Primary care, when prioritized in the health system, results in people living longer lives with more equitable outcomes. Yet primary care, with chronically low funding and infrastructure investments, is in danger.

With the mission to advance equitable, comprehensive, and sustainable primary care for all Texans, Texas Primary Care Consortium (TPCC) is the only multisectoral network focused on primary care in Texas. In summer 2022, TPCC, with support from Episcopal Health Foundation and St. David’s Foundation, brought together a statewide consensus panel to identify and advance bi-partisan, smart public policy that will improve primary care during the 88^th Texas legislative session.

Given the systemic and chronic nature of our state’s challenges, the consortium proposes a three-pronged framework of solutions for a positive and sustainable impact:

• Increasing access to care
• Promoting value-based payment systems
• Strengthening primary care

Increasing Access to Care

Texas continues to grapple with the highest rates of uninsured adults and children in the country. Nearly 5.2 million, or 1 in 5 Texans, lack health care coverage. Additionally, around 3.1 million Texans live in rural areas, more than in any other state in the country. We know that rural residents face significant challenges accessing preventive, acute, maternity, and chronic care services.

To address this gap, the consensus panel recommends these priorities:

• Reduce the number of uninsured Texans
• Strengthen access to primary care
• Modernize Texas Medicaid to make it easier to sign up for and renew benefits
• Optimize the use of telehealth

For example, by educating Texans on how to get coverage, expanding coverage for 12 months post-partum, and supporting Texas HHSC’s request to increase Medicaid reimbursement rates for primary care, we can help more people access regular and preventative health care.

‍Promoting Value-Based Payment

Value-based payment systems were identified as a priority for the consensus panel because the traditional fee-for-service structure is designed to focus on short-term needs and treatment of a patient’s episodic illness or acute condition. Accordingly, the primary objective becomes managing and treating symptoms, rather than addressing the underlying cause to avoid a recurrence.

One of the National Academies of Sciences, Engineering, and Medicine’s objectives of high-quality primary care is, “pay for primary care teams to care for people, not doctors to deliver services.” For high-quality primary care to be implemented in Texas, we recommended:

• Facilitate coordination and collaboration amongst payers, providers, and purchasers
• Promote prospective payment models

For example, by minimizing barriers to facilitating value-based care delivery and considering the impact of non-medical interventions—such as nutrition, housing, safety, and transportation—we could reduce health care costs.

‍Strengthening Primary Care

High-quality primary care is associated with better health outcomes, more health equity, and lower costs. However, primary care only accounts for 5-7% of total health care spending.

Research has found that people who receive care from a primary care provider are healthier, and that health is better in communities with more primary care providers. To strengthen primary care, our consensus panel identified these priorities:

• Invest in primary care
• Strengthen the primary care workforce

For example, leveraging information from the Texas All Payer Claims Database to understand primary care utilization and spending, increasing funds for medical and nursing education, and setting a target for primary care spending in Texas will lead to a stronger system and workforce.

Learn more about TPCC's 2023 policy priorities, and check out our video on "Making Primary Care Primary."

Join Texas Primary Care Consortium for a webinar on February 23 to learn why improving the state’s primary care system is urgent and critical, and how policy changes can improve health across the state.