Primary Care Payment Reform
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Making Primary Care Payment Reform a Reality Today

ByLynlee Espeseth

by Monica Morris, DO, CAFP President

The CAFP is excited to announce we are launching a new initiative to increase the investments being made in primary care to at least 15% of total health spending, double what we spend today. This initiative will accelerate the move to paying for high value services like primary care, and support the infrastructure of team-based models like the Patient Centered Medical Home (PCMH). In short, we want to make sure primary care is properly compensated for the high value work it does.

Hundreds of practices across Colorado have transformed to become a PCMH, because it works. This work has been done through programs like the Medical Home Pilot program, the State Innovation Model, Comprehensive Primary Care Plus, and others. These are excellent programs, but their funding is time limited. We need to ensure the money needed to sustain high value care is available.

We value what we measure. Until now, we have not measured how much we invest in primary care, or for that matter how much of our payments are value-based rather than fee-for-service. The time has come for the payment to match the results.

Recent research by the RAND Corporation and the Milbank Memorial Fund demonstrates in the best-case scenarios, only 8.6 cents of every dollar goes to primary care. Other research indicates typically only 4 to 7 cents of each dollar goes to primary care. This underinvestment leads to overall higher costs. Patients face longer wait times, shorter appointments, and often resort to using the ER for basic care. Care may be fragmented, because practices do not have the resources to integrate behavioral health, hire care coordinators and social workers, and support population health.

That’s why the CAFP is taking the lead to promote a new statewide Primary Care Investment Initiative. Following on success in Rhode Island and Oregon, Colorado should set a statewide target for primary care investment. Medicaid, commercial insurers, state employee plans – all should be investing at least 15% of their dollars in primary care. We know if we can invest these resources up front, we’ll see savings in downstream costs and we’ll see better health outcomes. These investments will add needed capacity to primary care by expanding the team. That’s a win for patients. And it’s a win for physicians facing burnout from the 30-visit days and endless 60 hour weeks.

Do you have questions about this initiative? Want to get involved? Email ryan@coloradoafp.org to learn more.