The National Academies Press

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Pages 3-18

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From page 3... ... report Primary Care: America's Health in a New Era, this foundation remains weak and under-resourced, accounting for 35 percent of health care visits while receiving only about 5 percent of health care expenditures. Moreover, the foundation is crumbling: visits to primary care clinicians are declining, and the workforce pipeline is shrinking, with clinicians opting to specialize in more lucrative health care fields. Read the entire page →
From page 4... ... The committee based this definition on the following concepts: • integrated, whole-person health; • interprofessional care teams; • foundational, sustained relationships between the interprofessional care team and patients and families; • the critical role of communities in providing primary care; • the importance of equitable access to primary care; and • the diversity of settings and modalities used to deliver primary care. This definition describes what high-quality primary care should be, not what most people in the U.S. Read the entire page →
From page 5... ... health care system, the committee's implementation plan includes objectives and actions targeting primary care stakeholders and balancing national needs for scalable solutions while allowing for local fit.2 The implementation plan includes five objectives to make high-quality primary care available for everyone in the United States: 1. Pay for primary care teams to care for people, not doctors to de liver services. Read the entire page →
From page 6... ... TABLE S-1 The Committee's Implementation Framework Public Private System Level Example Actor Example Actions Example Actor Example Actions Macro Federal/state Policies; Coalitions; Policy advocacy; legislative branch laws; funding associations Public accountability; professional standards Meso Federal, state, Regulations; Private delivery Management local executive contracting; organizations; policies and branch; federal payment; private payers; practices; training payers; public administrative corporations; delivery systems; practices; training institutions; educators educators Micro Individuals and Self-education; Individuals and Self-education; interprofessional quality assessment interprofessional quality assessment teams delivering and improvement; teams delivering and improvement; care in public behavior practice care; individuals behavior practice and government and families health systems; seeking care individuals and families seeking care Read the entire page →
From page 7... ... Action 1.1: Payers -- Medicaid, Medicare, commercial insurers, and selfinsured employers -- should evaluate and disseminate payment models based on the ability of those models to promote the delivery of high-quality primary care, as defined by the committee, and not on their ability to achieve short-term cost savings. 3 See Appendix D for a table that organizes the committee's recommended actions by system level and actor. Read the entire page →
From page 8... ... measuring and increasing the overall portion of health care spend ing in their state going to primary care. Implementing high-quality primary care requires committing to pay primary care more and differently given its capacity to improve population health and health equity for all society, not because it generates short-term returns on investment for payers. Read the entire page →
From page 9... ... First, payment reform innovations have been evaluated against short-term savings rather than the promotion of high-quality primary care. Repeated testing of new primary care payment models in search of short-term savings has left most primary care clinicians in underpaying FFS arrangements with the wrong incentives. Read the entire page →
From page 10... ... , rural health clinics, and Indian Health Service facilities in federally designated shortage areas. Action 2.3: To improve access to high-quality primary care services for Medicaid beneficiaries, the Centers for Medicare & Medicaid Services should: a. Read the entire page →
From page 11... ... Reforming Medicaid to mirror Medicare's payment standards may be the most straightforward path to ensuring equitable access to high-quality primary care for its beneficiaries. Short of that, modifying federal access-tocare standards for state Medicaid programs can catalyze state and managed care organization payment and coverage policies to prioritize high-quality primary care. Read the entire page →
From page 12... ... Objective Three: Train primary care teams where people live and work. Action 3.1: Health care organizations and local, state, and federal government agencies should expand and diversify the primary care workforce, particularly in federally designated shortage areas, to strengthen interprofessional teams and better align the workforce with the communities they serve. Read the entire page →
From page 13... ... Organizations that train, hire, and finance primary care clinicians should ensure that the demographic composition of their primary care workforce reflects the communities they serve and that the care delivered is culturally appropriate. Developing a workforce to deliver the committee's definition of primary care requires reshaping training program expectations and the clinical settings in which that training occurs. Read the entire page →
From page 14... ... and the Centers for Medicare & Medicaid Services (CMS) should plan for and adopt a comprehensive aggregate patient data system to enable primary care clinicians and interprofessional teams to easily access comprehensive patient data needed to provide whole-person care. Read the entire page →
From page 15... ... assess federal primary care payment sufficiency and policy; (2) monitor primary care workforce sufficiency including training financing, production and preparation, incentives for federally designated shortage areas, and federal clinical assets/investments (health cen ters, rural health clinics, the Indian Health Service, and the U.S. Read the entire page →
From page 16... ... Action 5.3: To improve accountability and increase chances of successful implementation, primary care professional societies, employers, consumer groups, and other stakeholders should assemble, and regularly compile and disseminate a "high-quality primary care implementation scorecard," based on the five key implementation objectives identified in this report. One or more philanthropies should assist in convening and facilitating the scorecard development and compilation. Read the entire page →
From page 17... ... Senior Secretary–level coordination is necessary given the widespread agency-level activities affecting primary care, including HRSA's workforce training and safety net funding, CMS's payment and benefits policy, health information technology within the Office of the National Coordinator for Health Information Technology, and the Agency for Healthcare Research and Quality's (AHRQ's) health services research. Read the entire page →
From page 18... ... The nation deserves nothing less than high-quality primary care for all, but creating such a system requires leadership, accountability, and clear steps to accomplish this work. The committee hopes the work captured in this report realizes this vision sooner rather than later. Read the entire page →

From page 3...

... report Primary Care: America's Health in a New Era, this foundation remains weak and under-resourced, accounting for 35 percent of health care visits while receiving only about 5 percent of health care expenditures. Moreover, the foundation is crumbling: visits to primary care clinicians are declining, and the workforce pipeline is shrinking, with clinicians opting to specialize in more lucrative health care fields.

Summary Pages 3-18

Summary
Pages 3-18