HHS offering $1 million to strengthen link between primary care and health equity

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The Department of Health and Human Services, through the Health Resources and Services Administration, is launching the Building Bridges to Better Health: A Primary Health Care Challenge. The national challenge aims to improve health outcomes by increasing the link between primary care and community supports that address the social determinants of health and health inequities.

A total of $1 million in cash prizes will be awarded to encourage innovation to improve patient access to primary care and strengthen the connection between healthcare and social services, HHS said. The competition is open to individuals, groups, healthcare organizations and other entities. 

The prizes will be awarded over three phases: Concept design, prototype development and testing, and scaling the approach. Phase 1 submissions are due by August 2. Phase 1 will include initial awards totaling $300,000 for up to 30 winners.

WHY THIS MATTERS

While the competition focuses on primary care and equitable access through HRSA-supported health centers, PCP care overall is a lever for better outcomes and decreased health inequities, according to Dr. Wayne Altman, chair of the Department of Family Medicine at Tufts Medical School.

However, access to primary care is a challenge due to fewer physicians going into PCP practice in favor of more lucrative specialties, according to Altman, who cited a 2021 report from the National Academies of Sciences, Engineering, Medicine. Unequal access to primary care remains a concern, with the pandemic amplifying disparities, the report said.

But PCPs have struggled to remain open, due to a shrinking workforce pipeline, a decline in visits to PCPs and payment reimbursement, according to Altman.

Current fee-for-service payments will need to move towards models that better support independent practices, the NASEM report said. "As the largest payer in the country, Medicare should be prioritized for payment reform, since its payment policies set the tone for other public and commercial payers," the report said.

Physicians are not being paid for answering emails from their patients or for services such as hiring a care manager or a social worker on staff to integrate behavioral health into the practice, Altman said. "So many aspects of care are not on the fee schedule," Altman said. "If I want to hire a care manager, I either pay out-of-pocket or say, 'We don't have this service.'"

Most private practices are part of larger group contracts, which Altman contends don't pay enough to give incentives to invest in innovation. Altman's answer is proposed Massachusetts legislation called Primary Care for You that would double primary care investment in Massachusetts by switching from fee-for-service to a monthly prospective payment system. About 10 states have similar legislative efforts, said Altman, who heads the Massachusetts Primary Care Alliance for Patients. MAPCAP was started in March 2019 and has been working for three years on the legislation.

The monthly prospective payment to primary care would be administered by a MA PC Trust. Physicians would be paid through the MA PC Trust billing commercial payers based on the number of members in their practice. The payers in turn would be given credit in terms of their medical loss ratio, according to Altman.

Pushback is expected from large hospital systems objecting to a proposed cap on price growth to offset the increased amount of money going to primary care. But increasing access to PCP care would lead to downstream revenue for hospitals, according to Altman. 

THE LARGER TREND

Earlier this spring, HHS released an overview of the Federal Social Determinants of Health Strategy and Action Plan – a whole-of-government, multi-sector strategy to advance health equity and address the underlying systemic and environmental factors that affect health status. In offering $1 million in prize money in the Primary Health Care Challenge, HHS is emphasizing the importance of primary care in meeting equity goals.

Nearly 62% of patients using HRSA's 1,400 health centers are racial and ethnic minorities, HHS said. In 2020, HRSA-funded health centers provided care for one out of 11 people in the United States and its territories, one in three people living in poverty, one in six people who are uninsured and one in five residents in rural areas. People who are underserved include those experiencing homelessness, agricultural workers and residents of public housing.

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org