SECTION 1.
(a) The Legislature finds and declares all of the following:(1) The COVID-19 pandemic has exposed our health care system’s weaknesses and pre-existing conditions, including an unsupported primary care foundation, inequitable health care delivery and outcomes, and payment system failure. These shortcomings impact one another. One reason for health inequity and the disproportionate impact of COVID-19 on minority and marginalized communities is inadequate access to primary and preventive care. And, one of the reasons for the inadequate access to primary and preventive care is the current predominant payment scheme of fee-for-service payments, which is not structured to support or sustain a comprehensive primary care system.
(2) The underfunding of primary care is also leading the way to increased consolidation as larger health systems purchase financially fragile and independent practices.
(3) Although these problems are exacerbated by COVID-19, they are not caused by COVID-19. After the pandemic, these problems will remain because they are underlying conditions of our health care system. There have been efforts to address these issues through health payer payment reform and quality measurement. However, these efforts have been isolated, limited, inconsistent, and disjointed, partly due to a lack of consensus on the best payment model and quality measures to adopt.
(4) Disjointed efforts, however, will not achieve the necessary changes to our health care system. In order to make impactful, overall health care system changes, payers, health care providers, and consumers must collaborate and have direct conversations to achieve alignment and consensus on a payment reform model, quality measurements, and reporting.
(5) There is consistent and growing evidence that investing in primary care promotes health equity, improves patient outcomes and experience, and reduces health care spending. Primary care-oriented health care systems are associated with fewer hospitalizations and emergency department visits, lower mortality, and increased self-rated health scores. Research published in 2019 found that having 10 additional primary care physicians in an area was associated with an increase in life expectancy by 51.5 days.
(6) Other states that have invested in primary care have seen significant reductions in expenditures and an increased supply of primary care providers. Oregon found that for every $1 increase in primary care expenditures, that $1 increase resulted in $13 in savings in other services, such as specialty care, emergency department services, and inpatient care. In addition, Oregon saved an estimated $240 million over the first three years of the initiative. Rhode Island experienced an increased supply of primary care providers per capita during the time period in which the state increased primary care investments.
(7) Initiatives in California have also seen reductions in expenditures and improvements in health outcomes. In a primary care initiative launched by the self-insured Fresno Unified School District’s Joint Health Management Board and the California Academy of Family Physicians, the district saved nearly $1 million, and health outcomes and patient satisfaction improved significantly one year after the launch of the initiative.
(b) Therefore, it is the intent of the Legislature to do all of the following:
(1) To direct payers, health care providers, and health care consumer representatives to come to the table and collaborate to establish multipayer payment reform pilots for primarily fee-for-service primary care practices.
(2) To ensure that the pilots described under paragraph (1) are established in areas hit hardest by the COVID-19 pandemic, particularly in regions where the impact has been greatest among communities of color, which face health disparities and lower access to culturally and linguistically competent care. Communities in these regions often rely on small- to medium-sized primary care practices that have been financially threatened by COVID-19 due to their predominant payment model of fee-for-service.
(3) (A) To make prescribed exemptions on state antitrust laws, and, to the extent possible, to ensure that entities be granted immunity from federal antitrust laws, pursuant to the state action doctrine, for any activities undertaken pursuant to this act that otherwise might be constrained by those laws.
(B) It is not the intent of the Legislature to authorize any person or entity to engage in, or to conspire to engage in, any activity that would constitute a per se violation of state or federal antitrust laws.
(4) To articulate a clear and affirmative policy describing its intent to manage competition with respect to the implementation of this act, and to actively supervise anticompetitive conduct and its results with ongoing oversight.