Advocacy & Policy Updates

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.

The Primary Care Collaborative (PCC) welcomed the Taskforce for Telehealth Policy’s (TTP) charge in June to examine key considerations that are front-of-mind for primary care in the age of COVID: how does telehealth impact quality, coordination, and costs? The Taskforce’s final report offers initial findings and recommendations that should be considered as policymakers chart the road ahead for telehealth now and post-pandemic. Many of these are sensible and important, while a few recommendations need further shaping. In light of the TTP’s final report, PCC calls on policymakers to:

1. Embed telehealth within existing advanced primary care and alternative payment models
2. Continue to provide telehealth parity until a COVID-19 vaccine is widely distributed
3. Support comprehensive, prospective payment for primary care that allows for flexible integration of telehealth
4. Address the underlying factors that contribute to and exacerbate health inequities, including those that are connected to telehealth

The PCC is among many national organizations throwing their support behind the Broadband Reform and Investment to Drive Growth in the Economy (BRIDGE) Act of 2020, introduced this summer by U.S. Senator Michael Bennet (D-Colo.), who said the bill will deploy affordable, “future-proof” broadband networks nationwide. Senator Angus King (I-Maine) also supports the legislation, along with dozens of national and state-level elected officials and organizations. 

“The coronavirus pandemic has brought into focus a 21st century reality: access to high-speed, affordable broadband is critical infrastructure that helps Americans across the nation operate their businesses, pursue their education, access telehealth, and interact with their communities,” said King. “Unfortunately, too many rural communities don’t have access to this vital tool, leaving them at risk of being left behind.”

As the regular surveys of primary care clinicians and patients conducted by the PCC and the Larry A. Green Center since March have shown, primary care pivoted to telehealth very quickly when stay-at-home orders were put into place and has depended on it as patients seek care but are not able to visit their primary care practices in person. Telehealth services are dependent on reliable internet networks, and networks moving to unserved and underserved areas will enable primary care to address health inequities, which sometimes follow the technological divides among population groups.

"As the pandemic keeps millions of families at home, it has never been more urgent to extend the benefits of affordable, high-speed broadband to every American,” said Bennet. “For years, the digital divide has prevented up to 42 million Americans—disproportionately from rural areas, low-income neighborhoods, and communities of color—from being able to fully participate in modern American life.”  

In an op-ed published today, Bennet emphasized how the pandemic has pushed Americans to rely on high-speed broadband more than ever to work, learn, and connect remotely. However, up to 42 million Americans still lack access to broadband. Bennet and King’s BRIDGE Act helps close this gap by providing $30 billion to states and $1 billion to tribal governments to deploy broadband in unserved and underserved communities nationwide and ensuring newly built networks meet minimum requirements for speed, service, and affordability. The legislation empowers communities to deploy their own broadband networks if they wish and makes them eligible for financial support. Finally, the legislation accelerates an overhaul of the Federal Communications Commission’s (FCC) broadband maps, which consistently overstate broadband access in America—especially in rural areas.

Read the full text of the bill. (also available: a section-by-section summary and a one-page summary)

Support for the BRIDGE Act from national organizations:

• Primary Care Collaborative
• American Library Association
• American Psychological Association
• Consumer Reports
• Fiber Broadband Association
• Institute for Local Self-Reliance
• National Association of Realtors
• National Farmers Union
• National Rural Health Association
• Public Knowledge
• Schools, Health & Libraries Broadband Coalition

Today (June 1) begins a week of national advocacy for primary care. The PCC and many other organizations are part of this campaign, called #saveprimarycare. We are reaching out to Congress and the administration to call for dedicated funding to primary care to help practices continue to serve patients during the public health and economic crisis posed by the coronavirus.

As part of the campaign, PCC, representing over 60 organizations, today sent a letter to Department of Health and Human Services Secretary Alex Azar urging him “and the Department of Health and Human Services (HHS) to make an immediate, targeted allocation from the Provider Relief Fund (PRF) to primary care clinicians and/or practices in order to offset reduced revenue and increased costs associated with COVID-19. The targeted allocation that HHS has already made to rural hospitals from the PRF should serve as a model for primary care.”

PCC will also be sharing campaign messages on its Facebook and Twitter pages this week. You are encouraged to join the campaign by reposting our social media messages or your own messages. Be sure your posts (especially on Twitter) include the campaign’s hashtag—#SavePrimaryCare—and tag Secretary Azar (@SecAzar) and his agency HHS (@HHSgov).