Our war against this novel coronavirus is far from over, but we must start planning now so this type of public health crisis and the economic devastation it has caused never happen again. We need a Marshall Plan immediately for our primary care and public health infrastructure in Colorado and across the country.
Following the devastation of World War II, the United States enacted the Marshall Plan, providing more than $15 billion to help finance rebuilding efforts on the European continent. It was crafted as a four-year plan to rebuild cities, industries and infrastructure heavily damaged during the war, to remove trade barriers between European neighbors and to foster commerce between those countries and the United States.
Shoring up our primary care system is not the only step we must take, but it is a necessary one if we want to prevent the kind of damage being caused by this pandemic.
Many medical practices we represent report visits are down 50 to 75 percent as patients stay at home, paralyzing revenue streams and hampering practices’ ability to make payroll, pay bills and keep the lights on.
These are practices that operate on tight margins and often only have two to four weeks of cash reserves on hand. Many across Colorado are already laying off staff.
This problem is not limited to Colorado. Other states are seeing the devastation this virus is causing to our health infrastructure. This is why it is so important for lawmakers, both locally, in Denver, and nationally, to understand the scale of our challenge.
Our Marshall Plan strategy includes investments across multiple sectors of the health care system to modernize care delivery so that it is focused on organized systems of care, committed to population health management that balances access and relational continuity.
We need immediate financial assistance to Colorado’s primary care clinics and community health centers. Without intervention, some 58,000 family physicians across the country could shut their doors. Congress passed limited funding for community health centers and funding for small businesses to weather the storm, but more will be needed urgently to ensure patients that need care can continue to be seen.
We must immediately change the way primary care is paid for, from transactional fee-for-service to prospective payment that rewards care management, relational care and continuity. We have the means to achieve this today ― the Primary Care First Model, being piloted by Medicare ― should be adopted quickly by Colorado Medicaid and private insurers.
We should make regulatory and payment changes to accelerate the adoption and use of telemedicine. Some of these changes are occurring during the emergency, but they should be expanded and made permanent to ensure we are not caught unprepared in the future.
The lengthy delay to distribute national stockpiles of personal protective equipment to areas of deepest need has hindered our response severely. We must procure and stockpile necessary items like personal protective equipment to address public health crises and develop appropriate plans for proper distribution in times of need.
Finally, we need to expand and tailor our primary care workforce by producing more primary care and public health workers, and by implementing strategies to encourage their appropriate geographic distribution. We could forgive medical school tuition for graduates who choose primary care specialties and provide further loan forgiveness for those who practice in under-served communities. We also can increase graduate medical education funding for primary care residency positions to incentivize academic institutions to invest more in those programs.
We have an unprecedented opportunity to redesign our health care system so that it truly serves Coloradans and the professionals who care for them. We must save our front line primary care and public health professionals and, in so doing, set the foundation for a better way of delivering and paying for care.
If we ignore the workforce crisis unfolding before us, the long-term consequences to our health care system and most importantly, to the patients who need access to care, will be dire.
John Cawley, MD, FAAFP, is the president of the Colorado Academy of Family Physicians, the largest medical specialty association in the state. He lives in Fort Collins.