America needs a national strategy to invest in primary care

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Primary care in the United States is in crisis, and not enough is being done to address it. Getting timely, high-quality primary care close to home is a real challenge for too many, even when a patient has an established relationship with a primary care professional.

Patients are told to build a relationship with a primary care clinician who gets to know them and their medical history. Yet a decades-long underinvestment in primary care – care that is proven to improve health, health equity and save our health care system money – has led to severe shortages of primary care clinicians and a surge of practice closures, closing the front door to patients’ primary partner for care and better health.

The U.S. Centers for Medicare & Medicaid Services (CMS) recently announced a new voluntary primary care payment model in select states, aimed at practices in underserved communities such as rural and Federally Qualified Health Centers. The Making Care Primary (MCP) model is an important step forward, focused on providing more comprehensive care in eight states – Colorado, North Carolina, New Jersey, New Mexico, New York, Minnesota, Massachusetts and Washington – across payers. CMS has also proposed a new add-on code, G2211, intended to provide patients and primary care clinicians more time together to manage complex conditions. This code needs to be implemented without interference from Congress.

Ann Greiner, MCP
_{Primary Care Collaborative}

Shari Erickson, MPH

Darilyn Moyer, MD, MACP

Much more must be done to make whole-person care a reality for everyone, starting with adequate investment in primary care through new payment models. Patients and communities urgently need greater access to robust primary care services, through this kind of bold action by policymakers.

Primary care is the backbone of organized medical practice and coordinated care. When communities have robust primary care systems in place, people stay healthier and live longer at less cost to our health care system overall. More primary care services are associated with fewer emergency department visits and hospitalizations, lower odds of dying prematurely, and lower health care costs. The 2022 data from Medicare’s largest accountable care organization (ACO) program – the Medicare Shared Savings Program (MSSP) serving nearly 11 million beneficiaries – evaluation reveals that physician led ACOs, particularly with 75% or more primary care clinicians, produced higher quality and more savings than health system led ACOs.

All of this makes America’s paltry investment in primary care even more difficult to understand. Just 5% to 7% of health care spending is dedicated to primary care, leaving one in four residents without a go-to source for preventive and regular health needs. People are forced to use expensive hospital and emergency care services that are not equipped to serve as a quasi-substitute, contributing to poor health outcomes at higher costs and exacerbating health inequities. When primary care capacity improves, so too will U.S. health care indicators like life expectancy that significantly regressed during the COVID-19 pandemic and remain a source of great concern.

MSSP should serve as a national roadmap to advance investment and innovation in primary care at the scale required to make a meaningful and lasting impact. One study shows that more primary care physicians and visits to them by patients yield lower costs overall, a testament to the importance of primary care. CMS should provide primary care services at a national scale by adopting a hybrid primary care payment model within MSSP that empowers primary care by paying upfront for most primary care services. Hybrid payment allows primary care to demonstrate its ability to improve health and health equity while managing health care resources and technology effectively.

CMS has an opportunity to make an urgently needed investment in primary care through MSSP that can deliver better health for patients, more resources for physicians and teams, and avoid unnecessary costs. Without bold action that harnesses proven care methods, our primary care crisis will only worsen, and our public health and health equity goals will not be reached. It’s time to give Medicare patients better health now and pave the way for all patients to benefit.

Ann C. Greiner, MCP, is the president and CEO of the Primary Care Collaborative.

Shari M. Erickson, MPH, is chief advocacy officer and senior vice president of governmental affairs at the American College of Physicians.

Darilyn V. Moyer, MD, MACP, is executive vice president and CEO at the American College of Physicians.