PCC Winter 2020 Newsletter
 
 

In This Issue
Click on a link below to be taken to that article.

Message from the President & CEO
Happy Holidays from the PCC
PCC Releases 2020 Evidence Report on Primary Care Investment
Policy & Advocacy Update
PCC, Two Employer Groups Announce New Attributes of Advanced Primary Care
New PCC Issue Brief on Multi-Stakeholder Advisory Groups
PCC Presents its Annual Awards for Excellence in the Field
PCC Presents its Top Achievements of the Year
New Articles, Research & Resources
PCC Webinars
Upcoming Conferences, Webinars & Events
Consider PCC Membership in 2021
 

Message from
Ann Greiner,
President & CEO





Dear Colleagues,

We are just coming off our annual conference, which we held online this year. The conference was followed by a invitation-only workshop of PCC Executive Members, state leaders, and others. They gathered virtually to discuss the PCC’s new 2020 Evidence Report and next wave of state-level primary care investment efforts. It was great to engage with so many of you in the PCC and wider communities at both of these events.
 
Upon reflection, it was good to hold these events later than usual given all the positive energy they generated toward transforming primary care as we head into 2021 with a new Congress, new administration and new state legislatures.
 
Much of this newsletter keys off those events, including the exciting joint announcement with the Pacific Business Group on Health and the National Alliance of Healthcare Purchaser Coalitions about new attributes of advanced primary care, the presentation of the PCC’s annual awards, and the PCC’s Evidence Report: Primary Care Spending: High Stakes, Low Investment.
 
COVID-19 has underscored the relevance of the Evidence Report’s findings of national and state-level investment in primary care between 2017 and 2019. The report showed low and declining investment in primary care during this period, which has not positioned our health system well for the onslaught of the pandemic. This reality has proved challenging for primary care clinicians and their ability to care for patients, including those from marginalized and vulnerable communities. And yet, primary care has proved resilient and quickly innovated to meet patient needs. 
 
Please take a few minutes to watch an inspiring video that opened our annual conference and gets at the heart of how primary care re-invents itself to respond to patients (immediately below). I also urge you to read the Evidence Report. We welcome your feedback and engagement on the report’s findings.
"Primary Care Strong"
As 2020 draws to a close, we have taken a look back at what has transpired. We want to share our Top Ten Accomplishments of 2020, made possible because of the work of so many of you. If you are not yet a PCC Executive Member, we urge you to consider joining us!
 
Wishing you and your family a restful, safe and happy holiday season and a happy new year,
 

Happy Holidays from the PCC

The staff of the Primary Care Collaborative wish you and yours happy, safe and healthy holidays. It has been a pleasure engaging with you this year and sharing in the work of making primary care better, more robust and more responsive to patients' needs and preferences. We look forward to continued work with you in 2021.
 

PCC Releases 2020 Evidence Report on Primary Care Investment
The U.S. health system’s investment in primary care, as measured by primary care spending, is low and declined between 2017 and 2019, both nationally and in a majority of states, according to the PCC’s recently released 2020 Evidence Report, Primary Care Spending: High Stakes, Low Investment. The findings support a growing body of literature showing that health systems with a foundation of robust, comprehensive primary care achieve better, more equitable health outcomes and are less costly.
 
These findings are particularly relevant in the context of COVID-19, which has affected primary care practices financially, with implications for primary care clinicians and their ability to care for patients, including those from marginalized and vulnerable communities.
 
Key findings of Primary Care Spending: High Stakes, Low Investment:
  • National spending falls: In 2019 primary care spending across commercial payers was only 4.67% of total national commercial healthcare spending, falling from 4.88% in 2017.
  • Spending across states varies: The primary care spending percentage across states varied from a low of 3.14% in Kentucky to a high of 9.48% in Michigan in 2019 using a narrow definition of primary care providers and services, and from a low of 5.57% in Pennsylvania to a high of 16.64% in Mississippi using a broad definition of primary care spending. Both the narrow and broad definitions vary by a factor of 3 between the highest- and lowest-spending states.
  • Spending in most states falling: The negative trend in primary care spending over a three-year period (2017 to 2019) was observed across 39 states when using a narrow definition of primary care clinicians and services and across 30 states when using a broad measure.
  • Higher spending has health benefits: This year’s report, like PCC’s 2019 report on state-level spending in primary care, documents an association between higher primary care spending at the state level and fewer emergency department visits, hospitalizations, and preventable hospitalizations. 
“This study and others have shown that, unfortunately, the U.S. is moving away from primary care, despite the evidence that it is associated with better value, including enhanced population health, greater equity, and more efficient use of healthcare resources,” said Darilyn Moyer, MD, FACP, FRCP, FIDSA, chair of the PCC’s board of directors and Executive Vice President and CEO of the American College of Physicians. “This report highlights to what extent our health system is oriented toward primary care by looking at one of the indicators of it—spending on it."
 
“This report is a three-alarm fire,” said Ann Greiner, PCC’s President and CEO. “The primary care platform was shrinking—and then the pandemic hit. Primary care practices were slammed financially and did their best to respond to patients’ needs, but they have been hamstrung. Patients, particularly those in vulnerable and marginalized communities, are the collateral damage.”
 
The report is the second consecutive year that the PCC has reported primary care spending nationally and at the state level. The report also confirms an association between higher primary care spending at the state level and fewer emergency department visits, hospitalizations, and preventable hospitalizations, documented in the PCC’s 2019 research report.
 
Also available:
We hope you find the report and its findings useful in your work of advocating for new policies to transform primary care. PCC staff are available to speak to your organization about the report, individually or in group and public settings, such as webinars. Please contact us!
 

Policy & Advocacy Update

Final Physician Fee Schedule Includes Wins for Primary Care


Earlier this month, CMS issued the final rule for the calendar year 2021 Medicare physician fee schedule. The rule retains increases to office-based Evaluation & Management (E/M) services and provides additional payments for visit complexity and prolonged visits. The increases are paid for through a reduction to the conversion factor - leading to strong opposition by many specialist groups. Telehealth services are also expanded under the final rule, though most will only remain in effect through the public health emergency; once the rule expires, site-based and geographic restrictions will return unless Congress takes action.
 

Primary Care First Participants Announced


CMMI recently announced the first cohort of participants in its Primary Care First model, a voluntary, five-year alternative payment model. Participants include 916 primary care practices and 37 “regional partnerships with commercial, State and Medicare Advantage plans.” Humana is among the payers that have signed on, with plans to offer the model to primary care clinicians across 48 states and Washington, D.C. CMS’s version of Primary Care First begins January 1.


Details Released on Geographic Direct Contracting Model


CMMI has released details on its new payment model, Geographic Direct Contracting (known as “Geo”). The model takes a geographic-based approach to care, with Direct Contracting Entities taking responsibility for the total cost of care for traditional Medicare beneficiaries in a specific region. These entities, which include health systems, ACOs, healthcare provider groups, and health plans, “will assume financial risk in return for enhanced flexibilities,” such as preferred provider networks and care coordination and clinical management. Geo will include two three-year performance periods, with the first beginning on January 1, 2022.
 

State Primary Care Investment Efforts Advance in Pennsylvania and Colorado


Pennsylvania Gov. Tom Wolf (D) has signed Executive Order 2020-05, establishing an Interagency Health Reform Council to "to evaluate the potential alignment of Commonwealth health care payment and delivery systems to provide efficient, whole-person health care that also contains costs, reduces disparities, and achieves better health outcomes for Pennsylvanians." Part of the council's responsibilities include setting spending targets for primary care and behavioral health to promote whole-person care in the state. And in Colorado, the Division of Insurance is nearing work to finalize a new primary care investment regulation that proposes to increase primary care investment in the state by one percentage point in 2022 and 2023. The proposal also includes new alternative payment model (APM) spend targets, including requiring 25% of payments to primary care to be made prospectively by the end of 2022.  
 

PCC, Two Employer Groups Announce New Attributes of Advanced Primary Care
The PCC, the National Alliance of Healthcare Purchaser Coalitions (National Alliance) and the Pacific Business Group on Health (PBGH) announced Dec. 1 ways the Shared Principles of Primary Care can be applied and realized in practice. These organizations jointly released a new set of attributes to characterize advanced primary care (APC), a practice that shifts the focus of primary care toward quality.
 
The attributes further develop the Shared Principles, created by over 100 organizations under the auspices of the PCC and FMAHealth and introduced in October 2017. To date, more than 350 organizations representing diverse healthcare stakeholders have adopted them. As employer groups, the National Alliance and PBGH have each developed employer-identified attributes of APC that were brought together by the PCC and aligned.
 
The announcement of the APC practice attributes was made by Elizabeth Mitchell, PBGH’s President and CEO, in the closing keynote address of the PCC’s annual conference, held online Nov. 30 and Dec. 1. In her announcement, Mitchell outlined how employer-identified attributes of APC conform to the Shared Principles and explained the new set of APC characteristics.
 
The three organizations see the set of attributes as a next step on the path to achieving APC. The PCC expects that these attributes will evolve as other stakeholders in primary care learn about them and seek to leverage them in their work to transform primary care delivery and payment. The work ahead includes developing ways to assess if a primary care practice has achieved APC according to these new attributes, including measures reported by and about patients, as input into purchasing and contracting decisions.
 
In addition to being rooted in the Shared Principles of Primary Care, the set of attributes was developed out of the National Alliance’s “Improving Healthcare Value with Advanced Primary Care” and PBGH’s “Advanced Primary Care: Defining a Shared Standard.”
 
“We applaud the leadership of the PBGH and the National Alliance, who understand that primary care is the foundation of a high-value health system,” said Ann Greiner, the PCC’s President and CEO. “The articulation of practice attributes is critical to turning our vision for advanced primary care into reality. We are pleased that the attributes focus on comprehensive, whole-person care and recognize that we will not achieve this unless we both invest more in primary care and pay primary care differently.”
View the new set of attributes
 

New PCC Issue Brief on Multi-Stakeholder Advisory Groups
The PCC recently released a new issue brief - Lessons Learned from Multi-stakeholder Advisory Groups. States have been leaders in catalyzing investment in primary care, but they can't transform primary care on their own. States must inspire clinicians, payers and other key stakeholders to join and align their efforts. The brief looks at the different models and approaches states have taken to establish and convene primary care advisory groups and the functions these groups perform. We hope the brief spurs discussion and greater recognition of the important role multi-stakeholder groups play in the long-term success of transforming primary care.
Go to the issue brief
 

PCC Presents its Annual Awards for Excellence in the Field
During its Virtual Annual Conference, held online Nov. 30 and Dec. 1, the PCC announced the recipients of its three annual awards for 2020. The awards recognize individuals and a practice in the primary care community that exemplify excellence in providing high-value primary care and shaping the policies that support such care.
Barbara Starfield Primary Care Leadership Award (Rebecca Etz)

Barbara Starfield Primary Care Leadership Award:


Rebecca S. Etz, PhD, Associate Professor of Family Medicine and Population Health at Virginia Commonwealth University and Co-Director of the Larry A. Green Center
 
The PCC established the Barbara Starfield Award in 2012 to honor Dr. Starfield, recognizing her enduring commitment to the philosophy that all individuals should receive comprehensive, coordinated, and person-focused care. The award is presented to an individual who demonstrates exceptional work toward advancing the goals of primary care and, in particular, a strong commitment to person-focused care.
 
Etz is a cultural anthropologist and has spent the last number of years working with practices and policy makers on primary care-related measurement, professionalism, and vision.
 
Read more about Etz’s accomplishments
 
“Starting on March 13, the Green Center, under Rebecca Etz’s leadership, acted swiftly to field a regular, national survey of primary care clinicians,” said Ann Greiner, PCC’s President and CEO. “The field has greatly benefited from this work, which involves hundreds of partners, including the PCC. Together we have gotten the word out about the challenges primary care faces, about primary care bright spots with respect to pandemic responses, and articulated key policies needed to support primary care.”
Primary Care Community Leadership/Research Award presentation (Tom Leyden)

Primary Care Community Leadership/Research Award:


Tom Leyden, MBA, Director II of the Value Partnerships Program of Blue Cross Blue Shield of Michigan (BCBSM)
 
The Primary Care Community Leadership/Research Award is presented to an outstanding individual who has demonstrated remarkable leadership and/or research to ensure that primary care is foundational to community or state healthcare-reform efforts.
 
Read more about Leyden’s accomplishments
 
“BCBSM’s leadership – including Tom Leyden – have been instrumental in evolving and strengthening the PCMH model and in achieving significant results in Michigan,” said Ann Greiner, PCC’s President and CEO. “One of its most important features is the strong BCBSM commitment to engaging the clinical community in defining and executing the program. This kind of partnership has made all the difference.”
Advanced Primary Care Practice Award (Share Our Selves)

Advanced Primary Care Practice Award:


Share Our Selves, an organization that provides medical and other services in Orange County, California
 
The Advanced Primary Care Practice Award recognizes an organization that is an extraordinary primary care practice. This practice serves as a model for transformation through innovation as reflected in the Shared Principles of Primary Care, including patient- and family-centered, team-based care and high value.
 
Read about Share Our Selves
 
“Share Our Selves is the embodiment of the Shared Principles of Primary Care, which envision a patient-centered, team-based approach to delivering comprehensive primary care,” said Ann Greiner, PCC’s President and CEO. “The 350-plus organizations that have signed onto the Shared Principles will be delighted to learn about the award to Share Our Selves. Seeing the achievement of the Shared Principles’ vision is incredibly exciting.” 
 

PCC Presents its Top Achievements of the Year
It’s been quite a year – full of challenges, for sure, but also full of opportunities. Throughout 2020, the PCC seized these opportunities and worked to advance a better, stronger and more equitable primary care system.

See our Top Ten Accomplishments of 2020 for our major areas of work and biggest achievements. The best part of this year has been doing these things with you and with your engagement – Executive Members, leaders and champions of primary care.
 

New Articles, Research & Resources

Issue Brief: A More Perfect Health Care System: Leaning Forward on Primary Care


From the Alliance of Community Health Plans, which presents principles and action steps for reinvigorating primary care as the fundamental building block to healthier communities
 

Caring for People with Mental Health and Substance Use Disorders in Primary Care Settings: Proceedings of a Workshop


From The National Academies of Sciences, Engineering, and Medicine
In an effort to understanding the challenges and opportunities of providing essential components of care for people with mental health and substance use disorders in primary care settings, the National Academies’ Forum on Mental Health and Substance Use Disorders convened three webinars held in June, July and August. The webinars addressed efforts to define essential components of care for people with mental health and substance use disorders in the primary care setting for depression, alcohol use disorders, and opioid use disorders; opportunities to build the health care workforce and delivery models that incorporate those essential components of care; and financial incentives and payment structures to support the implementation of those care models, including value-based payment strategies and practice-level incentives. This publication summarizes the presentations and discussion of the webinars.
 

Will We Ever Get Off This Escalator?


A Nov. 9, 2020, Health Affairs blog post by William Kramer, executive director for national health policy at the Pacific Business Group on Health, who comments on the report in Health Affairs by Gary Claxton and colleagues, “Health Benefits In 2020: Premiums In Employer-Sponsored Plans Grow 4 Percent; Employers Consider Responses To Pandemic”: “…the classic chart summarizing the trend in average annual premiums shows the same relentless increase in premiums that we have seen for more than 20 consecutive years…We have made little or no progress in addressing the enormous inefficiency and waste in our health care system…just continued pain and burden on employers and workers.”
 

Research article: Changes In Coverage And Access To Dental Care Five Years After ACA Medicaid Expansion


Nov. 2020

With the implementation of the Affordable Care Act (ACA), millions of low-income adults gained health coverage. We examined how the ACA’s expansion of Medicaid eligibility affected dental coverage and the use of oral health services among low-income adults, using data from the National Health Interview Survey from the period 2010-18. We found that the ACA increased rates of dental coverage by 18.9 percentage points in states that provide dental benefits through Medicaid. In terms of utilization, expansion states that provide dental benefits saw the greatest increase in people having a dental visit in the past year (7.2 percentage points). However, there was no significant change in the overall share of people who had a dental visit in the past year, although the expansion was associated with a significant increase in this metric among White adults. The expansion was also associated with a 1.4-percentage-point increase in complete teeth loss, which may be a marker of both poor oral health and the potential gaining of access to dental services (with subsequent tooth extractions). Our findings suggest that in addition to expanded coverage, policies need to tackle other barriers to accessing dental care to improve population oral health.
 

PCC Webinars

Most Recent PCC Webinars

 

Making the Call on the Best Use of Telehealth in Primary Care

October 21
At the beginning of the pandemic, telehealth use skyrocketed because clinicians and patients needed to be safe while providing and receiving needed care. Now, with many months of experience in heavy telehealth use, it’s worth taking stock of its profusion into primary care and evaluating which policies and practices make sense to continue in order to achieve the best health outcomes, advance efficiencies in care, and meet patient needs and preferences. This webinar examined ways primary care can prepare for a post-pandemic future and integrate telehealth into primary care practices in the right way. It looked at how telehealth can become a regular tool of primary care without fracturing it or weakening the clinician-patient relationship.

Panelists:

  • Chuck Ingoglia, MSW, President & CEO | National Council for Behavioral Health, and member of the NCQA, ATA and ACC Taskforce on Telehealth Policy
  • Steven J. Kravet, MD, MBA, President | Johns Hopkins Community Physicians
  • Beth R. Smolko, DMSc, MMS, PA-C, President | American Academy of PAs

Moderator: Christine Bechtel, Co-Founder | X4 Health

 

Primary Care's Got Your Back to School

September 21
For many, this year’s back-to-school season during a protracted pandemic is fraught with health risks and questions about student and teacher safety. Parents and teachers are concerned about the spread of the coronavirus in schools and between schools and homes. Primary care can help families navigate these uncharted waters. This webinar examined the role of primary care for children in the risk assessment, prevention, and treatment of COVID-19 as well as in addressing related behavioral health needs and inequities in care. The webinar also addressed planned vaccinations.

Panelists:

  • Chip Hart | Consulting group director, PCC Pediatric EHR Solutions
  • Nathaniel Beers, MD, MPA, FAAP | President, HSC Health Care System (Washington, D.C.)
  • Ashraf Affan, MD | President, Angel Kids Pediatrics (Jacksonville, Florida)

Moderator: Sarah Greenough, MPP | Director of Policy, Primary Care Collaborative
Watch past webinars
 

Upcoming Conferences, Webinars & Events
PCC's Online Event Calendar
These and other webinars and conferences are listed on PCC's event calendar on its website. Updated regularly, the calendar lists events of interest to the primary care community.
 

Webinar: Telehealth: Opening New Doors for Mental Health Care during COVID-19


TODAY! Tuesday, December 15, 3:00 p.m. ET
Join Mental Health America (MHA)'s Regional Policy Council (RPC) for a discussion of policy changes that are helping people access telementalhealth services. After months of social distancing, MHA’s national data reflects a tremendous increase in the number of youth and adults taking a screening; screening positively and more severely; experiencing loneliness and isolation and having recurring thoughts of suicide or self-harm. During the time of COVID-19, getting in-person help may not be a desirable option. Fortunately, recent expansion of telehealth coverage and services has allowed more people to receive mental health support where they feel safe, at home.


Vaccine Confidence: Information Gathering Session


Friday, December 18, 11:30 a.m.-4:00 p.m. ET
To inform a forthcoming rapid expert consultation on building public confidence in SARS-CoV-2 vaccines, the Societal Experts Action Network (SEAN) of the National Academies of Sciences, Engineering, and Medicine will hold an information gathering session on vaccine confidence. The session will cover the current state of vaccine confidence, reasons for hesitancy, and best practices for messaging. Facilitated discussions will incorporate special attention to communities at higher risk of contracting and dying from COVID-19, including underserved and vulnerable communities. Drawing from what is known about reaching and engaging diverse audiences to change beliefs and attitudes, this session will illustrate strategies that are likely to promote uptake of FDA-approved vaccines to prevent COVID-19.


Solving for Sleep SAMHSA Webinar Series

Integrating Care Through a Biopsychosocial Approach to Health
The Primary Care Development Corporation, in collaboration the SAMHSA Center of Excellence for Integrated Health Solutions, is engaging in a year-long virtual initiative focused on addressing sleep and related social and health needs through enhancing integrated primary and behavioral health care. This initiative will include live virtual learning opportunities, free tools and resources, and linkage to experts in the field. An anchor for the year will be a monthly webinar series focused on building foundations and advanced applications of sleep knowledge. Webinar sessions are 60 minutes each with a follow-on open "office hour" for Q&A with experts.

Remaining webinars:
All are 1:00-2:30 p.m. ET on the days indicated
  • Unseen Impacts: Health Disparities and Sleep | January 7, 2021
  • Sleep: Behavioral Health Lens on Sleep: Assessment and Intervention | February 4, 2021
  • Sleep: One Good Night: Experiences of Insomnia for Patients and Families Across the Lifespan | March 4, 2021
  • Physical Health and Primary Care Lens on Sleep: Assessment and Intervention | April 1, 2021
  • What about Us? A Discussion with and for Healthcare Providers | May 6, 2021


Medical Director Leadership Institute

Center for Primary Care at Harvard Medical School
Six-month virtual offering: January 14, 2021 to June 12, 2021
First Thursday of each month, 10:00 a.m.-1:00 p.m.
 
 

Become a PCC Executive Member in 2021!

Executive Membership in PCC comes with many benefits. Becoming an Executive Member allows you to:
  • Connect and network with organizations and individuals from different stakeholder groups who share a common commitment to furthering primary care
  • Contribute to the PCC’s policy and advocacy work 
  • Receive the monthly member-only e-newsletter that highlights policy developments, upcoming events, and key issues related to primary care 
  • Join and become an active participant in PCC's three workgroups
  • Receive discounts on event registrations 
  • Sponsor events and initiatives   
  • Do much more 
Visit the Executive Member page for more information, and watch the short (less than 2 minutes) video below that features organizations and why they chose to become Executive Members.
 
If you have questions about the membership process or benefits or would like to schedule a conversation about joining the PCC, please contact: 
 
Jennifer Renton
Membership Coordinator
membership@thePCC.org
 
Get more information and apply for membership
 

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  • upcoming PCC webinars
  • PCC’s upcoming virtual annual conference (Nov. 30-Dec. 1)
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  • news and developments in primary care
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