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CAFP Won a Major Victory for Primary Care Investment, Advanced Increase in 2020

ByJoshua Foust

As an early adopter of the patient-centered medical home (PCMH) model of care delivery, Colorado has been at the forefront of practice innovation. While primary care makes up more than half of all medical appointments, in the U.S. we have invested less than 10% of our health care dollars in primary care. This results in higher costs and worse health outcomes as patients frequent the emergency room in lieu of seeing their primary care physician.

The affordability crisis in Colorado remains serious. While more than 90% of Coloradoans have insurance, the Colorado Health Institute estimates nearly 20% struggle with their medical bills. Directing more investment into primary care is a proven way to reduce those cost burdens on families. At the same time, investing more into primary care has been proven to result in both lower costs and better health outcomes.

The Colorado Academy of Family Physicians has been at the forefront of advocating for more primary care investment. We were instrumental in the 2019 Colorado legislature passing HB 19-1233, which directs the Commissioner of Insurance to convene the Primary Care Payment Reform Collaborative. This Collaborative is leading the way for establishing affordability criteria for insurance, with the goal of reducing overall healthcare costs in the state.

A key report from the Collaborative, released in December, encourages the Commissioner to adopt policies that increase insurers’ investment in primary care by 1 percentage point per year through 2022 to support the PCMH, care coordination, integrated behavioral health, and other high value primary care services. While it might not sound like much, this represents an investment between $50-$100 million more per year so that primary care physicians can take significant strides to reduce ER visits and further improve the health of their patients.

There are examples of this working elsewhere. In 2010, Rhode Island implemented affordability standards that directed more investment into primary care and it led to a dramatic reduction, $220 per person per year, in overall healthcare costs for the state. Reforming our spending priorities to invest more into supporting primary care is vital toward making healthcare more affordable, more accessible, and more effective.

As we look at the Insurance Commissioner’s next steps in furthering investment in primary care, we will keep advocating for family physicians as the foundation of healthy communities and a strong Colorado.