While we are increasingly polarized in our politics, there is one issue on which most Americans agree: our health care system is broken. Despite spending more per capita on health care than any other country, Americans are in worse health, with lower life expectancies, higher hospital admissions, and at greater risk of suicide and maternal mortality compared to peer nations.
This is largely because our health care model has been focused on “sick care” aimed at addressing acute or chronic conditions rather than preventive health maintenance. We have increasingly placed greater value on specialty care over primary care. The numbers bear this out; the U.S. spends only 5-7% of its healthcare dollars on primary care — less than half of the 14% average in Western European countries.
This underinvestment in direct primary care is particularly concerning because accessible, quality primary care is the cornerstone of a well-functioning health care system. Numerous research studies have shown that primary care is associated with better population health outcomes including lower mortality rates, rates of premature death, and hospitalizations, as well as higher infant birth weight, life expectancy, and satisfaction with the healthcare system. Studies also indicate that greater primary care availability in a community is correlated with both better health outcomes and a decrease in utilization of more expensive types of health services, such as hospitalizations and emergency department visits.
To fix our healthcare system, we need to prioritize primary care and invest our time and resources in a new model that enables primary care physicians to successfully provide care locally, collaborate with one another productively, and be fairly compensated for their work.
The Vital Role of Primary Care
Primary care physicians (PCPs) are patients’ first point of contact with a health system and serve as the “quarterbacks” of their patients’ care, connecting and coordinating other parts of the health care system to ensure their well-being. These PCPs diagnose and treat acute and chronic illnesses; prevent disease and maintain health; collaborate with other health providers; and innovate and advance knowledge through research in patient care and its delivery. Primary care physicians see firsthand the effects of social determinants on a person’s health and well-being, and they act as a health care partner, educator and navigator, often throughout a patient’s lifetime.
Primary care physicians treat and maintain patient health in a variety of health care settings (e.g., office, inpatient, critical care, long-term care, home care, daycare) located within a specific community, which helps to facilitate access to care. These local PCP practices can also help foster meaningful connections and participation within their communities.
Given all this, it is clear that reorienting our priorities around primary care would yield significant benefits for the U.S. healthcare system, including:
- Improved Health Outcomes
People who see primary care physicians tend to have better health, receive timelier diagnoses and get more prompt treatment when it is needed. Research shows that patients who have a long-term relationship with their PCPs are also less likely to go to the emergency department. Primary care continuity is also associated with improved care coordination and increased patient satisfaction.https://www.commonwealthfund.org/publications/issue-briefs/2022/mar/primary-care-high-income-countries-how-united-states-compares
- Lower Costs
Greater access to primary care can lead to a reduction in racial, income, and insurance coverage disparities in access to care.Health care systems that prioritize primary care have lower health care costs, including decreases in costly hospitalizations and emergency department visits. Research has shown that U.S. adults who see a PCP have 33 percent lower health care costs and 19 percent lower odds of dying compared to those who see only a specialist.
Primary care can be leveraged to advance health equity, because care is about building trust and relationships, which are critical to mitigating the social and structural drivers of inequities. Primary care practices can connect patients to available sources of health insurance, use telehealth and other digital health interventions to enhance access, provide culturally and linguistically appropriate care, utilize an expanded care team and community assets to address unmet social needs, and engage the community in practice- and system-level decision-making. Greater access to primary care can lead to a reduction in racial, income, and insurance coverage disparities in access to care.
What’s Needed to Empower Primary Care Practices
Despite the central role they play in keeping us healthy, PCPs today face enormous obstacles to success. They lack the necessary contracts with payers, as well as the time, capital, and access to expertise to assume responsibility for their patients’ total needs. They are burning out in a system that rewards the volume of patient visits, not the quality of the care.
Healthcare management services organizations can help PCPs transition to value-based care by investing financial and other resources and moving physician partners off the fee-for-service treadmill. These organizations are dedicated to building collaborative networks of independent practices to help them deliver the very best care for patients and align practice economics with health outcomes of patients. By connecting PCPs to the operational, technical, and peer support they need to deliver high-quality primary care and better health outcomes more efficiently and effectively to their communities, and providing access to cutting-edge technology, tools, and processes that ease their administrative burdens, these healthcare management services organizations can empower PCPs to accelerate their transition to a value-based care model.
Building a Better Healthcare System for Tomorrow
Primary care physicians are the key to transforming health care. We must help them move from volume-based to value-based care by providing them with the tools and support they need to fill the gaps in care, integrate seamlessly with payers, collaborative productively with peers, grow their practices, and react to opportunities for improved outcomes.
About the Author:
Eric Lisle is CEO, President and Co-Founder of Southeast Primary Care Partners.