care Commission. The Collaborative will issue written recommendations by January 8, 2019, regarding appropriate levels of system-wide primary care investment, including an evaluation of whether 12% of health care spending should be directed to primary care and how primary care contributes to helping the state reach cost spending benchmarks. 

“As we change the way healthcare is paid for and delivered in Delaware, strengthening primary care is one of the most important pieces we need to address,” said Dr. Kara Odom Walker, Cabinet Secretary for the Delaware Department of Health and Social Services and a board-certified family physician. “Primary care is the foundation for promoting and delivering better health for all Delawareans and is critical in embracing value-based care – the idea that reimbursements are tied to providers’ success at keeping patients healthy.”

Delaware is the latest state to take action to strengthen primary care access and capability.  Leaders in Oregon and Rhode Island have already taken steps to drive additional resources to primary care in order to support the kind of care envisioned in PCPCC’s Shared Principles of Primary Care. Leaders in several states are working to enact similar changes, with progress in Colorado, California, and Vermont.

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About the Patient-Centered Primary Care Collaborative

Founded in 2006, the Patient-Centered Primary Care Collaborative (PCPCC) is a not-for-profit multi-stakeholder membership organization dedicated to advancing an effective and efficient health system built on a strong foundation of primary care and the patient-centered medical home. Representing a broad group of public and private organizations, PCPCC’s mission is to unify and engage diverse stakeholders in promoting policies and sharing best practices that support growth of high-performing primary care and achieve the “Quadruple Aim”: better care, better health, lower costs, and greater joy for clinicians and staff in delivery of care.

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