A Health Care Solution
We Can’t Afford to Ignore:
Primary
Care




There have been plenty of arguments over how to best deliver and pay for health care in the United States. But despite disagreements, there is one goal that virtually all stakeholders in the health care debate—policymakers, state governments, employers, health care providers, and the general public—share: better health care at a lower cost.
Today, the American health care system is the most costly in the world, accounting for almost 17 percent of the current gross domestic product, and a projected 20 percent by 2020, according to the Institute for Healthcare Improvement. We spend nearly $10,000 per person on health care annually, which is more than double that of developed countries, such as the United Kingdom.
U.S. health system is the most costly in the world
As a percentage of GDP, at 16.6%, the U.S. spent the most on health care compared to the other G7 countries.
Source: UK Health Accounts: 2014 and Organisation for Economic Co-operation and Development (OECD)
Despite spending the most on health care, the U.S. lags far behind in outcomes. Compared with 11 other major industrialized countries, including Canada, Australia, and Sweden, the U.S. is last in quality, according to the Commonwealth Fund. In terms of life expectancy among industrialized nations, we rank 26th alongside Slovenia, Chile, and the Czech Republic.
“Compared with other countries, we are paying more and getting less,” said Glen R. Stream, M.D., president and board chair of Family Medicine for America’s Health (FMAHealth), a collaboration of the eight leading family medicine organizations in the U.S. “The current system simply isn’t getting the outcomes that we want.”
As health care costs continue to soar and policymakers search for solutions, one area stands out as a model for providing better outcomes at lower cost: primary care. With a track record of using innovative strategies to deliver high-quality care, improve patient health, and lower costs, primary care could lead the way toward the creation of a less-expensive, more effective health care system.
Better Outcomes,
Lower Costs
Primary care, the overall day-to-day medical care provided by a physician, focuses on disease prevention, patient education, delivering acute, chronic and preventative care, and in some cases, mental health services. When a patient needs specific help, their primary care physician can also manage and collaborate with sub-specialists.
It can pay dividends when a primary care physician can collaborate and coordinate on their patients’ behalf, especially when several health care professionals are caring for a single person with multiple diagnoses. Costs can be reduced by eliminating testing, treatment, and medication redundancies and a trusting relationship can be established, which helps the patient to make informed choices and access preventive care such as vaccines.
Primary Care Accomplishments
There are many examples of the cost savings and outcome improvements associated with primary care. Studies have found that:
Extensive research has found that primary care is associated with all three of the “triple aims” (a framework developed by the Institute for Healthcare Improvement) of optimal health care system performance: improved health outcomes, improved patient satisfaction, and reduced per-capita health care costs. “We know that primary care is one of the best buys in health care,” said Dr. Stream.
Among the most dramatic findings in primary care research comes from Portland, Ore., where a study of Oregon’s Patient-Centered Primary Care Home Program found that every dollar invested in primary care resulted in $13 in savings in other health care services, including specialty care, emergency department visits, and hospital inpatient care. During the program’s first three years, it brought in $240 million in savings to Oregon’s health system.
Primary Care Innovators
Physicians are finding new ways to save money and improve care and outcomes. Here are a few examples of innovations happening at primary care practices around the country.
Strategies for
Strengthening
Primary Care
To extend money-saving primary care innovations throughout the U.S. health care system, several changes are necessary, including:
Increase primary care physicians.
By 2025, there could be a shortage of up to 31,000 primary care doctors. Medical students must be encouraged to choose primary care. “Too often students who start out planning to work in primary care end up going into a sub-specialty,” Dr. Stream said. “We urgently need to re-design our system to encourage students to select and stay with primary care.”
Change reimbursement structures
Switching from a fee-for-service model—where providers are paid for a specific procedure—to a value-based payment system, redirects focus toward improved patient outcomes. “The current payment model doesn’t foster the innovation we need to improve quality of care, continuity of care, and patient satisfaction with care,” Dr. Stream said.
Make investments in the future.
Numerous studies have confirmed, primary care investment lowers overall health care costs by reducing downstream expenses, all while improving health outcomes for patients. Increasing our overall investment in primary care from the current 6 percent to 12 percent would have major benefits. “Good primary care costs more, but overall health care costs will come down,” said Dr. Haymon.
Innovate delivery methods.
One-on-one in-office care will always be needed but a shift toward innovations such as team-based care, home-based care, group visits, and preventive care programs will provide high quality care at a lower cost. “We have to think outside the box on how we can help people,” said Dr. Sawyer.
Support team-based care.
Working under supervision of primary care physicians, health care teams may include nurses, pharmacists, physical therapists, behavioral specialists, and mental health care providers. This helps physicians use their time efficiently by assigning tasks to appropriate team members at a lower cost. This approach is especially efficient for managing chronic diseases and preventive care.
Moving forward
Change isn’t easy, but advocating for primary care could satisfy nearly all stakeholders in the U.S. health care debate. By evolving the ways in which primary care is delivered and paid for, the U.S. can provide better care and improved health outcomes at a lower cost. “If this amazing, wonderful, personal patient-centered care cost significantly more money, we’d have to ask if we can afford something that costs more,” says Dr. Cornwell. “But the fact that great primary care dramatically reduces costs makes it a question of, can we afford not to do this in our country?”