Advocacy & Policy Updates

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.

PCC Submits Primary Care Policy Priorities to Incoming Biden Administration

As president-elect Joe Biden and his administration prepare to take office on January 20, PCC has prepared a list of policy priorities in primary care that were submitted to Biden's transition team in late December. In sharing the priorities, PCC said that it "is eager to work with the new administration to ensure a strong primary care foundation to serve Americans both during and after the pandemic. Through its diverse executive membership, PCC is uniquely positioned to convene many of the key stakeholders in primary care to contribute to the president’s vision for healthcare reform and COVID response."

The PCC's priorities for the administration are:

  1. Support primary care’s ability to respond to, and sustain through, the pandemic.
  2. Strengthen CMS payment and delivery reform models.
  3. Advance health equity for patients. 

See the details of these priorities in the full document submitted to the Biden transition team.

PCC Telehealth Statement (October 2020)

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

PCC Supports Proposed 2021 Medicare Physician Fee Schedule

The PCC sent a letter today to the Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma to voice its strong support of CMS’s proposed Medicare Physician Fee Schedule (MPFS) for calendar year 2021. The letter stated that the "proposed MPFS moves toward fundamentally correcting the longstanding undervaluation of primary care services by retaining increases to office-based Evaluation & Management (E/M) services finalized in the CY2020 MPFS and set to take effect this January." The PCC also stated that the increased investment was essential—though not sufficient—to achieving high-performing primary care and that "it must also be accompanied by rapid movement toward global payments that are prospective and comprehensive."

Read the full letter.

PCC Endorses Bill That Would Support Telehealth by Expanding Broadband Coverage

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

 

 

 

 

PCC Among 340 Organizations Sending Letter to Congress Urging Action on Telehealth

PCC is among the 340 organizations that sent a letter today urging congressional leaders to make telehealth flexibilities created during the COVID-19 pandemic permanent. Organizations signing this multi-stakeholder letter include national and regional organizations representing a full range of healthcare stakeholders and all 50 states, the District of Columbia, and Puerto Rico.

Congress quickly waived statutory barriers to allow for expanded access to telehealth at the beginning of the COVID-19 pandemic, providing federal agencies with the flexibility to allow healthcare providers to deliver care virtually. If Congress does not act before the COVID-19 public health emergency expires, current flexibilities will immediately disappear.

Therefore, 340 stakeholders have sent a powerful message to Congress outlining the immediate actions necessary to ensure CMS has the authority to continue to make telehealth services available once the national health emergency is rescinded:

  • Remove obsolete restrictions on the location of the patient to ensure that all patients can access care at home and other appropriate locations;
  • Maintain and enhance HHS authority to determine appropriate providers and services for telehealth;
  • Ensure Federally Qualified Health Centers and Rural Health Clinics can furnish telehealth services after the public health emergency; and
  • Make permanent Health and Human Services (HHS) temporary waiver authority for future emergencies.

While federal agencies can address some of these policies going forward, the Centers for Medicare and Medicaid (CMS) does not have the authority to make changes to Medicare reimbursement policy for telehealth under the outdated Section 1834(m) of the Social Security Act. Following these priorities will allow CMS to build on the experience gained during the pandemic and expand access to telehealth in a thoughtful, data-driven way.

Read the letter to Congress, including the list of 340 stakeholders

PCC Joins #saveprimarycare Campaign to Call for Dedicated Funding to Primary Care

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).

The PCC Signs on to Families USA's "Give Families and and States COVID-19 Support Now" Comment Letter

The PCC recently signed on to Families USA's letter to Congress, urging them to pass legislation that provides aid allowing fiscal assistance for the COVID-19 pandemic. 

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