A new report from the National Academy of Medicine (NAM) calls on the Department of Health & Human Services to establish a Secretary’s Council on Primary Care and form an Office of Primary Care Research at the National Institutes of Health. It also recommends prioritizing funding of primary care research at the Agency for Healthcare Research and Quality.
The report, Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care, notes that “without access to high-quality primary care, minor health problems can spiral into chronic disease, chronic disease management becomes difficult and uncoordinated, visits to emergency departments increase, preventive care lags, and health care spending soars to unsustainable levels.”
Unequal access to primary care remains a concern, the report adds, “and the COVID-19 pandemic amplified pervasive economic, mental health, and social health disparities that ubiquitous, high-quality primary care might have reduced. Primary care is the only health care component where an increased supply is associated with better population health and more equitable outcomes. For this reason, primary care is a common good, which makes the strength and quality of the country’s primary care services a public concern.”
Changes in payment models
Policymakers should commit to paying primary care more and differently because of its capacity to improve population health and health equity for all of society, the report adds, not because it generates short-term returns on investment for payers.
The report suggests that payers using a fee-for-service (FFS) model should shift primary care payment toward hybrid (part FFS, part capitated) models, and make them the default over time. In addition, the Centers for Medicare & Medicaid Services (CMS) should increase the overall portion of spending going to primary care, and states should implement primary care payment reform by facilitating multi-payer collaboration and by increasing the overall portion of healthcare spending in their state going to primary care, the report says.
The authors suggest that HHS should invest in creating new health centers (including federally qualified health centers, lookalikes, and school-based health centers), rural health clinics, and Indian Health Service facilities in areas with a shortage of primary care. In addition, CMS should permanently support the COVID-era rule revisions and interpretations of Medicaid and Medicare benefits that have facilitated integrated team-based care, enabled more equitable access to telephone and virtual visits, provided equitable payment for non-in-person visits, eased documentation requirements, expanded the role of interprofessional care team members, and eliminated other barriers to high-quality primary care.
On the technology front, the report suggests that ONC and CMS should plan for and adopt a comprehensive aggregate patient data system to enable primary care clinicians and interprofessional teams to easily access comprehensive patient data needed to provide whole-person care.
The Primary Care Collaborative, a national nonprofit organization working to develop high-quality primary care as the foundation of a strong healthcare system, applauded the report and echoed its call for strengthening primary care to improve population health and reduce health inequities.
“Primary care is the ‘front door’ of our healthcare system and an evidence-based way to achieve health equity. Yet, given this prominent role and how vital it is to Americans’ health, it remains under-resourced,” said Ann Greiner, PCC’s president and CEO, in a statement. “As this momentous report is released from this respected institution, we have a historic opportunity. The Biden administration is looking to build our systems back better, and we are emerging from a health crisis that has catalyzed many changes in health care. Now is the time to come together to strengthen primary care as the foundation of a high-value U.S. health system.”
