Commission hears workgroup report endorsing study of universal primary care as a step toward a universal system

The Universal Healthcare Commission on June 18 received a report from its Universal Primary Care Workgroup recommending that universal primary care be added to the commission's work plan as either a foundational building block of a universal system or a transitional approach to expand access.

Workgroup member Hiroshi Nakano summarized options discussed by the group — phased implementation, a transitional bridge or a foundational step — and said members generally supported advancing the topic alongside the commission's broader universal health design work. "We believe the work should be evaluated in how it fits into the conceptual framework of this commission," Nakano said.

Commission staff and the Office of the Insurance Commissioner emphasized that many of the design questions for universal primary care — how to attribute members to providers, how to govern the system and how to finance it — overlap with the overall universal design the commission is developing. Ingrid Ullrich, the insurance commissioner's senior health policy adviser and delegate, said the OIC has dedicated regulatory-account funds to expedite work and urged the commission to create a "container" for detailed design and analysis.

Several commissioners pressed for clearer success metrics and implementation guardrails. Representative Joe Schmick asked what concrete measures would be used to know if the model is working; Hiroshi Nakano said proposals under consideration include explicit quality measures and tracking whether shifting resources to primary care reduces downstream hospital and emergency care costs.

Members also raised workforce concerns. Dr. Quanghette (Department of Health) and others warned that shortages of primary care clinicians — especially in rural areas — must be addressed in tandem with any financing changes. The commission discussed potential workforce strategies, including greater use of nurse practitioners and physician assistants, and suggested the primary care advisory body and workforce council be engaged.

On timing, staff said the commission could consider a formal vote on whether to integrate universal primary care into the work plan at its September 3 meeting, while acknowledging many detailed design questions will remain and additional workgroup meetings and analyses will be needed in the interim.

The commission directed staff and the workgroup to refine the scope of questions (metrics, populations, financing and provider participation) and return with a clearer proposal that identifies what information commissioners would need to make a policy decision in September.

The commission did not take a final policy vote at the June session; members agreed to continue developing the design and to schedule follow-up work between now and September.