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California led the nation in health care reform by enabling millions to obtain health insurance through the Affordable Care Act. This year, by expanding Medi-Cal to all Californians with low incomes, regardless of immigration status, our state will achieve another milestone: historically low numbers of residents lacking health insurance.
Having an insurance card, unfortunately, doesn’t guarantee access to a primary care team that knows you, your family or your community. Absent such relationships, many get lost in or ignored by the system, or don’t trust it — as shown during the COVID-19 pandemic.
California’s next challenge is to resolve the mismatch between coverage and quality care by making sure all of us have access to primary care.
To address this, Covered California and the California Public Employees’ Retirement System are working with other health care leaders statewide to strengthen primary care.
By reorienting health care back to patients and their relationship with primary care providers and teams — including physicians, nurse practitioners, physician assistants, community health workers and behavioral health staff — we can build a health care system that’s better at keeping us healthy and rooted in our communities.
Access to high-quality primary care is essential. Primary care teams help patients and families address physical and behavioral health needs — from prevention to new sicknesses to managing chronic disease to end-of-life care. They help patients overcome social stressors that impact health, such as violence or food insecurity, and navigate the health care system by coordinating testing and specialist care when needed. Most importantly, they become a trusted advocate for patient health and well-being.
A first-of-its-kind study of primary care spending in California’s commercial health insurance market finds organizations that invest a higher proportion of spending in primary care deliver better care. Encompassing 80% of California’s commercially insured adults, the study found the percentage of primary care spending among health maintenance organizations, preferred provider organizations and exclusive provider organizations varied from 4.9% to 11.4%.
The study delved deeper into primary care spending among 180 provider organizations serving 8.5 million people enrolled in health management organizations — almost half of California’s commercially insured adults. A higher percentage of primary care spending was associated with better care quality and patient experience, fewer hospital and emergency room visits and lower cost of care.
The study’s findings on variation in the level of investment reveal that many Californians may be missing out on primary care services that help them stay healthy. It suggests that increasing primary care investment could save an estimated $2.4 billion annually in care costs and prevent 89,000 emergency room visits among Californians enrolled in commercial health maintenance organizations.
A recent poll found that access to primary care also is a matter of health equity. Insured Californians with a primary care provider, compared to those without, report fewer health care access, language and distance barriers. They also are less likely to report negative experiences with health care providers, such as being talked down to or not being listened to. Insured Latinos were the least likely to report having a primary care provider compared to other insured Californians.
As we know, you get what you pay for. That’s why our organizations are raising the bar for primary care investment among health plans we contract with to provide health insurance for more than 3 million Californians.
Starting next year, CalPERS will require preferred provider organizations to match members with primary care providers to improve care quality. Covered California will require health plans to measure and report primary care spending.
Ultimately, strengthening primary care benefits everyone. It puts patients back at the center of care. It ensures medical professionals interact with the patients who need them most when they need them. It helps keep care costs affordable.
Above all, it makes health care more accessible and responsive.
Dr. Alice Hm Chen is the chief medical officer and leads the Health Equity and Quality Transformation Division at Covered California. Dr. Julia Logan is the chief medical officer at the California Public Employees’ Retirement System.
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