As I look back on 2023, one of the things I’m most proud of is our work to accelerate the power of primary care, and what this means for the future of health care in California. Primary care is among the most important contributors to our health, improving nearly every measure of wellbeing by delivering a usual source of care, early detection and treatment of disease, chronic disease management, and preventive care.
As part of the Industry Initiatives team here at Blue Shield of California (BSC), our mission is to ensure that all Californians have access to high-quality health care at an affordable price—and supporting accessible, equitable, affordable primary care is one of the most impactful ways to accomplish this priority.
Primary Care Today
Despite its benefits, 100 million Americans don’t have a primary care doctor. Lack of access to providers—from factors ranging from retirement to insurance acceptance—means nearly a third of the population is at risk of losing access to this essential care. In California, there will need to be a 32% increase in primary care physicians (PCPs) by 2030 to even maintain the status quo.
This complex gap has been recognized by the market, accelerating consolidation, innovation, and growth in 2023. Just consider Amazon’s foray into primary care via One Medical, new offerings coming from giants like CVS and Walmart, the consolidation of primary care practices and doctors by hospitals and health systems, and the success of relative newcomers such as Oak Street.
However, some of these market forces, designed to improve access, may be solving one dimension of improving high-quality primary care only to amplify others. A profit-driven approach often leads to reduced choices for consumers and diminished market leverage for health plans, making health care less, not more, affordable for patients. While these offerings can relieve the patient load on hospitals and health systems by addressing minor acute care needs (sprains, colds, cuts, and earaches) they aren’t able to deliver the same care delivered by consistent, community-based primary care physicians and practices. When community-based primary care is involved, women receive more mammograms, diabetes is controlled and high blood pressure doesn’t have a chance to cause strokes, among countless other measures of health. PCPs are critical to prevent or identify issues before they become more serious.
The Steps to Rebuild Primary Care
To rebuild and support primary care’s role as the foundation of the U.S. health care system, policymakers and others across the entire health care system have, in addition to other steps, been aligning to a published report from the National Academies of Sciences, Engineering, Medicine on specific actions that will help improve access to care. Below are a few of the key implementation objectives and how the Industry Initiatives team has been building on its past accomplishments while contributing to the path forward.
- Pay for primary care teams to care for people, not doctors to deliver services. Primary care is essential to bending the cost curve. That is why over the last year, I’ve been proud to represent BSC working closely with the Office of Health Care Affordability to improve investment in primary care and translating this national work for the benefit of Californians. The office plans to publicly report health care organizations' investments in primary care, fostering a transparent approach to drive positive outcomes such as the prevention and management of chronic conditions. I was also invited to join the State Transformation Collaborative as their first-ever California health plan representative. These collaboratives are responsible for continuing to shift the economic drivers away from fee-for-service to a value-based, person-centered approach to health through Medicaid and Medicare collaboration and partnership.
- Ensure that high-quality primary care is available to every individual and family in every community. The report recommends that payers should ask all covered individuals to declare a usual source of primary care annually and should assign non-responding enrollees to a source of care. We seek to go one step further in California by supporting independent primary care more deeply in 2024. Independent primary care has been shown to deliver care that is equal to, or better than, that of practices owned by hospitals and health systems. However, these independent practices face substantial administrative burdens and lack access to the resources of larger health systems, all the while suffering from greater payment and operational pressures that contribute to closures and buyouts.
- Ensure that high-quality primary care is implemented in the United States. Primary care, defined as accessible, affordable, and equitable, stands at the forefront of our mission. By reporting our work in alignment with the implementation of high-quality primary care and collaborating with national and federal leaders, including the federal and California Office of Health Care Affordability, we’re documenting transparent progress to improve access to high-quality care.
Amplifying the Power of Primary Care in 2024
As a regional, nonprofit health plan, BSC is unique among its national payer peers because we don’t have to accommodate shareholders, whose profit-driven values can often be in misalignment with mission-driven work. Our priority is our mission—delivering high-quality health care at an affordable price. The path to get there will be paved through deeper collaboration and cooperation not only with state and federal entities, but also by working with other payers that serve Californians, going against the norm of an industry often marked by fierce competition.
2024 promises to be another transformative year for primary care, and we can’t wait to share what’s ahead.