Viewpoints: Can primary care safety net handle region's newly insured?

Is the Sacramento region ready for health care reform? A knowledgeable source would hypothetically answer, "We're not as far along as we need to be." We should actually be asking a different question: "Are we doing enough to prepare for the transformative impacts of health care reform?"

As many residents of our region are aware, the passage of the Patient Protection and Affordable Care Act gives us the opportunity to to rethink, revitalize and reform the regional health care system that serves El Dorado, Placer, Sacramento and Yolo counties. Not all is in crisis; our region is fortunate to be served by multiple well-positioned health systems.

However, our primary care "safety net" system requires urgent care. This is critical, as 227,500 new enrollees are expected to enter the health care market starting January 2014. These new enrollees include those who can't afford insurance and those whose employers don't offer insurance.

This large number of new entrants into the regional health care market presents a big challenge as well as a significant opportunity. Successful implementation of the ACA will make access to care a reality for the newly insured, which in turn can drive the type of preventive health care approaches that save lives and money across our region. But there are two potential roadblocks to realizing these benefits – insufficient numbers of geographically and culturally accessible clinics, and the lack of resources (e.g., money, medical personnel) to help new enrollees to manage existing health issues or avoid getting sick in the first place.

Consider how this plays out with diabetes. The American Diabetes Association estimates the total cost of diabetes for people in the Sacramento region at $459.8 million annually, which includes excess medical costs of $324.4 million and lost productivity assessed at $135.4 million. For example, an uninsured father who cannot access primary care to manage his diabetes is more likely to require several trips to the emergency room.

Thus, the burden of failing to provide primary care for preventable illnesses falls squarely on other parts of the system, such as our hospitals. The overflow of patients impacts everyone's ability to access emergency services, regardless of income or insurance status, resulting in delayed care, higher health care costs and poorer health outcomes across the board. Long story short: We all pay the price for those who don't have access to primary care.

The challenges of the regional community health clinic system – lack of patient access, cultural and language barriers, transportation hurdles and administrative obstacles that constrain physicians – have been well scrutinized and verified for years, but to date the issues raised haven't been successfully addressed. That needs to change for us to avoid sinking an already vulnerable system.

In 2011, at the request of several community stakeholders, Sierra Health Foundation launched the Sacramento Region Health Care Partnership. The partnership, the first coordinated philanthropic, county agency, nonprofit provider and community clinic effort focused solely on preparing for regional health care reform, grew out of conversations with policymakers, health systems and community clinics and built on the Health Care Working Group convenings initiated in 2011 by Rep. Doris Matsui.

The partnership's work to date, co-funded by the California Endowment and the Sacramento Region Community Foundation, has been twofold: conducting a market analysis of our current primary care safety net to accurately determine where we are; and creating an actionable strategic plan that provides a path forward based on what we now know. Can the existing primary care safety net absorb a dramatic influx of newly insured patients? The market analysis defines the magnitude of the challenge, and it is huge: Across our four-county region, a projected 227,500 non-elderly adults and children will soon be eligible for health coverage. It seems clear that, without action, these newly insured residents will enter and overwhelm an already strained safety net system.

So, are we doing enough to prepare for the transformative impacts of health care reform? To answer this question, partnership members designed a strategic plan based on the vision of a collaborative, accessible, high-quality and culturally competent primary care health system, one that gets results and is financially viable. Breathing life into that vision will require us to focus on these significant issues facing our region: capacity building, care coordination for patients, collaboration, and primary care safety net and specialty care capacity.

Strengthening the safety net will require commitment and cooperation across the region. Even without the ACA as a catalyst, the vulnerabilities and inadequacies of our region's safety net were crying out for change. With the health care reform at our doorstep, it's time to work together to create a high-quality patient care system that will be ready, willing and able to serve our newly insured residents.

• Read more articles by Chet P. Hewitt

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