TAFP report outlines five-point plan to transform health care in Texas

Tags: Marshall Plan, prospective payment, 87th Texas Legislature

By Jonathan Nelson

Texas’ fragmented health care system has long been plagued by ever-rising costs, inconsistent access to care, poor health outcomes, and a shrinking primary care workforce. The COVID-19 pandemic exposed those critical weaknesses and laid bare the undeniable socioeconomic inequity endemic to our health care system.

In response to the ongoing pandemic, TAFP commissioned a report from FTI Consulting, an independent global business advisory firm, to study the impact the COVID-19 pandemic has had on Texas’ health care system. The report, “The Primary Care Marshall Plan: A Five-Point Plan to Transform Health Care in Texas” lays out specific actions that policymakers should take to reimagine and transform how primary care is funded and delivered to improve the health and economic productivity of Texans, reduce overall health care spending, and prepare us for future public health emergencies.

The report comes out four months before the 87th Texas Legislature is set to convene. Early this year, Speaker of the House of Representatives Dennis Bonnen appointed a select committee to study health care costs during the legislative interim.

The recommendations in this new report should inform the work of the interim select committee. The five-point plan recommends the state should:

  • Lead the way for primary care payment reform by changing the existing transactional RVU-based, fee-for-service model to a prospective payment model that supports continuous, comprehensive and coordinated care;
  • Decrease the rate of uninsured Texans through innovative market-based solutions;
  • Enable physicians and other health care providers to continue adapting to the digital age by supporting regulatory and payment changes that ensure appropriate use of telemedicine;
  • Ensure that all Texans have access to primary care by aligning state appropriations with Texans’ current and future health care needs; and
  • Develop effective public health workforce and surveillance capacity through a new kind of community health worker and full integration and interoperability of health care data across all levels of government.

“This pandemic has shown us in stark relief the fissures and cracks in our broken health care system. It has also crystalized our need to transform the way we pay for and deliver care,” said TAFP President Jake Margo, MD, of Rio Grande City. “We need a Marshall Plan for our primary care and public health infrastructure. Our elected leaders have an unprecedented opportunity to redesign our health care system so it truly serves Texans and the professionals who care for them.”

“Just as the aftermath of war offers an opportunity to rebuild, the devastation COVID-19 wrought on our health care system and our economy gives us the opportunity to rebuild a better, more cost-effective system of care,” the report says. “And just as the historic investments made under the Marshall Plan after World War II enabled European countries to rise from the ashes of war, today we need a Primary Care Marshall Plan to tackle the state’s most pressing health care problems.”

“COVID-19 exposed the ways that our health system fails patients. The pandemic revealed flaws in our payment systems, demonstrated how our rules and regulations inhibit technological progress in health care and highlighted how our public health surveillance system is inadequate to contain the spread of disease,” said Tom Banning, TAFP CEO. “But COVID-19 has also given us a roadmap to repair and rebuild a stronger, more resilient system prepared for future public health crises.”


  • John Tyson M.D. said

    All though I retired from active practice in 2007 -- I still maintain an interest in Primary Care delivery. DO NOT
    transform the delivery of care to a SOCIALIST style system --
    that would be the "death" of good care. All patients and physicians must have some "skin in the game" !!

  • Richard Nelson said

    TMB provides a Voluntary Charity Care to retired physicians. The problem is the lack of an organisational effort to link these physicians per county for the logistic preparedness of being involved immediately in case of a disaster or the current pandemic. I tried to volunteer but unable to do so due to ignorance of hospital administrators to provide logistic support. If TAFP wants to use this sleeping resource, let me know to design a working administrative model.
    Richard Nelson md, mba

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