Viewpoint: Increasing primary care access is good business

By Trinidad Navarro
Guest Columnist

I am an optimist. I know that we can find sparks of light in even the darkest of times.

Insurance Commissioner Trinidad Navarro

During COVID-19, belief in a better tomorrow was hard to hold on to when each tomorrow brought bad news – but now, reports are positive: new treatments are more successful, the vaccine is being administered, businesses are reopening, and people are returning to work.

While we are far from able to fully look back on the pandemic, the darkness of the past year has illuminated many lasting lessons. In part, it has shone a light on the need to create a more equitable, accessible, affordable health care system. A system that prioritizes patients – not paperwork or profits. A system that provides high-value care whether in-person or through telemedicine. A system that prioritizes primary care, reducing preventable emergencies and saving policyholders money. This need is known, but because of the pandemic we have more momentum for change than ever before.

Delaware employers have long recognized the connection between well-being and productivity. We know that when employees are physically and mentally healthy, they are absent less frequently and more efficient during the workday. And let’s not forget, a healthier population makes insurance premiums more affordable.

To foster a healthy workforce, we need to invest in primary care. When we increase utilization of these services, we can decrease expensive emergency room visits and hospital admissions. This emphasis doesn’t have to raise rates or increase the total cost of care, but it does take a restructuring of our priorities and a strong shared vision for success.

And, while we want health care to be affordable, it should also be worth the money – “high-value” care. We have seen that low-value care, for example, unnecessary diagnostic testing, makes up a large portion of health care expenses. Value-based care ties payments for service to the quality of care provided, encouraging a focus on positive patient outcomes while reducing costs.

With the support of many stakeholders, including the Primary Care Reform Collaborative and the General Assembly, we created the Office of Value-Based Health Care Delivery within the Department of Insurance. Our team’s inaugural report, Delaware Health Care Affordability Standards: An Integrated Approach to Improve Access, Quality and Value includes plans to more than double primary care spending in the commercial fully-insured market by 2025 without increasing the total cost of health care services to policyholders.

To achieve this dual goal, the affordability standards in the report include decreasing price growth for certain health care services and expanding use of payment models that aim to improve health care value. The data-driven analysis provided is the basis for the outlined health insurance premium affordability standards and targets for investments in primary care to better address our primary care shortage.

Making progress on these targets will make our workforce healthier and health care more affordable and accessible – one of my highest priorities. Over the past several years, we made strides toward this lofty goal. We have decreased health insurance rates, implemented a reinsurance program to balance out high-cost health care, began work to address rising pharmaceutical costs, and worked to protect residents with preexisting conditions through codifying portions of the Affordable Care Act, amongst other efforts. In recent weeks, I joined Insurance Commissioners across the country in making short- and long-term recommendations to the Biden administration on actions the federal government can take to foster a healthier community. And, with this report, we have produced a roadmap for emphasizing and enhancing primary care in Delaware. While we may encounter obstacles in rebuilding from this pandemic, we are more united toward positive action than ever before. As we continue to uncover opportunities for improvement in our health care system, I am optimistic about the future we can build together.

We are grateful to our partners, including those from the business community, who participated in the process of building these guidelines. Public comment on the report is open until Jan. 25 at email DOI-legal@delaware.gov.

Trinidad Navarro serves as Delaware Insurance Commissioner.