March 15, 2016

What I learned About Increasing the Primary Care Spend

Louise Cohen

A few weeks ago, I moderated a panel at our Primary Care Innovation Circle Annual Summit on how we can help primary care get the resources it needs to succeed. It was invigorating to share the room with so many people working in all aspects of primary care, and an honor to share the stage with such a distinguished panel.

Our discussion made clear that, while we all believe that primary care is the foundation of our health care system, and that primary care must be resourced adequately to effectively fulfill its mission, there is no consensus on which of the policy and programmatic approaches is best suited to solve this problem. Our panelists considered this issue through the lens of primary care practitioners in private practice, academia, government, policy, and health center administration. They raised concerns about adequate funding for salaries, care coordination and care management, population health, infrastructure, and technology.

From hearing this broad range of needs and solutions, I believe that there are three actionable steps we can take right now:

We need to determine how much we actually spend on primary care. What we can’t measure, we can’t improve. Astonishingly, what we spend on primary care nationally is a mystery. Unlike hospital services, pharmaceuticals, or diagnostic procedures, primary care is not uniformly defined at the national, state, and payer levels. We need a common definition of primary care, and then we have to measure it and trend this information as we do for any other significant health care service.

Everyone should know what is spent. All payers — Medicare, Medicaid, and commercial — should publicly report how much they spend on primary care, using the same definition. These reports should roll up on a state and national level, so that we can compare across payers and across states. This way, health care purchasers – individuals, businesses and government – can better choose which plans to buy, providers can better choose which plans to join, and plans can compete for both.

We should increase the primary care share of health care spending. Currently, the U.S. spends over $3 trillion dollars on health care, but less than six percent of that, by any measure, on primary care. Regardless, whether we all agree that it should be 10 percent or 25 percent, we must increase spending to reflect the value that primary care brings to individual and community health, as well as to the health care system. We have one example of how to do that. As Rhode Island Health Insurance Commissioner, one of our panelists, Chris Koller, required all commercial plans to increase primary care spending by one percent of total spending per year over five years. As a result, Rhode Island’s commercial plans have nearly doubled primary care spending as a share of total health care spending.

At the end of the evening, I was struck by what panelist Sherry Glied reminded us–primary care in and of itself is a public good. We need medical students to become primary care providers; we need regulatory reform; we need FQHCs to be the best that they can be; we need to pay for those elements of primary care that are underfunded and undervalued; and we need thoughtful evaluation and research to support the best primary care evidence-based approaches and programs to make a positive difference in people’s health.

Achieving a greater share of spending for primary care won’t be easy, but we have models, we have advocates and we know that policymakers want to do the right thing. You’ll be hearing more from PCDC about how we can work together to help grow primary care spending.

Take care,


The Primary Care Innovation Circle Third Annual Summit was generously sponsored by athenahealth and Custom Computer Specialists.