Report: Increasing investment, access will help restore ‘weakening’ primary care system

The National Academies of Sciences, Engineering and Medicine recently issued a report on how to make “high-quality primary care” available to all patients in the United States.

“Primary care is weakening in the United States and eroding, particularly in underserved and rural areas,” Bob Phillips, MD, MSPH, a co-chair of a committee that produced the report, said during a recent webinar hosted by the Primary Care Collaborative.

He added that primary care makes up “about 5% of total health care spending, which is lower than most countries and starving our capacity to deliver on health equity.”

In the National Academies of Sciences, Engineering and Medicine (NASEM) report, experts outline five objectives — payment, access, workforce, digital health and accountability — that need to be fulfilled to achieve high-quality primary care for all:

Payment

According to the report, Medicaid, Medicare, commercial insurers and self-insured employers should “pay for primary care teams to care for people, not for doctors to deliver services.” This will require payers to use payment models that focus on promoting high-quality primary care, “not on their ability to achieve short-term cost savings,” the report stated.

Bob Phillips

Phillips said that payers using a fee-for-service model should move towards a “hybrid model” of reimbursement that is part fee-for-service and part capitated.

Access

All people, regardless of demographic characteristics, need access to high-quality primary care, Phillips said. To achieve this, the report recommends that HHS invest in new health care centers, including federally qualified health centers, school-based health centers, rural clinics and Indian Health Service facilities. It will be particularly important to create new centers in underserved areas or areas with physician shortages, the report stated.

Workforce

Phillips said that providing community training where primary care clinicians live and work, “not just hospitals,” would be beneficial. The NASEM report calls on HHS to support training opportunities in rural and underserved areas, and to offer incentives such as loan forgiveness and salary supplements.

Digital health

Developers need to create information technology that “serves the patient, family and the interprofessional care team,” Phillips said. The report encourages the Office of the National Coordinator for Health Information Technology and CMS to “develop the next phase of digital health, including electronic health record, certification standards,” which should account for user experience, ensure equitable access and “hold health information technology vendors and state and national support agencies financially responsible for failing to achieve benchmarks.”

The report also calls for HHS to establish a Secretary’s Council on Primary Care whose responsibilities would include “coordinating primary care policy” and “ensuring adequate budgets,” Phillips said. The council would be guided by a Primary Care Advisory Committee and report its progress annually, he added.

Societies respond to report

The American Academy of Family Physicians, which was among the 17 groups that sponsored the report, applauded its details.

Ada Stewart

“The NASEM report clearly spells out the case for increased investment in our primary care system and ensuring everyone in our country has access to high-quality primary care,” Ada Stewart, MD, AAFP president, said in a statement.

George M. Abraham, MD, FACP, FIDSA, and president of ACP — another organization that sponsored the report — said apathy is not an option.

“Our health care system has long undervalued primary care, we need changes that better support primary care physicians and recognize the value they bring to patients and our health system,” he said in a statement.

PCPs can help drive change now

During the webinar, speakers discussed how PCPs can help improve primary care in the U.S.

Sinsi Hernández-Cancio

Sinsi Hernández-Cancio, JD, vice president for health justice at the National Partnership for Women and Families, encouraged PCPs to collect data, “especially disaggregated data by race, ethnicity and the subgroups within them,” to better understand health inequities.

Kavita Patel

Kavita Patel, MD, MS, a nonresident fellow at the Brookings Institution, said the primary care community needs to pressure politicians to take action.

“We need [them] to feel like they’re in a corner unless they can talk about what they are going to do to make primary care better,” she said. “It is no longer acceptable for primary care to be tucked neatly into a subset of policy paper.”

References:

• ACP. ACP says new recommendations from NASEM could help strengthen primary care medicine.
• Available at: https://www.acponline.org/acp-newsroom/acp-says-new-recommendations-from-nasem-could-help-strengthen-primary-care-medicine. Accessed May 12, 2021.
• AAFP. AAFP praises new report that recommends increased investment in and access to high-quality primary care. Available at: https://www.aafp.org/news/media-center/releases/aafp-praises-new-report-that-recommends-increased-investment-in-and-access-to-high-quality-primary-care.html. Accessed May 12, 2021.
• The National Academies of Sciences, Engineering and Medicine. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care.
• https://www.nap.edu/catalog/25983/implementing-high-quality-primary-care-rebuilding-the-foundation-of-health. Accessed May 12, 2021.
• The National Academies of Sciences, Engineering, and Medicine. High-quality primary care should be available to every individual in the U.S., says new report; Payment reform, telehealth expansion, state and federal policy changes recommended. Available at: https://www.nationalacademies.org/news/2021/05/high-quality-primary-care-should-be-available-to-every-individual-in-the-u-s-says-new-report-payment-reform-telehealth-expansion-state-and-federal-policy-changes-recommended. Accessed May 12, 2021.