Page 16 - Delaware Medical Journal - July-August 2018
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Primary Care in the Spotlight:
From Yellow Light to Red Light — Senate Bill 227
I caution light turned solid red. Delaware’s strong, independent,
community-based primary care system was in jeopardy. Reimbursement rates for our frontline care providers had dropped to unsustainable levels. Practices were closing, consolidating with systems, or adopting a concierge model, pushing thousands of patients back into the physician. Primary care in Delaware was on the brink.
The national average for primary care reimbursement in the commercial market is 120-140% of Medicare. In Delaware, low as 65-85% of Medicare. At a system level, the national average spend on primary care is 5-8%. A “proper” spend for a robust system is 12-15%. Delaware’s is estimated at 3-4%.
Our primary care practitioners saw this crisis coming. Even before Delaware received a $35 million State Innovation Model grant from the Center for Medicare & Medicaid Innovation (CMMI) in 2014, primary care lighted the yellow light, cautioning that our community system was stressed. The warning was clear — access to care was straining and despite all the talk of value-based care, high- quality, low-cost care would be impossible
without the primary care infrastructure in place.
Their concerns were noted. White papers and roundtables through Governor Markell’s administration stated as a forgone conclusion that, of course, primary care was a fundamental necessity to the system. That a patient-centered medical home model and team-based care started on the frontlines. That tackling social determinants of health meant moving services upstream. That keeping patients out of emergency and urgent
care meant opening up access in the community.
While great strides had been made in expanding insurance coverage, little
was done to take the necessary steps
to improve access. Insurers dabbled
with incentive programs, the state invested some resources into practice transformation, and practices were enticed (and mandated) into making costly technology investments. The Obama
and Markell administrations ended. The
In 2016, John Carney took up the mantle as Governor. He looked at his rate and concluded, “[h]ealth care costs are rising at a rate that’s, frankly, unsustainable... We’re paying way too
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Del Med J | July/August 2018 | Vol. 90 | No. 6
