8/25/2021 Healthy California for All Commission Meeting
Wednesday, August 25, 2021
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The next public meeting of the Healthy California for All Commission has been set for August 25 and will be held via Zoom.
The Healthy California for All Commission will focus its August 25th meeting on Barriers to Access and consider payment methods including risk-based capitation.
Though other countries with national healthcare system utilizes per capita payments they do so without the financial incentives of our commercial insurance industry and do not create incentives for restricted access to care that has a disproportionate impact on BIPOC communities and reduces equity.
We need to separate per capita payment methods from insurance risk and profit-making.
Care coordination that could be reimbursed through per capita payments may be necessary to ensure equitable delivery of care.
Public control of capital budgets can help to eliminate the incentive to restrict care access among private health systems who would use net income for corporate expansion and priorities.
Simply put, risk-based per capita payment methods can worsen healthcare disparities:
For a summary of the research on how “value-based purchasing,” and Accountable Care Organizations based on per capita payments exacerbate healthcare disparities see Rita Rubin, JAMA, February 21, 2018. Specifically, Rubin writes that:ACOs (accountable Care Organizations) have not worked for Medicare and will not work for the broader health care system.
In a recent study in Annals of Internal Medicine, McWilliams and his coauthors found that the PVBM (Physician Value-Based Payment Modifier Program) had no effect on the quality or efficiency of care provided and likely exacerbated health care disparities by disproportionately penalizing practices that care for lower-income or sicker patients.
Per Health Justice Monitor (8/18/21), we now have a decade of impressive empirical evidence demonstrating minimal if any benefit from ACOs of several designs.
It’s imperative when designing payment methods for a California single payer system, we avoid any financial incentive for providers tied to access to care.
Policy analysts have shown that efforts to restrict “unnecessary” care, such as the high deductibles that are included in Covered California health plans, inevitably restrict, and reduce necessary care.
Regarding accountability for health outcomes and quality, it is possible to deliver high-quality care to the population that has access to care and the means to pay for it, while delivering poor-quality care to the smaller share of the population that lacks those means. The result may be an average level of performance overall but create a health system that nevertheless inadequately serves the sickest and most vulnerable, which are often from Black and brown communities.
Instead, we need to recognize that accountability and health equity won’t be achieved unless we have robust regulatory standards and regional health planning for clinics and hospitals.