CAFP was joined by several prominent health care organizations in signing a letter (below) that addresses the lack of primary, preventive health care in current reform bills in the State Legislature. The letter explains that primary care is fundamental to any effective health care policy. Groups signing the letter include organizations such as the California Psychiatric Association, Kaiser Permanente, California Association of Physician Groups, California Center for Public Health Advocacy, California Academy of Physician Assistants, and the California Primary Care Association.

June 28, 2007

The Honorable Don Perata, President pro Tempore, California State Senate
The Honorable Fabian Nuñez, Speaker, California State Assembly
California State Capitol
Sacramento, CA 95814

Dear Senator Perata and Assemblymember Nuñez:

Thank you for your legislative efforts to improve health care in California. The current discussion over health care reform in which you and other legislative leaders are engaged will have a profound effect on Californians' health. You and your staffs have worked hard to achieve a balance in your proposals between that which is achievable and that which will have the greatest impact on the uninsured.

To maintain this balance, we ask you to consider a more strategic use of primary care services in your plans. The experiences of other states have shown that increased access to a primary care "medical home" means cost savings and quality improvement. A medical home is a place where a patient receives primary health care, through a team partnership, for physical or mental health issues before they become catastrophic. A primary care physician leads the medical home with the support and direction of the patient, the patient's family, clinic staff, community agencies, school nurses and specialty care service providers. The result is better management of chronic disease and the optimal delivery of preventive care, both of which contribute to improved outcomes for patients and significant cost savings by avoiding hospital-based and emergency room care.

It is a tall order to move millions of previously uninsured patients into the California primary care system in the short term. We urge you to consider the expediency of phasing in the various populations over time in your plan, so that adequate healthcare workforce can be marshaled to meet the demands of those previously underserved.

For these reasons, we urge you to consider three recommendations to address the above concerns:

1) Structure your proposal to emphasize the primary care medical home and proven cost effective, preventive care;

2) Count the actual full-time-equivalent providers of care in the Medi-Cal/Healthy Families programs and support trailer legislation providing assistance to proven health care workforce training programs and other appropriate workforce incentives to ensure that an adequate provider base exists that does not compromise the quality of care patients receive; and,

3) Adopt a phased-in methodology, starting with all children and those with chronic health care needs, so that no taxpayer, patient or employer pays for health care benefits that the health care workforce cannot deliver.

Our group of health care consumers, providers and payers believes that these three changes in your plans will improve health outcomes, reduce costs and provide real access to care. A reform plan that neither leverages the value of primary care nor addresses the primary care workforce shortage will continue to take us down the path of escalating costs, inappropriate use of emergency rooms and unacceptable quality of care.

We look forward to meeting with you at your earliest convenience to discuss our proposal in more detail.

The following organizations signed this letter:

The California Academy of Family Physicians
The California Psychiatric Association
The Center for Public Health Advocacy
Kaiser Permanente
The California Association of Physician Groups
The California Academy of Physician Assistants
TMJ and Orofacial Pain Society of America
Asthma & Allergy Foundation of America - California Chapter
The California School Health Centers Association
The Latino Coalition for a Healthy California
The California Council of Churches
COPE Health Solutions
The American College of Physicians - California Chapter
The American Academy of Pediatrics - California District
The National Fibromyalgia Association
The California Association for Nurse Practitioners