by James C. Sherlock
I have written columns here and in various newspapers across the state for a number of years supporting health enterprise zones (HEZ’s) in underserved areas of Virginia.
I drafted and Republican Attorney General candidate Jason Miyares sponsored legislation of that title in the General Assembly.
It lost. Like night follows day, Democrats killed it. Fast forward.
The National Academy of Sciences, Engineering and Medicine released an implementation plan May 4 for the U.S. government, recommending it provide high-quality primary care to all Americans. The program proposed is simply too large in my view to be run effectively in 50 states by the federal government and its one-size fits all regulations.
But it contains good ideas — action items that Virginia can and should legislate without waiting for federal legislation that may never see the light of day.
I lifted the HEZ concept in its entirety from a remarkably successful program in Maryland. It is designed to both improve health and lower Medicaid costs by bringing better primary care to underserved communities. In Maryland it has triumphantly achieved both goals.
The HEZ program works through incentives for primary care physicians who would like to serve the poor.
They get help to establish their practices with community sponsorship. That support is a huge deal. Usually rent-free office space in government owned properties, security support, and referrals from community organizations.
Medicaid helps them pay off student loans and grants above market payments in return for their service. In return, Medicaid saves a fortune net by keeping poor patients out of the hospitals.
The community health gains in Maryland communities served by HEZs have been spectacular.
As I wrote earlier, in the General Assembly it took a Republican to introduce it and Democrats to kill it.
Pretty hard to imagine why the Democrats would kill such a bill. But the Medicaid savings are attained by poor people making far fewer hospital visits.
Update: Virginia Hospital and Healthcare Association spokesman Julian Walker said that the VHHA supported the Miyares bill. “We supported the legislation and testified in favor of it in committee. R. Brent Rawlings, VHHA senior vice president, said, “We support this legislation. It’s in alignment with our population health initiatives, and in general with the philosophy and mission of our member organizations. So, thank you to the patron.”
Let’s move to the May 4th plan: “Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care”.
It contains three recommendations that, if adopted by the General Assembly, will implement HEZ here and save the state money at the same time.
ACTION: To facilitate an ongoing primary care relationship, all individuals should have the opportunity to have a usual source of primary care.
• Medicaid, Medicare, commercial insurers, and self-insured employers should ask all covered individuals to declare a usual source of primary care annually and should assign non-responding enrollees to a source of care using established methods, track this information, and use if for payment and accountability measures.
• When health centers, hospitals, and primary care practices treat people who are uninsured, they should assume and document an ongoing clinical relationship with them.
ACTION: … target sustained investment in creating new health centers … in areas with a shortage of primary care.
ACTION: Primary care practices should move toward a community-oriented model of primary care by including community members in their governance and practice design and partnering with community-based organizations.
The first is an excellent idea. The second and third are implemented in Maryland’s HEZ program and were in the original Virginia HEZ bill before it was rewritten in committee and killed. All three can be implemented in Virginia law for everything but Medicare.
The enterprise needs a single regulator. The Department of Health, fairly wretched at what it does already and controlled by the hospitals, has no experience in overseeing primary care. Look it up.
As a combination of insurance and provider measures, I recommend HEZ oversight be led by the State Corporation Commission with assistance of the Department of Health Professions, not the Department of Health.
DHP is composed of Virginia’s 13 health regulatory boards, the Board of Health Professions, the Prescription Monitoring Program and the Health Practitioners’ Monitoring Program. DHP licenses and regulates over 380,000 healthcare practitioners across 62 professions. It will far better represent the interests of primary care physicians than the VDH.
Democrats should grow spines and vote for such legislation. Nearly all Republicans will support it.
Whether or not Virginia gets Republican GA majorities from the fall election, there are a few Democrats such as Senator Chap Petersen who can lead the way and shame some of the rest into doing the right thing.
I hope they will.
(Updated June 1 at 8:35)