In the midst of a national public health crisis, the physicians who serve at the front line of the healthcare system suddenly can’t pay their bills.
As patients skip visits in droves and elective procedures get canceled, family physicians and other primary care physicians from Little Rock to Los Angeles are being forced to cut staff, skip payrolls and plead for loans to keep their offices open. The government has stepped in, approving advanced payments for Medicare patients, but it is time for private, ERISA, and Medicaid plans to follow suit.
These plans, utilized by the vast majority of U.S. business owners to cover nearly 160 million Americans, support a fee-for-service system that is devastating what is the foundation of every well-functioning healthcare system in the world: primary care. And for that very same reason, they’ve played a part in accelerating the spread of COVID-19.
We don’t know the exact percentages, but at least some patients with Covid-19 are asymptomatic. Most others have only a mild illness. These are patients who are better treated in a home setting, with regular communication with a trusted physician who can monitor their progress.
We know this now. But in the early stages of this crisis, when we carried on with “business as usual,” these plans effectively allowed healthcare dysfunction to drive these sorts of people into already overwhelmed hospital settings. There, they sat in waiting rooms either spreading the disease to others – needlessly endangering the lives of other patients and clinicians – or contracting it themselves.
Keeping as many patients as possible out of the hospital and their emergency departments preserve resources for those patients who truly need extreme measures of care. This is the goal right now, and for obvious reasons, this must remain our goal in the future.
To execute on that, health plans will have to encourage beneficiaries to visit value-based family and primary physicians. If the employer is self-insured (most are), they simply need to direct their third-party administrator to move to a monthly fee with high-value primary care that eliminates damaging fee-for-service primary care. If they are fully insured, they should demand their carrier pay in the same way. Carriers such as Premera Blue Cross are doing just that with value-based primary care organizations such as Vera Whole Health.
This would finally put value-based primary care at the heart of our healthcare system. It would allow trusted physicians, who already understand and manage the underlying health conditions of their patients, to serve as the first line of surveillance and defense against future public health crises. It is what we need to do to come out of this crisis better than we were before.
The problem is, none of this is possible unless we show our immediate support for those practices that are presently struggling.
That is why I am calling for a Primary Care Marshall Plan. I’m calling on all health insurers, plus the business leaders and state and local government officials who sign their contracts, to move to prospective payment (versus after-the-fact billing). By looking at what they paid for their beneficiaries’ primary care needs last year and awarding those physicians the same amount, insurers and plan sponsors will quite literally be investing in the nation’s future health and wellness.
Because public health so evidently impacts all of us, there’s no greater investment decision-makers could possibly make. Family and primary care physicians’ livelihoods are on the line, and until we help them survive this moment and thrive once it passes, so too are ours.