The primary care provider is key to achieving health equity – Capitol Weekly | weekly capitol

California is preparing to make history. The state will achieve near-universal health coverage in 2024 by expanding Medi-Cal, the state’s Medicaid program, to all income-eligible Californians. Immigrant status will no longer be an obstacle.

This step follows the expansion of Medi-Cal access to all income-eligible children in 2016, young adults in 2020 and older Californians this year. But expanding coverage alone is not the end of the game.

Having a relationship with a trusted primary care provider is an ongoing need for patients to make the best medical decisions.

As COVID-19 has shown, Californians critically need access to healthcare professionals who understand their language and community, build long-term relationships with patients, and can help navigate complexities. health care. A primary care provider should fill this need.

Primary care providers and teams, including physicians, nurse practitioners, physician assistants, community health workers, and behavioral health personnel, administer essential frontline care for physical and behavioral health.

They help patients diagnose symptoms, prevent disease and receive vaccinations, manage chronic illnesses, and overcome social stressors that impact health, such as violence or food insecurity. They also help coordinate care regimens when needed, such as tests and specialist care.

Having a relationship with a trusted primary care provider is an ongoing need for patients to make the best medical decisions and avoid getting lost or being ignored by the healthcare system. Ultimately, it’s about fairness, ensuring that all Californians, regardless of insurance coverage, can find, access, and trust a primary care provider.

Despite its essential role, primary care is consistently under-resourced.

Medi-Cal covers about one-third of Californians, nearly half of the state’s children, and disproportionately serves communities of color. Specifically, Medi-Cal serves 34% of Latinos in the state, 28% of Black Californians, and 15% of the Asian Pacific Islander community. Medi-Cal also serves people facing health challenges shaped by poverty, housing and food insecurity, pollution, and racial injustice.

Because of these longstanding systemic inequalities, Californians enrolled in Medi-Cal are less likely to have a usual source of care and twice as likely to have poor overall health. To ensure high-quality care for all Californians, the state must strengthen primary care in Medi-Cal and ensure that everyone enrolled in the program has a trusted primary care provider.

There are rarely simple solutions in the field of health. Yet access to primary care is associated with reduced mortality and health disparities. Despite its essential role, primary care is consistently under-resourced. Investing more in primary care will help ensure that our healthcare system is equipped to keep us healthy instead of waiting until we get sick to treat ourselves.

A first-ever analysis of 13 managed care plans contracted by the state to provide care for nearly half of Medi-Cal members finds they spend between 5 and 19 percent on primary care. Californians enrolled in plans that invest more in primary care receive higher quality care and have better and more positive care experiences.

These results show the importance of primary care in the broader Medi-Cal reforms underway. California has made primary care a foundation of its Bold Goals 50X2025 quality and equity strategy, seeking to halve disparities in healthy child exam and immunization rates, maternity care, mental health care and other essential services. From 2024, payments to managed care plans will be tied to quality and equity measures, and plans will be required to report their primary care spending.

By investing in and strengthening primary care, we can put all patients at the center of health care and build a more accessible and responsive health care system. Ensuring transparency of primary care investments and managed care performance measures will hold plans accountable for the quality, value, and equity of health outcomes for Californians of all backgrounds.

This is the next frontier of health care reform, and California is leading the way.
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Editor’s Note: Palav Babaria, MD, is Quality and Medicine Manager and Deputy Director for Quality Management and Population Health in the Department of Health Care Services, which oversees the Medi -Cal. Kiran Savage-Sangwan is the executive director of the California Pan-Ethnic Health Network.