In March, the Insurance and Real Estate Committee advanced HB 5042: An Act Concerning Health Care Cost Growth with unanimous and bipartisan support. This bill is an important step to address the growing cost of healthcare delivered in Connecticut while improving healthcare quality. As the legislative session draws to a close, we call for action on this progressive and important measure.

One component of this legislation is establishment of benchmark spending for primary care, ensuring necessary funding for efforts to deliver high-value comprehensive, preventive, and coordinated care to patients. The American College of Physicians (ACP) strongly supports this increase for primary care commensurate with its value in achieving better outcomes while limiting growth of exponentially increasing costs.

As the largest medical specialty organization in the United States, representing over 160,000 internal medicine physicians and related subspecialists, including 2,300 in Connecticut, we see every day the benefit provided to patients who have access to high-quality primary care and the obstacles and poorer health outcomes faced by those who do not.

Rather than limit access, the benchmark targets in this bill would enhance it for other essential, but often hard to find, fundamental services such as mental health care. Given the crucial nature of addressing mental health, these services are increasingly and effectively integrated in primary care practices rather than being considered as independent specialty practices. With enhanced primary care spending, the barriers to needed care which can be removed far exceed any erected, as access and opportunities to comprehensively engage in behavioral healthcare increase. True specialty and subspecialty care can often be hard to reach and much of the work prior to and after evaluation is done in primary care, again highlighting the critical nature of bolstering this fundamental service.

Some concern has been raised regarding transition from traditional fee for service model that reimburses based on procedures and visits performed toward global payments. It is important to note that this legislation does not require, mandate, or propose use of any of these alternative payment models.

Under the assumption that any of these models is adopted, there is certainly a theoretical risk of underutilization given risk-adjusted advance payment, and the best plan may be some combination of these: mixed global and fee for services payment; population-based models; and appropriate quality-based metrics.

It is also important to recognize that these have to be compared to fee for service plans where there is an inherent financial incentive to do more with less opportunity for implementation of appropriately developed high value quality metrics.

Physicians and other healthcare practitioners cannot allow financial considerations to affect their clinical judgment or patient counseling on treatment options, including referrals to needed specialty services and care; actions should always be guided by patient best interests and appropriate utilization.

While we care deeply about the quality of care delivered to our patients, neither the ACP nor its members have an individually vested financial interest in the outcome of this legislation and any shift in allocation of healthcare spending will not affect the income of individual practitioners.

Some estimates suggest that implementation of this bill will have a substantial price burden based on actuarial projections of past national data. While total expenditures under this legislation would still continue to increase, uncontrolled growth would be limited by tying it to economic and median income growth. Thus, the realistic cost based on payment data in Connecticut is likely much lower than these other projections but still can provide a significant boost to needed primary care funding.

By ensuring a higher proportion of funding is dedicated to additional and adequate funding of primary care, costs over time can be reduced through decreases in hospital admissions, reduced ER utilization and effective coordination of care. With these savings and without any decreases to overall expenditures, for-profit commercial insurers then have no need to reduce any covered services provided to consumers and patients.

A final component that the legislation aims to address is primary care clinician burnout which is a critical issue facing the country and state. Over one in five practitioners providing primary care across the country is now projected to retire in the next two years and Connecticut is poised to feel a significant impact from this with one of the oldest primary care workforces in the country. This known and existing shortage will only get worse without mechanisms to sustain and bolster this essential service.

In some senses, the proposed shift seems radical to many. To us, it is necessary and the current environment is unsustainable. There are already myriad issues with access to care among many marginalized populations made even clearer during the pandemic.

Increasing primary care resources will enhance the opportunity to interact with a personal primary care clinician who is intimately familiar with the individual patient and can appropriately facilitate needed specialty care.  

Multiple states including Delaware, Rhode Island, Oregon, Washington and Colorado have in place or recently passed similar legislation with promising effects. Additional states including California have recognized the importance of this and are strongly considering an analogous proposal.

We encourage Connecticut to lead and adopt this legislation, ensuring the future health of our citizens with the primary care workforce serving as a fundamental leader of the multispecialty healthcare team.

Dr. Anthony Yoder is Co-chair of the Connecticut chapter of the American College of Physicians Health and Public Policy Committee. Dr. Ruth Weissberger is Governor of the CTACP.