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Call to Action: ‘This Is a Good Time to Redesign Our Healthcare System’

Tens of thousands unite under the Texas Primary Care Consortium to address access, payment, and the uninsured.
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The Primary Care Consortium is advocating for significant changes in the way the state delivers healthcare. With the support of many of the state’s medical groups, is pushing for changes in federal aid distribution, primary care payment, and Medicaid expansion.

The consortium made its case in a letter and brief to Governor Abbott and state legislators that includes support from the American Heart Association, Catalyst Health Network, CHRISTUS Health, Genesis Physicians Group, Texas Medical Association, Texas Nurses Association, and other groups representing more than 100,000 healthcare employees and millions of patient lives. “The escalating COVID-19 pandemic has had an unprecedented impact on our primary care systems,” the letter reads.

The group outlines the impact of chronic disease, economic uncertainty, and Texas’s nation-leading and growing uninsured rate as reasons to act immediately. “The slow disintegration of primary care will not only significantly put Texans’ health at high-risk but also impact the state’s reopening efforts by curtailing job creation and economic viability of many communities, particularly rural ones. It also has the potential to increase our health care costs,” the brief reads.
It proposes that the next round of federal aid target primary care physicians who have experienced a drop in revenue due to the COVID-19 pandemic. In addition, the state can use its influence over state employees and the Teacher Retirement Service to change the way primary care is paid for to sustain those practices.

Looking ahead, the brief asks the state to convene a panel to “assess the system-wide impact and pursue forward-looking primary care and health system transformation efforts in Texas.” The committee could address payment reform and a move toward value-based care and away from fee-for-service for primary care physicians. It could also look at continued investment in primary care, which results in lower healthcare spending overall in reducing downstream costs.

Telemedicine, which can help address the state’s primary care physician shortage (Texas ranks 47th in primary care physicians per capita), is now being funded equally to an office visit. The group wishes to make that change permanent beyond the pandemic. “We want to convene a consensus panel and understand the issues, come together, and come up with some tangible things we can do,” says Dr. Sue Bornstein, an internal medicine physician who is executive director of the Texas Medical Home Initiative and co-lead with the Texas Primary Care Consortium.

The group wants the state to improve access to underserved populations in urban and rural areas. “There are large portions of Dallas that are medically underserved areas,” says Bornstein. “You go to southern Dallas, and there is no medical care. That has been exacerbated by COVID-19, and access is already a challenge.”

Finally, the group is pushing for Texas to address its uninsured population. The expansion of Medicaid would be one way to do so. Texas is one of thirteen states that has not done so, contributing to the ballooning uninsured population that puts such a burden on the healthcare system. Another option would be the use of a Community Accountable Care Organization, which organizes a network of safety net providers to provide health for an entire community.” This is a good time to redesign our healthcare system,” Bornstein says.

“The time has long since come, and we have to address the uninsured,” Bornstein says. “It’s a disaster, it’s gotten worse, and will keep getting worse if we don’t do something. These are not new issues, but they are under a very bright spotlight because of COVID-19.”

Find the full brief and letter here.

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