Health insurers asked to spend an additional $2.5 billion on primary care: Why?

Jan. 29, 2021 / By L. Gordon Moore, MD

Current payment models are inadequate for the full scope of work in primary care. Last month, the Purchaser Business Group on Health (PBGH) and the California Medical Association (CMA) addressed this by asking health insurers to pay independent primary care practices in the state an additional $2.5 billion.[1] 

The request flows from these observations:

  • People (think “employees and beneficiaries” in this conversation) who have primary care providers (PCPs) have better health outcomes and lower per-capita health care spending than those who do not.[2]
  • Primary care is suffering in the pandemic. Here are some of the results from an ongoing survey of primary care and patients from the Larry A. Green Center:[3]

  • Less primary care and less effective primary care (i.e., stretched to or beyond capacity) leads to worse outcomes (Starfield 2005 again).
  • People who do not have COVID-19 are using much less health care and health plans and self-funded employers may be sitting on a lot of unspent dollars.[4]
  • Given the urgency of the pandemic on top of the usual stresses facing primary care, now is a great time to consider using these unspent dollars to shore up access to this critical resource.

The PBGH and CMA are making a case that resonates across the entire nation: We all benefit when we have access to good primary care. When current payment models don’t address the full scope of primary care, it leaves Americans in the lurch. We can fix this.

L. Gordon Moore, MD, is senior medical director, Clinical Strategy and Value-based Care for 3M Health Information Systems.

[1] https://www.pbgh.org/modern-healthcare-employer-physician-groups-want-calif-insurers-to-pay-primary-care-2-5-billion/ accessed 1/28/2021

[2] Starfield, Barbara, Leiyu Shi, and James Macinko. “Contribution of Primary Care to Health Systems and Health.” The Milbank Quarterly 83, no. 3 (September 2005): 457–502. https://doi.org/10.1111/j.1468-0009.2005.00409.x.

[3] https://www.green-center.org/covid-survey

[4] https://www.nytimes.com/2020/08/05/health/covid-insurance-profits.html accessed 1/28/2021

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