Addressing needs in rural primary care now: How and why government entities can do more

Christopher Crow, MD

Kavita Vyas, MD

With new eyes turned toward primary care – within the health care and technology segments, as well as the investment community at-large – the industry has received a dose of desperately overdue attention and support.

The U.S. Department of Health and Human Services (HHS) awarded over $155 million to expand training for primary care physicians (PCPs) in rural and underserved communities, a move that shines a light on the need to address workforce and access challenges that have long burdened primary care nationwide. Amazon’s $3.9 billion purchase of One Medical underscores the value and essential importance that market makers are placing in primary care. CVS Health, UnitedHealth Group, Walmart, and a multitude of others have joined the conversation with similarly focused investments. More than ever, primary care is garnering attention from major players, change-makers, and innovators. The market is ripe for transformation, but lacks in rural areas, where the ratio of patients-to-PCPs lags behind urban areas by more than 25%, according to the National Rural Health Association.

All of this opportunity for transformation comes with a major caveat. Change cannot be achieved in scalable, sustainable, and meaningful ways without a continued push to evolve how primary care is delivered and how it is compensated. The recent awards from HHS are important steps in trying to address PCP access and relieve physician burnout. They serve as recognition of the fact that PCPs in rural areas often play unique and pivotal roles as health leaders and community leaders. However, when compared to the industry’s challenges at hand, these measures represent just a drop in the bucket.

The care that PCPs are capable of delivering is also the care that patients (and providers) want and need: accessible, relationship-based, lower cost, higher quality. But in the industry’s current state—amid decades of insufficient investment and a fee-for-service (FFS) payment model that rewards volume over quality – the best version of primary care becomes nearly impossible to deliver with long-term consistency or scalability. The U.S. health care system needs primary care at its best, and the public sector (including HHS) must embrace its responsibility to step up in a bigger way for the sake of healthier communities and more sustainable healthcare costs.

Tech-enabled care teams create relief today

Integrated, expanded, technology-enabled care teams offer one promising way to mitigate the ongoing workforce and capacity challenges that prevent primary care from reaching its full potential today. In this model, a typical primary care practice (which could include physicians, nurses, and other staff members) is augmented with a virtual team of care managers and coordinators, behavioral health specialists, social workers and more—specialized experts to keep patients moving effectively on their health journeys in between the times that patients are in front of their doctors.

This integration doesn’t just require constant communication and the right technologies to keep all care team members in synch. It also hinges on the practice of deep trust and transparency.

With the buy-in of all parties (including patients), an integrated, expanded care team is stronger than the sum of its parts. It alleviates burden for each stakeholder, combatting the incessant burnout that is driving so many physicians away from primary care. Patients benefit from more accessible, personalized, higher quality care. Particularly for patients with chronic conditions, the greater attention to crucial health markers significantly increases the chances of improved health, better overall outcomes, and reduced total cost of care. This potential value is magnified further in rural communities, where lower concentrations of providers across larger geographies have historically created obstacles to timely access to care. HHS and other major influencers in the public and private sector can play crucial roles in advancing and funding this extended model of care with greater ubiquity.

Better payment models must align with better outcomes for more people

It took a pandemic for the masses to acknowledge many of the gaps in our health care system. During this time of crisis, it became painfully clear that inequities and systemic barriers have been preventing high-quality care from being delivered to those who need it most. New and up-skilled PCPs will help, but it’s not enough. For the transformative change required, PCPs must be empowered to deliver the longitudinal, relationship-driven care that can address social determinants of health in a wide-reaching way.

The only way this can happen on a national level is to shift from traditional FFS payment models toward value-based care with prospective payment—and the support of HHS and other entities is crucial in advancing this change. It’s no small feat, but it’s absolutely essential if we want to change primary care from a specialty that incentivizes volume to one where providers can spend the requisite time with patients to understand them and care for them. We must remove PCPs from the hamster wheel of FFS and create the payment structures, supporting services and whole-health mindsets that finally allow PCPs to deliver on the promise of what primary care was always meant to be. Moves like these would likely produce even greater impact in rural areas, where greater trust and tighter, longer-lasting relationships between patients and PCPs are more regularly seen. By doing so, we’ll create better patient outcomes and satisfaction, as well as a more provider-friendly environment to spur on additional improvements in physician recruitment and retention.

Make no mistake: The primary care market is at a tipping point. PCPs have never been more valued; and at the same time, they’ve never been more burned out. Which way the market will ultimately go depends on how wisely we deploy the current investment and innovation efforts from the public and private sectors. If we use this wave of interest and investment to create expanded care teams and change the payment model, we could produce a force multiplier to help recruit and retain PCPs in rural communities for generations to come and set the example for primary care across the nation.

Christopher Crow, MD, is CEO and cofounder of Catalyst Health Group, a founding partner of Primary Care for America. Kavita Vyas, MD, specializes in internal medicine in Nacogdoches, Texas.