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Advancing Primary Care: Interventions to Support and Replicate

Posted By Louise Probst, Tuesday, October 1, 2019
Updated: Tuesday, October 1, 2019

For half a century, the U.S. health care system has undervalued and underpaid primary care providers relative to other specialists. The unintended consequences of this chronic underinvestment loom large: out-of-control cost, declining and inadequate access to primary care physicians, outcomes that lag behind other nations, high rates of overuse and medical mistakes, and growing evidence that financial incentives too often drive clinical decision-making.


According to the Patient-Centered Primary Care Collaborative (PCPCC), overall U.S. health care spending on primary care is assumed to be between 5% to 7%, half or less that which is spent in other developed nations. A recent study by the Milbank Memorial Fund found that primary care spending in Medicare was only 2% to 4% of its overall spending.  


Yet, considerable evidence has shown that a strong primary care foundation is essential for a high-performing health system. By example, regions with a higher ratio of primary care physicians have better health and lower rates of mortality from heart disease, cancer, stroke, and other causes, even after controlling for sociodemographic measures. Data from the Midwest Health Initiative confirms that commercially insured patients in St. Louis who regularly see a primary care physician are less likely to visit the emergency department.


Since it takes about a decade to train a primary care physician, and demand for their services is growing faster than the supply of new primary care providers, the time for action is now. Below are examples of truly meaningful strategies that warrant our attention and support.


(1) CMS recently announced that it is considering using different E&M (Evaluation and Management) codes for primary care and medical subspecialist physicians compared to those used for surgeons and other procedure-based physicians. The use of separate codes would enable CMS and private sector payers to begin to rebalance payments by offering higher increases to primary care providers, without automatically increasing reimbursements to other specialists. These codes would also better enable measurement of primary care spending relative to other specialties. On behalf of employers, the BHC recently offered its support for this proposal to CMS Adminstrator, Seema Verma.  


(2) State governments are taking real actions to require greater investment in primary care. By example, between 2009 and 2014, as a condition of having their rates approved, Rhode Island required commercial insurers to raise their primary care spending rate by one percentage point per year (in ways other than by increasing fee-for-service rates). The state’s primary care spending was 5.7% in 2008 and increased to 9.1% in 2012, while total health care expenditures fell 14%. Check out this quick summary of Rhode Island’s and five other state's efforts. 


(3) The PCPCC issued a call for a consensus process to define a common definition and standardized measurement of primary care spending. This would enable the value of primary care to be quantified over time, as well as comparisons across states, health plans, and accountable care organizations. It would also help guide future investments and the evaluation of new value-based payment models across payers and payer types. Read PCPCC’s call to action here


The BHC recognizes that many of its members have taken action to strengthen primary care through ACO arrangements, worksite clinics, or other health plan programs. If you are interested in sharing what you are doing or connecting with others on this path, please let me know. 

Warm regards,

Louise Probst
BHC Executive Director

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