Phillip Bergquist is the chief operating officer at the Michigan Primary Care Association (MPCA) and leads MPCA’s engagement with state and federal legislation.
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Patrick Jones: What important conversations has MPCA had surrounding the Michigan Health and Human Services budget recently?
Phillip Bergquist: “We’ve had pretty significant focus over the course of the last few months on a couple of major issues. One of those has been the ongoing COVID-19 response. Health centers have been really engaged in COVID-19 response providing community-based testing services, vaccine administration services, and then helping patients get connected to treatment including monoclonal antibody therapy. So a portion of our budgetary focus has been making sure that we have sufficient funding for those efforts. We’re really proud of the work that health centers are doing reaching at risk communities that have been harder to reach, with other providers.
Our other major budgetary focus is primary care investment, and specifically, primary care investment focusing on the implementation of an alternative payment methodology. The alternative payment methodology approach is using one-time resources that are available to the state of Michigan to make a long-term change in the way that community health centers provide care. So the general idea behind the alternative payment methodology is to go from a per patient, encounter-based reimbursement system to a per patient system [where] you’re reimbursed regardless of the number of encounters that patient has with your care team. So, in the budget we’re focused on a one-time investment to help make that transition possible.
As you can imagine, this is a huge transition for health centers and is transforming how they provide services. So they’ll be adopting different models of care, training team members differently, and making investments in IT systems that support different styles of care. We’ve really advocated for an investment, using one-time resources using federal American Rescue Plan (ARPA) resources to support the implementation of an alternative payment methodology.”
PJ: How might funding for this alternative payment method kickstart the implementation of the program? What are the first steps following the budgetary process?
PB: “There’s design work to do to get in the details of how the payment works. We’ve already gone through the work of what the payment methodology will look like, how it ties into quality measures, who will be involved, and what types of Medicaid beneficiaries would be included. But then, there’s also the internal workings of Medicaid payments, and some of that design process needs to happen, as well as filing for federal approval. The upfront steps will focus a lot on finishing that design, looking for federal approval, working very closely with MDHHS (Michigan Department of Health and Human Services), and MDHHS really leading the work to bring an alternative payment methodology into operational implementation at the individual health center level.
[Within health centers], a lot of their focus will be on service delivery transformation, looking at the way that we deliver services today, and what can we do differently that better meets the needs of our patients, if we’re paid in a more flexible manner. We’re looking for the financial investment to occur over the first two years that the payment methodology is implemented. So, it might be a year after the budget is done so that language makes its way into the budget. For example, it might take about a year afterward, maybe even a year and a half, to complete the design, get federal approval, and line up all of those components.
We had a lot of support so far both from state departments as well as the legislature. A lot of good questions about ensuring that a payment change of this magnitude is tied to quality and tied to outcomes.”
PJ: What are some other priorities MPCA is keeping an eye out for in relation to the health budget?
PB: “From a direct budgetary perspective, I think the COVID response alternative payment methodology has been the ones that are closest to fiscal items. Simultaneous to those, we’re also watching and providing feedback on behavioral health integration proposals that are happening in the state legislature. In their current legislative format, they’re not directly part of the budget, but those proposals could have budgetary impacts. [This is ] something that we have pretty deeply engaged our Community Health Center membership across the state on because it’s so critical for the patients that we serve.
Alongside the budget, we’re also really closely following policy issues that may or may not have budgetary impacts. Those include pharmacy related items, so we’re particularly interested in protections for health center pharmacies and the services that they provide to patients. We’re also following and contributing to legislation on telehealth services.”
PJ: Two plans concerning behavioral health and physical health integration are going through the House and Senate. Which plan does MPCA support and how are you engaging in these discussions?
PB: “We’ve looked at both the House proposal as well as the Senate proposal really carefully, and we’ve heard directly from legislators and stakeholders. We’ve not taken a formal position of support for either legislative proposal currently, but in that engagement, we have identified areas where there is opportunity in both. There are elements to both proposals that seem very consistent with the concept of further integrating care, which is what our membership is interested in seeing. We’re getting feedback on both proposals and we’re engaging health centers on both to understand, ‘how would this impact you and your patients? Are there elements to these proposals that could be potentially improved to better serve your patients?’”
PJ: What gives you hope for the future in terms of any of that legislation that we mentioned, or some of your budgetary priorities?
PB: “We are really excited about the opportunity to make an investment in an alternative payment methodology. Health care reimbursement is not always the most exciting thing to talk about, but it makes a significant impact in the way that we can deliver services. We’ve learned over the course of the last couple of decades what’s making a difference for our patients. We’ve seen the services that we need to provide to really move the needle on health outcomes. You have to go beyond serving patients in briefer encounters or even beyond the work that we can do with our current team-based care approaches.
Creating flexibility in payment and paying more at the population of patients level versus per service provided allows that flexibility to happen, and everything that we can see shows there’s a real need for a bigger embrace of team-based care. We’re really excited about how much good could be done in the investment of transitioning to a different payment approach.”
This interview was edited for clarity and length.