Primary care is a vital health service that should be available to all Americans, according to a new study and report from the National Academies of Sciences, Engineering, and Medicine.
Salt Lake City, UT -- (ReleaseWire) -- 07/08/2021 --According to a new study and report from the National Academies of Sciences, Engineering, and Medicine, primary care is a vital health service that should be available to all Americans.
Ensuring access to high quality primary care will require reforming payment models, expanding digital and telehealth services, and supporting the implementation of integrated team-based care.
Without immediate reform and action at the federal level, pervasive health inequities exposed during the COVID-19 pandemic will continue to widen, leading to poorer health outcomes and higher death rates across the U.S., the committee reported.
Brenda Reiss-Brennan, PhD, director of mental health integration and principal investigator of integrated team-based care at Intermountain Healthcare in Salt Lake City, and one of the key members of the national committee.
She says the new report, "Implementing High-Quality Primary Care: rebuilding the Foundation of Health Care," is a call to action for all Americans.
"It's vital that all people have access to a consistent, trusted source to whole-person integrated and equitable health care that is rooted in sustained and coordinated relationships between caregivers, patients, families, and communities.
"Primary care makes a strong foundational contribution - critical to the health of the American people and it is the only part of the healthcare system that can claim that increase in supply is associated with improved equitable outcomes for the population" added Dr. Reiss-Brennan. "Therefore, a key finding of the report claims primary care as a common good for all Americans, regardless of their ability to pay."
The study and report, which was undertaken by the National Academies' Committee on Implementing High-Quality Primary Care, found that primary care in the U.S. is woefully underfunded and unsupported.
"Having access to primary care is vital to addressing the disparities in healthcare that the pandemic brought to light, and to making health care affordable for every American," said Mark Briesacher, MD, senior vice president and chief physician executive for Intermountain.
"If we serve people in ways that they want and support them in their self-care for wellness and managing their medical conditions, the experience will meet their expectations, give them control of their decisions in care, and drive down the costs they bear in co-pays, co-insurance and deductibles," he added. "People are stronger, families are stronger, and communities are stronger. Now is the time to act with courage and conviction."
Despite accounting for a third of all healthcare visits, the U.S. invests just five percent of total healthcare spending on primary care. There aren't enough primary care doctors either: the report found that declining primary care workforce capacity is associated with 85 deaths per day.
In fact, primary care where for some is the only place they seek care has also been sidelined from COVID-19 response. The report found that primary care practices were denied COVID-19 relief funds in initial relief packages. Furthermore, primary care teams have largely been left out in addressing health disparities and in COVID-19 testing, tracing and vaccination efforts.
"Primary care is where people trust and go to get immunizations and vaccines for flu, tetanus and shingles and now their COVID-19 vaccine. Primary care is their advisor in health, wellness and recovery and their team can also address any emotional trauma and safety concerns or misinformation about the COVID-19 illness and immunity" said Dr. Reiss-Brennan.
"The fact that family doctors, providers and their teams have not been considered as an integral coordinated 'whole person' response part of COVID -19 of vaccine distribution as well as management of the mental health, economic and social health fall out of this devastating pandemic shows how misaligned our health system is in valuing and funding primary care, and the perilous need for that to change," she added.
The committee was charged with reviewing the recommendations from a 1996 report by the Institute of Medicine, and the current state of primary care and building an implementation plan that would strengthen the provision of high quality primary care in the U.S.
The findings of this new report are different in that they are woven into a collective set of interdependent objectives through an implementation science lens which identifies key strategic domains of the implementation plan that should be adopted, monitored, and measured over time.
To achieve its vision for high quality primary care in the U.S., the committee has organized five implementation objectives each with pragmatic implementation actions and actors.
1. 'Pay for primary care teams to care for people, not doctors to deliver services'
Action: Reform payment models: Private and public payers should shift from a fee-for-service (FFS) payment model to hybrid models (part FFS, part capitalized, where clinicians are rewarded for better outcomes and paid per patient, rather than per visit or procedure). CMS should also aim to increase physician payment rates for primary care services by 50% and identify overly expensive health care services.
2. 'Ensure that high quality primary care is available to very individual and family in every community'
Action: Increase access points: The U.S. Department of Health and Human Services (HHS) should invest in the creation of new health centers, particularly in areas that are underserved or have a physician shortage.
3. 'Train primary care teams where people live and work'
Action: Design interprofessional care teams: A leading findings of the report is the creation and support of integrated diverse team based-care vs solo provider disease specific care. Primary care teams should fit the needs of the community, work at the top of their skills and coordinate care across multiple settings, which means meaningful engagement of the full range of primary care professions, including physician assistants, nurse practitioners, medical assistants, community health workers, and behavioral health specialists and others. The report also calls out the largest body of evidence supporting behavioral health integration for child and adult populations and describes opportunities for integration between primary care and public health, social health, oral health, and pharmacy.
Action: Support community-based training programs: HHS should support training opportunities in community settings and in rural and underserved areas, and provide economic incentives such as loan forgiveness and salary supplements.
4. 'Design information technology that serves the patient, family and interprofessional care team.'
Action: Make health information technology user-friendly: Digital health technology should make the primary care experience more efficient, higher quality and more convenient. In the next phase of electronic health record certification standards, the HHS Office of the National Coordinator for Health Information Technology and Centers for Medicare and Medicaid Services should account for user experience of clinicians and patients.
5. 'Ensure that high quality primary care is implemented in the United States'
Action: Established accountability and effective measurement: The report calls for Federal leadership to take an active coordinating role in ensuring primary care as a common good by establishing a Secretary Council on primary care. Implementation progress for measuring success in strengthening primary care should guided by a formal set of metrics that are agreed upon and pared down to focus on overall health and well-being and equity rather than disease specific outcomes or payment. The report proposes a 'high quality primary care implementation scorecard' based on the five implementation objectives to track progress and assess whether objectives are achieved and recommendations adopted overtime.
Action: Create a primary care research agenda: Primary care research makes up less than 0.4% of National Institutes of Health's budget. Creating a research arm for primary care would build an evidence-based infrastructure to guide improvements in care quality, experience, and cost. The report also recommends prioritizing funding of primary care research at the existing National Center for Excellence in Primary Care Research office at the Agency of Healthcare Research and Quality.
These recommendations are a roadmap for leaders and communities that are ready to partner together and launch an implementation plan towards meaning change to ensure whole person care for all, said Dr. Reiss-Brennan.
"Everyone should have access to this trusted common good. Everyone should have a place where they can go to begin to identify their health issues and begin their well-being journey through healing trusted relationships that are connected to the best evidence and results.
We can make this a reality by supporting the value of primary care and working together to implement the findings of this report," she said.
About Intermountain Healthcare
Intermountain Healthcare is a nonprofit system of 25 hospitals, 225 clinics, a Medical Group with 2,600 employed physicians and advanced practice clinicians, a health insurance company called SelectHealth, and other health services in Utah, Idaho, and Nevada. Intermountain is widely recognized as a leader in transforming healthcare by using evidence-based best practices to consistently deliver high-quality outcomes and sustainable costs.