Underlying issue of primary care in US is ‘overwhelmingly investment’

WASHINGTON — Primary care is severely underinvested in the United States, especially when compared with some other high-income countries, according to a speaker at the Primary Care Collaborative annual conference.

During his conversation with Mark Del Monte, JD, chief executive officer and executive vice president of the American Academy of Pediatrics, Paul Grundy, MD, the founding president of the Primary Care Collaborative (PCC), noted that in Denmark, for example, 21% of health care investments go into primary care, compared with about 5% in the U.S.

Because of those significant differences, “we really have our work cut out for us,” Grundy said. “In the Danish system, the primary care provider is the best paid specialist, and should be.”

The 2-day PCC conference centered around the National Academies of Sciences, Engineering and Medicine’s (NASEM) report on rebuilding primary health care through five objectives: payment, accessibility, the workforce, technology and accountability.

During the COVID-19 pandemic, it has become more obvious that payment is one of the most severe shortcomings of primary care, Del Monte said.

“If there’s anybody who had any doubts that the current payment system didn’t work, we now know this to be a certainty,” Del Monte said. “The payment system collapsed in the midst of a pandemic. It didn’t work for access for families, it didn’t work for access to primary care.”

In the early days of the PCC, Grundy said much of the conversation around primary care reform focused on delivery models. The core issue that needs to be addressed, however, is “overwhelmingly investment,” he added. That is where the PCC’s Better Health – Now campaign comes into play, Del Monte said. The campaign aims to strengthen primary care by advocating for policies that will increase investments and help transition to a population-based prospective hybrid payment model.

Grundy cited Rhode Island as an example of how primary care investments can lead to success. Rhode Island’s commissioner of insurance increased payments to primary care by 1% more a year. That increase resulted in “huge savings overall,” Grundy said.

“That’s been replicated in Oregon and other places across the country,” he added. “I think we really just need to keep at it.”

The payment system was one of three factors listed by Grundy that need to be addressed to create a more accessible system. Others included technology and the cultural shift away from episodic care.

“That’s the cultural awareness of your patients, of your provider,” Grundy said.

While the PCC and its partners continue to advocate for payment reform and more investments into primary care, Grundy said it will take time to fully transform the system.

“One of the important things is that ... what you started may not happen in your lifetime,” Grundy said. “I think what we’ve started is really important.”

References:

• Del Monte M, Grundy P. Better Health: Now – Why payment has become PCC’S focus. Presented at: Primary Care Collaborative Annual Conference; Dec. 14-15, 2022; Washington.
• Concordance recommendations for primary care payment and investment. https://www.pcpcc.org/concrecs. Accessed Dec. 15, 2022.
• Implementing high-quality primary care: Rebuilding the foundation of health care. https://nap.nationalacademies.org/read/25983/chapter/1. Accessed Dec. 19, 2022.