Family physicians like myself work inside California’s community health clinics every day, delivering care to patients who often have nowhere else to turn. Prop. 44 puts that work — and the clinics themselves — in serious jeopardy.

The problem lies in how the measure is written. Its spending rules are so rigid that, by some estimates, roughly 91 percent of the state’s health centers would fail to meet them. An independent analysis commissioned by the California Primary Care Association found that clinics could collectively face as much as $1.7 billion in penalties in just the first year, with continuing costs in the years after. That’s money that currently keeps clinic doors open and supports the kind of comprehensive, community-based care that has made these centers a trusted resource for millions of Californians.

The financial fallout could be severe. Recent data suggests that the vast majority of clinics statewide are already operating on thin margins. A sudden wave of penalties tied to Prop. 44 could push most of them into the red, forcing painful decisions about which services to cut just to stay afloat.

If that happens, some clinics may be forced to shut down entirely — eliminating safety-net care for the very communities that depend on it most. Each year, California’s community clinics serve more than 7 million patients, including children, working families, uninsured residents, seniors, veterans, and roughly one in three Medi-Cal enrollees. Prop. 44 threatens the funding base that keeps this system functioning.

Beyond the financial risk, the measure is poorly constructed and legally murky. Clinics could be penalized simply for spending money on the things that keep them running — new medical equipment, technology upgrades, disaster preparedness, or reserve funds set aside for emergencies. Under the initiative’s language, even responsible financial planning could trigger steep penalties.

Anyone who has spent time inside a community clinic understands that health care extends well beyond the exam room. Programs that provide patients with transportation to appointments, telehealth options for those who can’t make it in person, and enrollment assistance to help people access insurance they qualify for are not extras — they are essential parts of keeping people healthy and connected to care. Prop. 44 puts all of that at risk.

Perhaps the most troubling piece of this measure is what it does to the relationship between doctors and patients. Prop. 44 would give the state Attorney General — an elected official without medical training — significant influence over which services clinics are able to offer. If recent years have taught us anything, it’s that political figures should not be inserting themselves into decisions about a patient’s care.

Our health care system is already stretched thin. Costs continue to climb, wait times for primary care and specialist appointments keep growing, and emergency rooms are routinely overwhelmed. If Prop. 44 leads to clinic closures or reduced services, patients won’t simply stop needing care — they’ll delay treatment until conditions worsen, often ending up in emergency rooms for issues that should have been handled through routine, preventive visits. That shift would only add more strain to hospitals, lengthen wait times, and drive health care costs even higher.

Opposition to Prop. 44 spans a wide and politically diverse coalition — not just physicians, but many others who understand what’s at stake for the patients who rely on these clinics every day. Millions of Californians are counting on voters to get this one right.

Original source: CalMatters

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The Centers for Medicare & Medicaid Services (CMS) announced a new primary care model – the Making Care Primary (MCP) Model – that will be tested under the Center for Medicare and Medicaid Innovation in eight states. Access to high-quality primary care is associated with better health outcomes and equity for people and communities. MCP is an important step in strengthening the primary care infrastructure in the country, especially for safety net and smaller or independent primary care organizations. The model seeks to improve care for patients by expanding and enhancing care management and care coordination, equipping primary care clinicians with tools to form partnerships with health care specialists, and leveraging community-based connections to address patients’ health needs as well as their health-related social needs.

The goals of MCP are to 1) ensure patients receive primary care that is integrated, coordinated, person-centered and accountable; 2) create a pathway for primary care organizations and practices – especially small, independent, rural, and safety net organizations – to enter into value-based care arrangements; and 3) to improve the quality of care and health outcomes of patients while reducing program expenditures.

The MCP Model will provide participants with additional revenue to build infrastructure, make primary care services more accessible, as well as better coordinate care with specialists. CMS expects this work to lead to downstream savings over time through better preventive care and reducing potentially avoidable costs, such as repeat hospitalizations. MCP will run for 10.5 years, from July 1, 2024, to December 31, 2034. The model will build upon previous primary care models, such as the Comprehensive Primary Care (CPC), CPC+, Primary Care First models, and the Maryland Primary Care Program (MDPCP).

CMS will test this advanced primary care model in Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington. CMS will work with model participants to address priorities specific to their communities, including care management for chronic conditions, behavioral health services, and health care access for rural residents. CMS is working with State Medicaid Agencies in the eight states to engage in full care transformation across public programs, with plans to engage private payers in the coming months. The model’s flexible multi-payer alignment strategy allows CMS to build on existing state innovations and for all patients served by participating primary care clinicians to benefit from improvements in care delivery, financial investments in primary care, and learning tools and supports under the model.

“The goal of the Making Care Primary Model is to improve care for people with Medicaid and Medicare,” said CMS Administrator Chiquita Brooks-LaSure. “This model is one more pathway CMS is taking to improve access to care and quality of care, especially to those in rural areas and other underserved populations. This model focuses on improving care management and care coordination, equipping primary care clinicians with tools to form partnerships with health care specialists, and partnering with community-based organizations, which will help the people we serve with better managing their health conditions and reaching their health goals.”

Strong relationships with primary care teams are essential for patients’ overall health. Primary care clinicians provide preventive services, help manage chronic conditions, and coordinate care with other clinicians. By investing in care integration and care management capabilities, primary care teams will be better equipped to address chronic disease and lessen the likelihood of emergency department visits and acute care stays, ultimately lowering costs of care. This model will support participants with varying levels of experience with value-based care, including Federally Qualified Health Centers (FQHCs) and physician practices with limited experience in value-based care, as CMS continues to work to reduce disparities in care and drive better patient experience and outcomes.

“Ensuring stability, resiliency, and access to primary care will only improve the health care system,” said CMS Deputy Administrator and Center for Medicare and Medicaid Innovation Director Liz Fowler. “The Making Care Primary Model represents an unprecedented investment in our nation’s primary care network and brings us closer to our goal of reaching 100% of Traditional Medicare beneficiaries and the vast majority of Medicaid beneficiaries in accountable care arrangements, including advanced primary care, by 2030.”

The model includes a progressive three-track approach based on participants’ experience level with value-based care and alternative payment models. Participants, which include FQHCs, Indian Health Service facilities, and Tribal clinics, among others, in all three tracks will receive enhanced payments, with participants in Track One focusing on building infrastructure to support care transformation. In Tracks Two and Three, the model will include certain advance payments and will offer more opportunities for bonus payments based on participant performance. This approach will support clinicians across the readiness continuum in their transition to value-based care, furthering CMS’s goal to ensure 100% of traditional Medicare beneficiaries are in a care relationship with accountability for quality and total cost of care.

Primary care organizations within participating states may apply when the application opens in late summer 2023. The model will launch on July 1, 2024.

To view the MCP webpage, visit: https://innovation.cms.gov/innovation-models/making-care-primary

To view a model key highlights video, visit: https://youtu.be/8vy3PHHlCe4 

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November 10, 2020 — Riverside University Health System (RUHS) received a $625,000 grant from the Office of Statewide Health Planning and Development (OSHPD) to expand access to primary care, making it the only hospital in the Inland Empire to win the full award. The grant will allow RUHS to train an increased amount of residents on campus and provide the resources they need to succeed.

The grant allows the continued funding of essential resources for the program, such as, funds to cover resident’s attendance to the AGME national conference, board review materials and high school pipeline resources. These are crucial assets that allow the program to excel. This level of excellence supports continued attraction to some of the nation’s top family medicine resident candidates, who may then be converted into full-time employees.

“We are so honored to receive this grant from OSHPD,” said Parastou Farhadian, RUHS Family Medicine Resident Program Director. “It is important now, more than ever, that we continue to expand access to our most vulnerable community members through enhanced primary care training for students, who will then be leaders in our community that help shape and grow overall well-being of our community families.”

RUHS’s 49-year-old Family Medicine Residency Program qualified for the grant award based on its ability to attract and admit underrepresented and underserved community members. To win the grant, another requirement is the development of residency programs that train students in underserved areas and place their graduates in those regions. This is the 49th year that the program has received this grant. During the life of the program, RUHS has been able to host over 300 residents.

The $625,000 awarded to RUHS was part of OSHPD’s pledge of $35 million in grants to 86 primary care residency programs to expand primary care access to underserved Californians. The California Healthcare Workforce Policy Commission, which recommends funding awards for multiple medical disciplines under the Song-Brown Healthcare Workforce Training Act, approved award recommendations for the Primary Care Residency Program earlier this year.

Medical disciplines under the Primary Care Residency Program include family medicine, internal medicine, obstetrics, gynecology and pediatrics. The Song-Brown funds now support nearly 730 primary care residency positions annually and has funded 185 new positions since 2017.

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