Direct primary care pilot program clears second round

A bill that would create a pilot program offering direct primary care to state employees was amended and advanced to final reading March 28.

Sen. Merv Riepe
Sen. Merv Riepe

LB1119, sponsored by Ralston Sen. Merv Riepe, would create a pilot program for state employees eligible to participate in the Nebraska state health insurance program. The three-year pilot program would begin in fiscal year 2019-20 and require that the state insurance program include at least two primary care options—one high-deductible and one low-deductible—for state employees.

The University of Nebraska system, state colleges and community colleges would not be included in the pilot program.

Under the bill, a participating provider would be required to:
• provide primary care to an enrollee;
• coordinate care across all care settings;
• oversee transitions in care between settings; and
• minimize the risk of gaps in care.

Providers would receive a monthly payment of a per-member, per-month fee for each enrollee and would be required to continuously monitor care quality measurements. The state Department of Administrative Services would provide the Legislature an annual report on the clinical and financial performance of the program.

The bill also would establish minimum standards and patient satisfaction measurements—which a provider must continually monitor—including a patient engagement measurement and a prevention measurement.

Riepe offered an amendment during select file debate to add provisions of his LB604, which would adopt the Nebraska Right to Shop Act. The act would apply to any health insurance carrier in the state that elects to be subject to it and would give DAS the discretion to develop and implement a right-to-shop program for state employees.

Riepe said a similar program in New Hampshire has saved the state $12 million and has saved consumers more than $1 million.

“Right to shop is a price transparency [measure] and it empowers consumers with the knowledge to make smart choices about how and where to obtain health care,” he said. “Through right to shop, insurance carriers provide patients with tools to find the best value [and] patients are incentivized to find the best value by receiving cash from savings attained.”

The act would require participating insurers to disclose the allowed amount for a nonemergency admission, procedure or service within three working days. The information provided to a patient or prospective patient by the insurance carrier also would identify out-of-pocket costs.

Insurers would be required to develop and implement a program that provides incentives for insured individuals who opt for services from network providers that charge less than the average price paid by the insurer for that health care service. Individuals would receive at least 50 percent of the insurer’s saved costs for each service chosen.

Gothenburg Sen. Matt Williams supported the amendment.

“We have a looming crisis in health care and looking at alternative ways to be sure people understand what they are buying, how much they are paying for it and—with right to shop—having the insurance company have the option to give incentives … just makes great sense moving forward,” he said.

Following the 33-0 adoption of a technical amendment offered by Riepe that would extend the direct primary care pilot program by one year, LB1119 advanced to final reading by voice vote.

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