Primary Care Investment
Primary care leads to better health outcomes, improved community status, and reduced costs, yet adequate funding for a robust primary care system has yet to be realized. Because no federal definition of primary care exists, it is difficult to compare primary care outcomes and investment across states or nationally. However, it is estimated that as little as five to seven percent of health care costs go toward primary care.
PCDC supports policies that grow primary care investment, expand community development financing that promotes primary care access and quality in underserved communities, and incentivize primary care within delivery system reform.
Our Policy Issues
REBALANCING HEALTH CARE SPENDING
Define, measure, report, and increase the proportion of the health care dollar allocated to primary care.
Underinvestment in primary care is a consistent problem across all states. As of February 2020, nine states have acted to rebalance their health care investments through regulatory or legislative means. PCDC advocates for other states to follow suit in this progressive action, and has been advancing state and national conversations on primary care investment for years.
INVESTING IN PATIENT-CENTERED MEDICAL HOMES
Protect funding for Patient-Centered Medical Homes (PCMH) incentive programs.
PCMH puts patients at the forefront of their care delivery. Research shows that PCMHs build better relationships between patients and their care teams; improve quality, patient experience, and staff satisfaction; and reduce health care costs.
Since 2008, PCDC’s content experts have helped more than 760 practices achieve PCMH recognition. PCMH has been central to health care payment reform in Medicaid, Medicare, and commercial health plans. Many states have also linked PCMH to financial incentives for providers.
Given the demonstrated benefits the PCMH program has and will continue to produce, PCDC has persistently advocated for renewed and increased funding for these programs and supported policies that will expand the model’s reach and impact.
RE-FOCUSING DELIVERY SYSTEM TRANSFORMATION ON PRIMARY CARE
Primary care must be a central priority in delivery system transformation efforts.
PCDC supports efforts made in several states to transform the health care system, including using federal 1115 Medicaid Waivers to implement state initiatives such as Delivery System Reform Incentive Payment (DSRIP) programs. There are also promising state and federal strategies to advance health care payment and delivery system reform models — ultimately strengthening community health, improving clinical outcomes, and reducing costs.
However, the desired transformation can only be accomplished with sufficient, quality primary care that is accessible to all families and communities. The need for increased investment and more effective policies to achieve the promise of primary care is clear. PCDC has worked across the country on this issue and advocated at the state and federal levels to enhance primary care within system transformation.
PROTECTING THE 340B DRUG DISCOUNT PROGRAM
Preserve the 340B Drug Pricing Program and protect medically underserved communities.
The 340B Program entitles qualifying covered entities — Health Resources and Services Administration (HRSA)-supported health centers, AIDS drug assistance programs, and safety net hospitals and providers — to receive discounts on eligible outpatient drugs. Covered entities may provide 340B drugs to all eligible patients, regardless of a patient’s payer status and how the drug is administered.
Through working in rural and urban communities across the country, PCDC intimately understands how safety net providers rely on the 340B Program to bring accessible care to underserved patients. In recent years, the program has faced several threats both nationally and at the state level, which PCDC has vehemently opposed and advocated against. Because 340B providers exclusively see the most vulnerable populations, limiting the program will disproportionally impact these already hard-hit communities. PCDC strongly supports policies that safeguard the program and its vital benefits.
COMMUNITY DEVELOPMENT FINANCING
Protect funding programs that allow for greater investment in and development of underserved communities.
PCDC is one of many Community Development Financial Institutions (CDFIs). CDFIs are private organizations that meet the needs of economically disadvantaged rural and urban communities by addressing challenges through responsible, affordable lending. The Community Reinvestment Act and programs like the New Markets Tax Credit create crucial opportunities to revitalize low- and middle-income communities by providing financial assistance to expand access to quality primary care.
PCDC has provided direct financing and leveraged more than $1.2 billion through these programs, with more than $5 of private investment for each $1 of public investment. With such transformative potential for so many communities, PCDC advocates for continuously upholding and supporting these critical investment programs.
Primary care access must be improved, increased, and sustained to ensure health equity, according to a Journal of the American Medical Association essay by PCDC.
The piece, authored by CEO Louise Cohen, MPH, and Board member Dave A. Chokshi, MD, MSc, identified new priorities in light of the 40th anniversary of the Alma-Ata Declaration.