When a state has recently recognized family medicine's crucial importance to the health of its citizens, what's the next step?
In Oregon, where lawmakers in 2017 unanimously passed legislation(olis.leg.state.or.us) requiring that 12% of all health spending go toward primary care, the AAFP's answer is simple: Build on that.
In a March 4 letter(2 page PDF) to the Oregon Senate's health care committee, the Academy expressed support for a bill introduced this session(olis.leg.state.or.us) that would maintain the 12% mandate while updating the law to solidify family medicine's gains there the past few years. The Oregon AFP, meanwhile, submitted separate testimony(olis.leg.state.or.us) supporting the updated law.
"Family physicians recognize Oregon's need to strengthen the definition of primary care and total medical expenditures so that an accurate understanding of Oregon's true investment in primary care will be available," the Academy wrote, noting that the bill "does just that."
In recent letters (which were, like the Oregon correspondence, signed by Board Chair Michael Munger, M.D., of Overland Park, Kan.), the AAFP put its shoulder to similar primary care spending bills in two other states.
In Vermont, the AAFP and the state chapter endorsed legislation(legislature.vermont.gov) that would, said the Academy's correspondence,(2 page PDF) "increase health care spending investment and transparency in primary care."
The House and Senate measures, which have each passed and now await the governor's signature, collectively require Vermont's Green Mountain Care Board(governor.vermont.gov) -- which oversees the state's health system -- to "develop a definition of primary care and determine the proportion of health care spending allocated to primary care" by consulting stakeholders. The legislation directs the board to produce an analysis describing the potential impacts that different methods of achieving increases in primary care spending would have on health outcomes, patient satisfaction, patient access and availability, and progress in implementing Vermont's all-payer accountable care organization model.(gmcboard.vermont.gov)
And in Missouri, the AAFP and the state chapter have written to both chambers of the General Assembly to advocate for passage of twin bills that would require all health insurance carriers to report their annual health care medical expenditures and their total primary care medical expenditures to the state each year, for review by legislators.
"A fundamental change in the health care system to prioritize a primary care-based system is essential to improvements in access, quality and cost," the Academy said in an April 18 letter(2 page PDF) to the chair and vice chair of the Missouri Senate Insurance and Banking Committee. "It's time we discuss the importance of primary care and evaluate our investment. We urge Missouri to pass the Primary Care Transparency Act.(www.senate.mo.gov)"
In all cases, the Academy cited evidence from the Patient-Centered Primary Care Collaborative(www.pcpcc.org) affirming that Americans benefit from "the documented value of primary care in achieving better health outcomes, higher patient satisfaction and more efficient use of resources."
Primary care spending legislation has been introduced in five other states, as well -- Colorado, Hawaii, Maine, Washington and West Virginia -- in some cases, gaining traction with chapter support.
In West Virginia, a recently enacted law(www.wvlegislature.gov) requires an annual report on the amount of Medicaid expenditures devoted to primary care each year; the bill passed unanimously in both chambers.
And the Colorado AFP, working with a grant from the Center for State Policy, has helped state legislation(leg.colorado.gov) on primary care spending pass that state's House and the Senate respective health committees.
Colorado AFP representatives will speak about the legislative push during this year's Family Medicine Advocacy Summit, May 20-21 in Washington, D.C., and share advocacy resources with other chapters.
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