A Growing Insurance Crisis Points the Way to Primary Care Capitation
As we saw last week, two new surveys have revealed that unemployment as a result of the pandemic is having a major impact on health insurance, with Black and brown Americans affected most severely.
That’s particularly troubling. Diverse communities have already been hit hardest by the pandemic; a Johns Hopkins study found that Black Americans were three times as likely as whites Americans to get COVID-19 and twice as likely to die from it, with the rates for Hispanic Americans even higher. As a result of decades of institutional racism, communities of color are less well-employed, paid inequitable wages, underinsured, and, as a result, less healthy, with higher rates of chronic conditions such as diabetes and cardiovascular disease. And now, millions of people are losing their insurance.
The U.S. Census bureau estimates that by last year, the number of uninsured in America was 30 million. This week, studies by Avalere and Civis show that the number has grown by as much as 7 million, and that the impact is falling on communities of color.
For example, Civis found that 8% of Americans overall lost their health insurance coverage due to COVID-19-related unemployment. Black and brown Americans were affected disproportionately; by September, more than a quarter (26%) of Black Americans were uninsured, following a steady rise from 17% in February. Latinx Americans, too, saw uninsured rates climb from 18% in February to 21% by September. In contrast, 11% of white Americans were uninsured in February, rising slightly to 12% in September.
To meet the “insurance deprivation” emergency, health-sector players need to consider relief in the short-term — for example, drug companies could provide drugs free of charge for those who have lost insurance. Payers must also seize on this moment to shift the way we reimburse primary care for the services they render.
As I wrote in MedCity News last week, sticking with fee-for-service is doubling-down on a losing bet, while primary care capitation is a far more rational payment model that can help bring equity to healthcare. The emerging insurance crisis provides payers the opportunity to correct course. I provided C3’s roadmap for how this can be accomplished.
The health of our most vulnerable hinges on good primary care. We must invest in approaches that comprehensively address physical, behavioral, and social needs in complex, low-income populations. That includes paying for an expanded, multidisciplinary team with community health workers addressing social determinants of health, and peer supports and recovery coaches working with people with mental health and substance use disorders. It also demands flexibility for health care team members to spend time with patients outside of the health center, both via telemedicine and in-person. These innovations don’t work under the fee-for-service payment model, which incentivizes providers to generate volume, rather than prioritize the comprehensive teamwork that is needed to provide patients with optimal care.
Payers need to consider how fee-for-service is failing our most vulnerable, and how they can support patients’ immediate needs during this emergency. Moving to primary care capitation will increase affordability and access, and help the millions of Americans who have become uninsured — especially in hard-hit communities of color — now and after the pandemic is over.
