Over 160 participants gathered Wednesday evening at the Primary Care Innovation Circle Third Annual Summit to take on the glaring underfunding of primary care. The event, titled Growing the Primary Care Share of Health Care Spending, was organized by the Primary Care Development Corporation (PCDC) and held at the New York Academy of Sciences in Lower Manhattan.
“Primary care is so important, and yet is undervalued and underfunded by our health care system,” said Louise Cohen, MPH, CEO of PCDC and moderator of the event. “What emerged from this Innovation Circle will guide our work to increase spending on primary care so it can improve health outcomes, lower costs and ensure healthier families and communities.”
Primary care accounts for 55 percent of all U.S. medical visits but receives only about five percent of health care spending,which threatens efforts to increase access and move to a value-based care delivery system.
The night’s conversation was led by panelists Lawrence Casalino, MD, PhD, Chief, Division of Healthcare Policy and Research, Weill Cornell Medical College; Lindsay Farrell, CEO, Open Door Family Medical Centers; Sherry Glied, PhD, Dean, NYU Wagner; Christopher Koller, President, Milbank Memorial Fund; and Troy Oechsner, Deputy Superintendent for Health, NYS Department of Financial Services.
Drawing on their extensive experience in research, policy and practice, the panelists offered solutions to increase the share of primary care spending. Highlights included:
- Nearly doubling the primary care share. Koller recounted how, as health insurance commissioner of Rhode Island, he used the power of “rate review” to increase the primary care share of commercial health plan spending from 5.8 percent to 10.8 percent over five years. The additional spending supported medical home incentives, performance-based payments and health IT, without saddling health plans with excessive regulations. New York State is currently encouraging health plans to invest in practice transformation and care coordination to support “Advanced Primary Care” models. “The ideal is to give them carrots and create a value proposition to make it easier for insurers to make those investments,” said Oechsner.
- Where should the money go? Farrell said that if spending were doubled she would invest in additional and modernized space, as well as more training to ensure the health center was operating at its full potential. Casalino added that some of the money should increase provider and staff salaries to close the pay disparity between primary care providers and specialists and close the talent gap.
- Is it all about “value?” Glied challenged the assumption that primary care must save money to warrant additional investment. “Suppose we found out that primary care doesn’t save money, but makes people feel better? I think we can invest money in primary care, even if it has no effect on spending, because it is something we care about,” she said.
- The cost of measurement. Panelists lamented the burden of reporting requirements, highlighting a recent Casalino study published in Health Affairs revealing that physicians spend more than $15.4 billion per year on quality measurement reporting, with primary care practices spending $50,000 annually per physician – more than any other specialty surveyed.
- Publicly report primary care spending. Koller suggested that New York could publicly release reports (at least annually) showing how much each health plan spent on primary care, which would encourage them to compete on primary care investment in a “race to the top.”
The Primary Care Innovation Circle Third Annual Summit was generously sponsored by athenahealth and Custom Computer Specialists. PCDC’s signature event series, the Primary Care Innovation Circle brings together health care leaders to offer fresh perspectives on challenges facing the industry. Past events have tackled issues such as private sector and social investment in primary care, payment reform, workforce challenges, delivery system reform and the sustainability of the medical home model.
For more information about the Primary Care Innovation Circle, and for follow-up information related to the March 9 event, visit www.pcdc.org/innovationcircle.
Founded in 1993, the Primary Care Development Corporation (PCDC) is a nationally recognized nonprofit organization dedicated to expanding access to quality primary care, in order to improve the health of families and communities, lessen disparities and reduce health care costs. PCDC offers training and technical assistance on providing health care services that are accessible, high-quality, and compassionate; affordable capital to renovate and expand community health centers so that services are offered in settings that promote efficiency, dignity, and respect; and advocacy to advance public policies that strengthen and sustain quality primary care. To date, PCDC has helped over 1,000 primary care practices improve delivery of care and financed over $670 million to enhance capacity in low-income communities.
1 Ambulatory Care Use and Physician Office Visits. Centers for Disease Control and Prevention website. http://www.cdc.gov/nchs/fastats/physician-visits.htm. Updated April 29, 2014. Accessed March 1, 2016.