New York to Establish Primary Care Reform Commission | Healthcare Innovation

States such as Rhode Island and Oregon have taken steps increase the percentage of healthcare spending dedicated to primary care. Now the New York State Legislature has enacted legislation to establish a primary care reform commission.

The commission’s goals include defining and measuring New York’s baseline spending on primary care, setting targets for enhanced investments in primary care, and testing pilot programs to identify the most promising models.

The legislation creating the commission notes that research shows that an increase of just one primary care provider per 10,000 people can generate 5.5 percent fewer hospital visits, 11 percent fewer emergency department visits, and 7 percent fewer surgeries. Yet, it is estimated that as little as 5 percent of U.S. healthcare spending goes toward primary care. The legislation says that New York currently spends more per capita on healthcare than the national average, but consistently ranks below many other states in key health indicators.  “This is indicative of a lack of access to and an underinvestment in primary care.”

Participants would include experts on health care financing, reimbursement, and regulation from primary care providers, federally qualified health centers and professional practice groups, as well as representatives with relevant expertise from businesses operating within New York, public and commercial health plans including managed care plans, and primary care professional and advocacy organizations. Third party payers would be compelled to provide data requested by the commission, with protections for proprietary property.

The first report of recommendations would be published by March 31 following the year of enactment and include a comparative analysis of current primary care spending, and recommendations to the governor and the legislature regarding the barriers to primary care and how to overcome them.

In February, New York Health Foundation President and CEO David Sandman provided testimony to the New York State Joint Legislative Budget Hearing. In his testimony, he addressed the opportunity for New York to improve health outcomes and save money by placing more emphasis on primary and preventive care.

Sandman spoke about the way New York State consistently underinvests in and undervalues primary care. As of 2017, New York State spent $10,000 per New Yorker in health care costs—20 percent higher than the national average, he said. But all that spending isn’t providing enough value for New Yorkers. “Our health outcomes are often poor. New York does not rank among the top 10 states for positive health indicators such as rates of cardiovascular diseases, low birth weight, diabetes, preventable hospitalizations, drug-related deaths, and excessive drinking. We can and must do better. We don’t need to spend more on healthcare. We need to spend in smarter and better ways that return better value. The solution is to rebalance our healthcare spend; that means allocating a greater percentage of what we spend to primary care.”

Sandman said a review by the Primary Care Development Corporation (PCDC) shows that nearly a dozen states have introduced or enacted policies to invest more of their healthcare dollars in primary care:

• Rhode Island led the way when it set a target of increasing the share of commercial insurer primary care expenditures by 5 percent over a five-year period. Over the same period, the State’s total expenditures fell by 14 percent. Rhode Island was the only state in New England to increase the supply of primary care physicians per capita, while spending by commercial health insurers grew more slowly compared with other states in the region.

• In Oregon, legislation requires that primary care spending increase by 1 percent annually, with a goal that primary care account for 12 percent of total spending by 2023.

• In Massachusetts, the governor introduced legislation to increase spending for primary care and behavioral health services by 30 percent over three years.

“The time is ripe for New York to join other vanguard states and rebalance our spending to emphasize primary care,” Sandman said. “While other states provide models and options, New York will find its own way. What has worked in smaller states like Rhode Island to reallocate resources toward primary care may be more challenging in a state with a health care system as large and complex as New York’s.”