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Connecticut Should Lead Primary Health Care Cost Reform

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In March, the Insurance and Real Estate Committee advanced HB 5042: Health Care Cost Growth Act with unanimous and bipartisan support. This bill is an important step in addressing the rising cost of health care in Connecticut while improving the quality of health care. As the legislative session draws to a close, we are calling for action on this progressive and important measure.

One of the elements of this legislation is the establishment of benchmark expenditures for primary care, guaranteeing the necessary funding for efforts to provide patients with high-value comprehensive, preventive and coordinated care. The American College of Physicians (ACP) strongly supports this increase in primary care commensurate with its value in achieving better outcomes while limiting the growth of exponentially rising costs.

As the largest medical specialty organization in the United States, representing more than 160,000 internal medicine physicians and related subspecialists, including 2,300 in Connecticut, we see the benefits to patients every day who have access to primary care. high quality and the barriers and poorer health outcomes faced by those who don’t.

Rather than limiting access, this bill’s benchmarks would improve it for other essential, but often hard to find, foundational services, such as mental health care. Given the crucial nature of mental health care, these services are increasingly integrated effectively into primary care practices rather than being seen as stand-alone specialist practices. With increasing primary care expenditures, the barriers to needed care that can be removed far outweigh those erected, as access and opportunity to comprehensively engage in behavioral health care increases. True specialist and sub-specialist care can often be elusive and much of the pre- and post-assessment work is done in primary care, again underscoring the essential nature of strengthening this fundamental service.

Some concerns have been raised about the transition from the traditional fee-for-service model that reimburses based on procedures and visits performed to global payments. It is important to note that this legislation does not require, impose or offer the use of any of these alternative payment models.

In the event that one of these models is adopted, there is certainly a theoretical risk of underutilization given the risk-adjusted prepayment, and the best plan may be a combination of these: overall mixed payment and fee-for-service; population-based models; and appropriate quality-based measures.

It is also important to recognize that these should be compared to fee-for-service plans where there is an inherent financial incentive to do more with fewer opportunities for implementing high-value quality indicators developed appropriately.

Physicians and other health care practitioners should not allow financial considerations to affect their clinical judgment or advice to patients about treatment options, including referrals to needed specialist services and care; actions should always be guided by the best interests of the patient and appropriate use.

Although we are deeply concerned about the quality of care provided to our patients, neither the CPA nor its members have any personal financial interest in the outcome of this legislation and any changes in the distribution of healthcare expenditure will not affect not the incomes of individual practitioners.

Some estimates suggest that the implementation of this bill will result in a substantial price burden based on actuarial projections of past national data. While total spending under this legislation would continue to grow, uncontrolled growth would be limited by tying it to economic growth and median income. Thus, the realistic cost based on payment data in Connecticut is likely much lower than these other projections, but can still provide a significant boost to needed primary care funding.

By ensuring that a higher proportion of funding is dedicated to additional and adequate primary care funding, costs over time can be reduced through reduced hospital admissions, reduced emergency room use and effective coordination of care. With these savings and without any reduction in overall expenses, commercial for-profit insurers no longer need to reduce covered services provided to consumers and patients.

A final element that the legislation seeks to address is primary care clinician burnout, which is a critical issue facing the country and the state. More than one in five practitioners providing primary care across the country is now set to retire within the next two years and Connecticut is poised to feel a significant impact with one of the oldest primary care workforces. from the country. This known and existing shortage will only get worse without mechanisms to support and strengthen this essential service.

In some ways, the proposed change seems radical to many. For us, it is necessary and the current environment is unsustainable. There are already myriad issues of access to care among many marginalized populations, made even clearer during the pandemic.

Increased primary care resources will increase the ability to interact with a personal primary care clinician who knows the patient intimately and can appropriately facilitate the necessary specialist care.

Several states, including Delaware, Rhode Island, Oregon, Washington, and Colorado, have introduced or recently passed similar legislation with promising effects. Other states, including California, have recognized the importance of this and are seriously considering a similar proposal.

We encourage Connecticut to lead and pass this legislation, ensuring the future health of our citizens with the primary care workforce serving as the fundamental leader of the multispecialty healthcare team.

Dr. Anthony Yoder is co-chair of the Connecticut Chapter of the American College of Physicians Health and Public Policy Committee. Dr. Ruth Weissberger is Governor of CTACP.