February 13, 2018 04:20 pm News Staff – Lawmakers in Oregon and Rhode Island who understand how important primary care is to improved health outcomes have enacted legislation that increased insurer spending on primary care, and an upcoming AAFP webinar aims to help members bring the same success to their states.
The webinar on state-level primary care spending will be held 12:30-1:30 p.m. CST on Feb. 21. Evan Saulino, M.D., Ph.D., a family physician at Providence Medical Group-Southeast in Portland, Ore., will discuss his state's efforts to support primary care. In addition, Andrew Bazemore, M.D., M.P.H., director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, will share research related to primary care spending, and members of the AAFP Government Relations team will discuss resources and answer questions.
Oregon took a deliberate approach to increasing spending on primary care by first creating an advisory board and requiring insurers to report their primary care spending levels. A February 2017 report to the state legislature revealed that about 12.5 percent of the total medical spending of Medicaid coordinated care organizations went to primary care, while other payers spent only about 9.5 percent on primary care.
Four months after receiving the report, Oregon legislators passed a law requiring more insurers to devote 12 percent of total spending on physical and mental health to primary care. Insurers are expected to explore ways to improve reimbursement, including investment in efforts that address social determinants of health.
Rhode Island blazed the trail on primary care payment reform with efforts that began with a 2004 law establishing a commissioner charged with regulating the state's health insurance industry. The office set standards to reduce overall costs and pay primary care practices in a different manner.
In 2008, Rhode Island compared the primary care budgets of insurers in the state to those of high-performing health systems in other states. The figure was 5.9 percent in Rhode Island, far behind the high of 14 percent in a Washington state-based system.
The state responded by requiring insurers to increase primary care spending. A report found that as this spending increased by 37 percent between 2008 and 2012, total medical spending declined by 14 percent.
Rhode Island now requires insurers to spend at least 9.7 percent of expenses on primary care, as well as 1 percent on what it calls "indirect primary care."
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Fresh Perspectives blog: Primary Care Needs a Raise -- All of Us