Implementing High-Quality Primary Care Rebuilding the Foundation of Health Care (2021) / Chapter Skim
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12 A Plan for Implementing High-Quality Primary Care
12 A Plan for Implementing High-Quality Primary Care
Pages 369-386
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From page 369... ...
One result is that primary care teams deliver 55 percent of ambulatory care services but only receive about 5 percent of total health care spending -- a figure that continues to decline (Martin et al., 2020; PCPCC, 2018; Reiff et al., 2019)
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From page 370... ...
The committee declared its vision for high-quality primary care in the United States with the definition it stated in Chapter 2: High-quality primary care is the provision of whole-person, integrated, accessible, and equitable health care by interprofessional teams who are accountable for addressing the majority of an individual's health and wellness needs across settings and through sustained relationships with patients, families, and communities. To make this vision a reality for everyone in the United States, the committee recommends specific actions, detailed below, that fall under five critical implementation objectives: 1.
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From page 371... ...
• Implementing high-quality primary care requires clear and meaningful measures of whole-person care, ongoing research, and leadership in the federal government to ensure federal poli cies support its development. If clear recommendations supported by strong evidence were enough, the landmark 1996 Institute of Medicine (IOM)
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From page 372... ...
OBJECTIVE ONE: PAY FOR PRIMARY CARE TEAMS TO CARE FOR PEOPLE, NOT DOCTORS TO DELIVER SERVICES 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. Action 1.2: Payers -- Medicaid, Medicare, commercial insurers, and selfinsured employers -- using a fee-for-service (FFS)
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From page 373... ...
. Many health systems providing primary care services through employed or contracted models have accepted global capitated payments but continue to operate and compensate primary care on an FFS model, blunting the effects of payment models intended to strengthen primary care.
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From page 374... ...
OBJECTIVE TWO: ENSURE THAT HIGH-QUALITY PRIMARY CARE IS AVAILABLE TO EVERY INDIVIDUAL AND FAMILY IN EVERY COMMUNITY Action 2.1: To facilitate an ongoing primary care relationship, all individuals should have the opportunity to have a usual source of primary care.
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From page 375... ...
Action 2.4: The Centers for Medicare & Medicaid Services should permanently support the COVID-era rule revisions and Medicaid and Medicare benefits interpretations that have facilitated integrated team-based care, enabled more equitable access to telephone and virtual visits, provided equitable payment for non-in-person visits, eased documentation requirements, expanded the role of interprofessional care team members, and eliminated other barriers to high-quality primary care. Action 2.5: Primary care practices should move toward a communityoriented model of primary care by: a.
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From page 376... ...
Meeting federal access standards and those from accrediting bodies will require states and their contracted managed care organizations to take the actions needed, including increasing Medicaid rates for primary care and expanding primary care provider networks. Primary care accessibility should not be limited by the walls of the practice, however.
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From page 377... ...
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.
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From page 378... ...
Primary care is no exception, and organizations that train, hire, and finance primary care clinicians bear a responsibility to ensure that the demographic composition of its primary care workforce reflects the communities and that the care delivered is culturally appropriate. More fundamentally, developing a workforce able to deliver the committee's definition of primary care will require reshaping what is expected of training programs and the clinical settings in which that training occurs.
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From page 379... ...
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.
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From page 380... ...
Improved EHR functionality and a comprehensive data system can facilitate the aggregation of information across all settings, including the community, and make that information usable by the entire primary care team to promote access to care, care coordination, strong relationships, and integration with population health. OBJECTIVE FIVE: ENSURE THAT HIGH-QUALITY PRIMARY CARE IS IMPLEMENTED IN THE UNITED STATES Action 5.1: The U.S.
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From page 381... ...
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.
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From page 382... ...
Objective 1: Pay for primary care teams to care for people, not doctors to deliver services Measure 1.1: Percentage of total spend going to primary care -- commercial insurance Measure 1.2: Percentage of total spend going to primary care -- Medicare Measure 1.3: Percentage of total spend going to primary care -- Medicaid Measure 1.4: Percentage of primary care patient care revenue from capitation Objective 2: Ensure that high-quality primary care is available to every individual and family in every community Measure 2.1: Percentage of adults without a usual source of health care Measure 2.2: Percentage of children without a usual source of health care Measure 2.3: Primary care physicians per 100,000 people in medically underserved areas Measure 2.4: Primary care physicians per 100,000 people in areas that are not medically underserved Objective 3: Train primary care teams where people live and work Measure 3.1: Percentage of physicians trained in community-based settings, rural areas, Critical Access Hospitals, Medically Underserved Areas Measure 3.2: Percentage of physicians, nurses, and physician assistants working in primary care Measure 3.3: Percentage of new physician workforce entering primary care each year Measure 3.4: Residents per 100,000 population by state Objective 4: Design information technology that serves the patient, family, and interprofessional care team The committee is not aware of adequate measures or data sources that capture the use or availability of person-centered digital health in primary care (or any health care) settings, underscoring the urgency for further research in this area Objective 5: Ensure that high-quality primary care is implemented in the United States Measure 5.1: Investment in primary care research by the National Institutes of Health in dollars spent and percentage of total projects funded
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From page 383... ...
A key task for the council, in addition to coordinating federal policies and receiving input and guidance from a Primary Care Advisory Committee, will be overseeing the establishment of clear accountability measures for providing primary care consistent with the committee's definition. Done judiciously and with stakeholder input; a focus on core, evidence-based, high-value primary care functions; uniform guidelines that allow for flexible application based on contextual population need,
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From page 384... ...
Organized capacity for this work of accountability is profoundly absent: the professional diversity of the high-quality primary care team is its clinical strength but its political and economic weakness. While a single voice to advocate for public policy change exists for other health care services, such as hospitals, the pharmaceutical industry, and nursing homes, primary care has no similar voice and as a result suffers in the policymaking process.
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From page 385... ...
• Ensure that high-quality primary care is available to every indi vidual and family in every community. • Train primary care teams where people live and work.
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