Editorial - Jonathan Nelson, Texas Academy of Family Physicians


Report outlines five-point plan to transform health care in Texas

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, the Texas Academy of Family Physicians 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 policy makers 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. 
This five-point plan paves the way for Texas to reform and improve our health care system. Texas 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 crystallized our need to transform the way we pay for and deliver care,” said Jake Margo, MD, of Rio Grande City, president of the Texas Academy of Family Physicians. 
“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. 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, CEO/EVP of the Texas Academy of Family Physicians. “But COVID-19 has also given us a roadmap to repair and rebuild a stronger, more resilient system prepared for future public health crises.”
To access the report, “The Primary Care Marshall Plan:  A Five-Point Plan to Transform Health Care in Texas,” go to