Mary Campagnolo

Primary Care Is a Public Good. It's Time We Started Treating It Like One. A recent article in JAMA calls for the creation of a multi-payer—or all-payer—primary care financing system. The concept itself is not new, but it arrives at a particularly important moment in our national health policy debate. Too often, conversations about new ideas begin with what is missing or what is wrong. We should resist that tendency. Any discussion of this proposal should start with what the authors get right: primary care is a common good that benefits not only individual patients, but also families, communities, and society as a whole. The authors make a particularly important observation: “Primary care has long fit awkwardly as an insurable risk in the marketplace. Insurance is designed to protect against large, unpredictable expenses. Yet primary care is largely predictable, similar to food, housing, and other common necessities.” That insight deserves serious consideration. The proposal does not seek to replace the broader health insurance system. Rather, it seeks to establish a sustainable financing mechanism for universal access to primary care—one that exists outside the economic and administrative complexities of insurance. That is a conversation worth pursuing. Many health care services can deliver value during discrete episodes of care. None, however, can match the long-term impact of comprehensive primary care. Nor can any consistently produce the same value per dollar spent. The evidence supporting this conclusion is overwhelming. It is also why the highest-performing health systems around the world are built upon universal access to primary care. In fact, universal primary care may be the single most important distinction between the world's highest-performing health systems and the United States health care system as it exists today. The authors' use of the term public good is especially important. Like clean water, public safety, and fire protection, the benefits of primary care extend well beyond the individual who receives the service. Strong primary care creates healthier communities, strengthens workforce participation, reduces avoidable health care spending, and contributes to economic stability. Its value is both personal and societal. One of the most compelling aspects of this proposal is its potential to eliminate variation in financing and administration. A universal primary care financing model could finally create the conditions necessary for true prospective, population-based payment—payment that rewards access, continuity, prevention, and innovation rather than volume. Importantly, such a model would not require a single practice structure. Direct primary care practices, community health centers, independent practices, and integrated health systems could all continue to operate and innovate. Patients would benefit from a more consistent experience, while practices would be relieved of many of the payer-specific rules, reporting requirements, and administrative burdens that increase costs and create barriers to care. The authors describe their proposal as a compromise between single-payer and free-market approaches. That characterization feels accurate. With oversight delegated to states and room for diverse delivery models, the proposal reflects a pragmatic approach to reform rather than a wholesale restructuring of the health care system. No proposal is perfect, and this one is no exception. Important questions remain about implementation, governance, accountability, and financing. Those questions deserve thoughtful debate. But one thing is clear: primary care is a public good, and our current health care system has denied too many people access to its full value for far too long. The conversation started by this proposal is the right one. At a time when confidence in our health care system continues to erode, we should focus less on preserving the status quo and more on building the foundation that every high-performing health system requires. That foundation is primary care. And it should be available to every person and every community. jamanetwork.com/journals/jam…

As the map shows, we are in the midst of a widespread illness across the country. The CDC estimates there have been 120,000 hospitalizations for influenza or influenza like illness so far this season. The CDC also reports that at least 11 million people have fallen ill due to the flu and there have been 5,000 deaths due to flu so far this season, including at least nine children. The @aafp urges every individual, 6 months or older, to get a flu vaccination. cc: @AAFP_advocacy

Parents and caregivers deserve sound, evidence-based recommendations to assist them in making medical decisions for their children. The @aafp Child & Adolescent Immunization Schedule for Ages 18 Years and Younger is below. You can also find the full set of recommendations for adults and pregnant individuals here --> aafp.org/family-physician/pa…

The practice of “downcoding” has become a significant issue in recent months. The prevalence of programs aimed at utilizing automated systems to review and reduce the level of Evaluation & Management (E/M) codes submitted by family physicians has reached concerning levels for our members. Systems used by insurers often rely on opaque algorithms that lack transparency and are applied without clear standards or clinical context. As a result, family physicians frequently discover that their claims have been "downcoded" only when they notice lower-than-expected payments, and they are left with the burden of pursuing costly and time-consuming appeals. The lack of transparency around these programs has raised significant questions as to their legality considering anti-trust laws. Earlier today, the @aafp sent a letter to the federal oversight agencies – Federal Trade Commission (FTC), Department of Justice (DOJ), and the Centers for Medicare and Medicaid Services (CMS). Our letter calls on the agencies to: ▪️ Investigate the use and impact of downcoding algorithms by health plans; ▪️ Require disclosure of downcoding criteria and ensure uniform application—including to health plan-owned practices; ▪️ Mandate streamlined, transparent appeals processes with clear standards and timelines; and ▪️ Engage physicians and regulators in oversight of these practices. Primary care is seeking to meet the needs of individuals and communities in the face of historical under-investments and an already crushing set of administrative functions. Programs such as "downcoding" only further erode our primary care system and make access to timely care more out of reach for more people.