Lawmakers promote access to direct primary care in Medicaid

The Medicaid Primary Care Improvement Act, a law that has passed in the House and is now under consideration in the Senate, seeks to expand the opportunities for direct primary care arrangements in Medicaid, according to an emailed press release from Sen. Marsha Blackburn's (R-Tenn.) office.

Blackburn and Sen. Mark Kelly (D-Ariz.) introduced the bill in the Senate after it passed in the House. The bill seeks to improve access to care in rural areas.

"Rural residents often experience worse health outcomes and higher hospital utilization compared to urban populations, and 78 of Tennessee's 95 counties are rural -- making it extremely important to improve primary care access for Medicaid recipients in these communities," said Senator Blackburn. "The Medicaid Primary Care Improvement Act would address disproportionate health care coverage in rural areas by providing states with greater flexibility to address primary care challenges within Medicaid populations."

Direct primary care arrangements build on the maxim that "the primary care provider is the quarterback of care." The underlying assumption is that by positioning the primary care provider as the hub for a beneficiary's whole person care, the beneficiary's experience will boast better care coordination, better preventive care follow-through, lower administrative burden and, ultimately, better patient outcomes.

In direct primary care arrangements, primary care providers receive a fixed fee each month to cover a member's care, the press release explained. As a result, providers do not have to bill for services, eliminating an entire set of activities that tend to usurp providers' time, focus and energy.

Furthermore, these arrangements could impact the provider shortage. Proponents have argued that direct primary care arrangements give providers more time and energy to focus on patients, instead of on paperwork. As a result, they might have more bandwidth to see a higher number of patients and may be less likely to leave the workforce due to burnout, in which case direct primary care could improve access to care. On the other hand, this model could incentivize providers to accept healthier patients and it fails to address the high costs of specialty care, according to a Wolters Kluwer expert insight.

Nevertheless, the senators indicated that direct primary care could be a step forward for their constituents and advocated for increasing Medicaid programs' ability to implement this approach.

"While DPC practices are primarily used by privately insured or self-pay patients, there is growing interest in adapting the model for Medicaid beneficiaries to improve access and outcomes, particularly in underserved areas," the press release on the Medicaid Primary Care Improvement Act stated.

The Act seeks to provide an opportunity for Medicaid programs to utilize this approach. Without this Act, Medicaid programs are only able to enter into direct primary care agreements if states use a waiver, which few states have opted to do.

"By expanding care options for patients, this bill will allow providers to meaningfully address health needs and improve preventive care," Kelly argued in the press release.

Kelsey Waddill is a managing editor of Healthcare Payers and multimedia manager at Xtelligent Healthcare. She has covered health insurance news since 2019.