San Francisco, May 26, 2020 (GLOBE NEWSWIRE) -- The Pacific Business Group on Health (PBGH), which represents private employers and public purchasers spending more than $100 billion annually on health care, as part of a coalition of physician, consumer and business leaders, has called on California state legislators to support independent primary care providers vulnerable to the drastic economic impacts of the COVID-19 pandemic.
With the support of the California Medical Association, PBGH has developed an initiative that would require health plans to use unspent premiums already collected from employers and consumers to pay primary care providers emergency prospective payments for 2020 and 2021. These prospective payments would serve as a lifeline to primary care providers who have suffered a serious loss of revenue during the COVID pandemic and may be forced to close their practices or be acquired by large health systems.
The Care for Californians Initiative would also establish a process, led by the California Secretary of Health and Human Services, to develop recommendations for payment models that foster resilience and support primary care as a central element of the movement toward high-value, patient-centered care.
“Employers know that primary care is essential to a healthy work force and employees’ access to a high-value health care system. Primary care should be the front door to the health care system and it’s currently in danger of closing,” said Elizabeth Mitchell president and CEO of PBGH. “If we don’t support primary care practices, they’ll either close or be bought up by larger health care systems or private equity groups. We know from historical evidence that this will drive market consolidation and increase costs without any increase in quality or improvement in patient experience.”
The Care for Californians Initiative:
- Holds health plans accountable for paying for primary care: Health plans would be required, for 2020 and 2021, to pay primary care providers a portion of their fees on a prospective basis for the express purpose of helping physicians weather the current COVID-19 pandemic.
- Establishes a reconciliation process to ensure that the emergency prospective payments do not result in undue compensation: The reconciliation process would adjust payments to primary care providers to ensure there is not over-compensation resulting from the combination of fee-for-service and emergency prospective payments.
- Supports movement to virtual care through the likely duration of the COVID-19 pandemic: Maintained would be the requirement that virtual and telehealth visits, including telephonic visits, be reimbursed, on par with in-person services, by health plans and their delegated risk bearing organizations through at least the end of 2021.
- Ensures a successful transition to resilient and value-promoting payment models: The proposal is focused on short-term immediate interventions to protect the viability of independent primary care while also moving towards a restructuring of payments that promote resilience and better care over the long-term.
“Before California can reasonably and responsibly reopen, we must ensure that our health care system is able to serve patients who need care,” said California Medical Association President Peter N. Bretan, M.D. “This proposal will help ensure that health insurance companies do their part to maintain adequate provider networks, and make sure primary care physicians can keep their doors open to serve patients, including those who need well-child visits, immunizations, gynecological exams, behavioral and mental health care,” Dr. Bretan said.
“Large employers are deeply concerned about the impact widespread closures of primary care practices will have on the cost and quality of health care services,” Mitchell of PBGH continued. “We call on the California Legislature to act now to protect independent primary care throughout the state, and with it, the very foundation of our health care system.”
To review the Care for Californians Initiative, please visit here.
About Pacific Business Group Health
Pacific Business Group on Health is an action-oriented 501c(3) non-profit organization focused on improving health outcomes, experience and affordability for consumers and purchasers across the United States. Since 1989, PBGH has distinguished itself as a national innovator driven by some of the largest and most influential public and private purchasers of health care in the country, including Boeing, CalPERS, Comcast, Intel, and Walmart. PBGH leverages purchaser action in partnership with providers, payers, and policymakers to identify, test, and scale innovative models for improving health outcomes and affordability. For more information visit PBGH.org and follow PBGH on Twitter and LinkedIn.
About the California Medical Association
The California Medical Association represents the state’s physicians with more than 50,000 members in all modes of practice and specialties, and CMA is dedicated to the health of all patients in California. For more information, please visit CMAdocs.org, and follow CMA on Facebook, Twitter, LinkedIn, YouTube and Instagram.