Post-Marketplace Challenges and Recommendations

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The National Council of Asian Pacific Islander Physicians (NCAPIP) conducted in 2015 seven regional meetings in four U.S. states with Asian American physicians and other health care stakeholders to document physicians’ perspectives on the implementation of the Affordable Care Act. NCAPIP is a national health policy organization that represents physicians committed to the advancement of the health and well-being of Asian American, Native Hawaiian and Pacific Islander communities. The topics focused on the impact of expansions of health insurance exchanges (HIE) on their patients and practices, the provision of culturally and linguistically appropriate care, use of electronic medical records, participation in medical home and accountable care initiatives, and readiness for value-based payments and other health care reforms.

This report documents the important role of Asian American physicians in solo and small group primary care practices in providing health care to their patients and communities. The physicians who participated in the regional meetings recognized that accessibility and affordability of health care two years post marketplace are still a challenge for their patients, putting an emphasis on the rising costs of prescription medications.

They acknowledged the benefits of using electronic medical records (EMR) but pointed to specific challenges in the provision of culturally and linguistically appropriate services, i.e., consent and release forms only available in English language. The lack of interoperability and structured health information exchange were identified as another significant one.
In discussing clinical practice transformation in support of health care quality improvement, physicians strive to do their best and are generally doing well on quality measures. However, they believe that the patient satisfaction surveys might be culturally biased.

The shortage of psychiatrists and behavioral health providers pose a challenge to primary care physicians as they implement patient-centered medical home model. As team-based care is being in place in some practices, training has to be provided in order for physicians to know how to delegate responsibilities and to better explain team-based care and patient- centered care to their patients.

In some discussions, physicians reflected on the state of their profession and the context of continuing changes and reforms. They expressed feeling of being powerless to negotiate with health plans in their regions. There also was discussion about how the local hospitals in that region had been leading accountable care initiatives, intentionally excluding the local independent practice association and local physician leadership from the final design of shared savings from accountable care initiatives.

While the seven regional meetings do not allow the results to be generalized for all Asian American primary care physicians, many common themes were articulated about how Asian American primary care physicians might be better recognized, valued, and supported.

The eight recommendations that emerge focus on:

  1. Access and Affordability;
  2. Culturally and linguistically appropriate outreach and education;
  3. Culturally and linguistically appropriate HIE and Medicaid care services;
  4. Open source, interoperable EMR solutions;
  5. Active role of solo and small group primary care physicians and racial and ethnic minority physicians in the design, implementation, and evaluation of clinical practice transformation and value-based payment initiatives;
  6. Committed supporting role of the Transforming Clinical Practice Initiative (TCPI), Regional Extension Centers (REC), Primary Care Extension Centers, Community- Based Collaborative Care Networks, and Community Health Teams to solo and small group primary care physician practices;
  7. Ability of independent practice associations (IPAs), racial and ethnic minority physician organizations and other physician-support entities to provide technical assistance to their membership and peers on clinical practice transformation and value-based payment; and
  8. Inclusion of health care delivery system reform, health insurance, quality improvement, and culturally and linguistically appropriate services into medical school and other health professional academic curricula.