Primary care provider key to achieving health equity

California is gearing up 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. Immigration status will no longer be an obstacle.

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

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

As COVID-19 has shown, Californians are in critical need of access to medical professionals who understand their language and community, build long-term patient relationships, and can help navigate the complexities of 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 staff, administer critical first-line care for physical and behavioral health.

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

Having a relationship with a trusted primary care provider is a lifelong need for patients to make the best medical decisions and to avoid getting lost in or ignored by the health care system. Ultimately, it is a matter of equity, ensuring that all Californians, regardless of insurance coverage, can find, access, and trust a primary care provider.

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

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

Due to these longstanding systemic inequities, 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 of care for all Californians, the state must strengthen primary care in Medi-Cal and ensure everyone enrolled in the program has a trusted primary care provider.

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

A first-ever analysis of 13 managed care plans contracted with the state to provide care for nearly half of Medi-Cal members reveals that 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 findings 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 rates of well-child exams and immunizations, maternity care, mental health care, and other essential services. Starting in 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 in primary care investments and managed care performance measures will hold plans accountable for quality, value, and equity in health outcomes for Californians from all walks of life.

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

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