Why We Need to Strengthen Primary Care
Reprinted by permission of the National Academy of Medicine.
The U.S. Department of Health and Human Services (HHS) recognizes that effective primary care is essential for improving the health and well-being of individuals, families, and communities and advancing health equity. It is well documented that health systems with a robust primary care base provide better access to health services and have improved health outcomes, lower mortality, and more equity. Strong primary care can also result in significant cost savings.
By strengthening primary care, HHS will advance the Department’s strategic goals of expanding access, reducing disparities, improving health outcomes, and ensuring HHS programs reach underserved communities (HHS, n.d.a). Robust primary care is essential for addressing behavioral health, including the overdose epidemic and the child and adolescent mental health crisis; improving maternal and child health, such as by reducing disparities in maternal mortality; and preventing and managing chronic conditions.
Primary care in our nation is facing numerous challenges. Too many people lack access to primary care and an ongoing, trusted relationship with a primary care clinician and team. There are disparities in access based on race, ethnicity, age, geography, as well as other demographic factors (Jabbarpour et al., 2022). Key federal programs providing primary care to more than 30 million people in rural and underserved areas require additional investment and support to meet the needs in their communities. In addition, the workforce is not growing as fast as demand and the new generation of clinicians seek other disciplines with better work-life balance and compensation (HRSA, 2022; Steinwald et al., 2019). Federal investment in primary care research is low (Mendel et al., 2021). Last, coordination of primary care with other clinical services and sectors is also often challenging.
HHS Actions to Strengthen Primary Care
Since 2021, multiple HHS agencies have collaborated on developing a coordinated set of HHS-wide actions, with input from external stakeholders and members of the public, to strengthen primary care and advance health equity. These actions build on HHS’s longstanding work in primary care and leverage the Department’s policies, programs, and authorities.
HHS has adopted the definition of high-quality primary care put forth in the 2021 National Academies of Science, Engineering and Medicine consensus report, Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care:
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.
*Whole-person health focuses on well-being rather than the absence of disease. (NASEM, 2021)
With its set of actions and the adoption of this definition, HHS is capitalizing on its investments in primary care, strengthening multidisciplinary teams and team member roles, improving digital health tools, advancing primary care research, and supporting practice improvement to facilitate the provision of whole-person primary care.
The Department’s actions aim to advance health equity by improving equitable access to whole-person primary care; fostering ongoing, trusted relationships between patients and their primary care clinicians and teams; incorporating input from the community into primary care; increasing the diversity of the workforce; increasing cross-sector partnerships to coordinate preventive services and address social needs and environmental factors affecting health (see ACF, n.d.); supporting bi-directional integration of health care services across systems for people with behavioral health conditions; increasing resilience to disasters and emergencies through partnerships and workforce competency development; and advancing digital health care and primary care research using a health equity lens.
These HHS actions are complementary to and aligned with federal priorities such as the HHS Strategic Plan, the HHS Roadmap for Behavioral Health Integration, the HHS Strategic Approach to Addressing Social Determinants of Health to Advance Health Equity, the HHS Overdose Prevention Strategy and the White House Blueprint for Addressing the Maternal Health Crisis. (HHS, n.d.a, n.d.b, 2022a, 2022b; White House, 2022).
HHS is moving forward with implementing actions to strengthen primary care. Just last week, the Centers for Medicare & Medicaid Services (CMS) released the Physician Fee Schedule Final Rule for Calendar Year 2024, which recognizes that primary care is instrumental in the delivery of high-quality, whole-person care (CMS, 2023a). Building an effective longitudinal relationship, in and of itself, is a key aspect of providing reasonable and necessary medical care and will enhance adherence to treatment recommendations after the visit and during future visits. It’s the work building this important relationship between the practitioner and patient for primary and longitudinal care that has been previously unrecognized and unaccounted for during evaluation and management visits. CMS will begin to provide certain additional payments for physicians and other practitioners delivering primary and longitudinal care starting in 2024.
Other implemented actions include the record number of patients served in rural and underserved communities through Health Resources and Services Administration-supported health centers; record numbers of scholarships and loan repayment assistance awards through the National Health Service Corps for physicians and nurses currently providing care in rural and underserved communities; a major expansion of training and teleconsultation access for primary care providers on treating mental health conditions and integrating mental health into school-based health centers; new grants supporting training for new primary care doctors to better serve individuals with limited English proficiency and individuals with disabilities; the release by the by the CMS Center for Medicare and Medicaid Innovation of a new payment and care delivery model, Making Care Primary, which aims to advance health equity and test the provision of enhanced payments, resources, and data to primary care clinicians; the expansion of disciplines whose services are paid by Medicare, to further support multidisciplinary teams; the distribution of new primary care residency slots to underserved areas; and actions that facilitate behavioral health and primary care integration (CMS, 2023b). For example, the Substance Abuse and Mental Health Services Administration’s newly released Strategic Plan for 2023-2026 includes advancing the integration of behavioral and physical health care as one of five key priority areas (SAMHSA, 2023). Also, HHS is in the early stages of developing a Primary Care Dashboard that will monitor the “health” of our nation’s primary care system and the impacts of HHS actions to strengthen primary care.
These are just a few of the many actions HHS has recently taken to strengthen primary care. HHS has released an issue brief that describes more completely primary care actions already taken and highlights the Department’s planned future work to strengthen primary care (HHS, 2023). With the release of this issue brief, HHS aims to foster collective action among stakeholders and across the health care system and other sectors to maximize individual and population health and well-being; ensure access to affordable, comprehensive, whole-person primary care throughout the country; and make it possible for all communities to be served by trusted primary care clinicians and multidisciplinary teams who reflect the communities they serve.
A robust primary care foundation for our health care system is essential for improving the health of our people and advancing health equity. HHS is making strides in strengthening primary care in our nation and has plans for further actions, described in the issue brief. The Department will monitor the health of our primary care system to develop additional, data-informed interventions and maintain focus on strengthening primary care.
ACF (Administration for Children & Families). n.d. Medical-legal partnerships plus. Office of Community Services. https://www.acf.hhs.gov/ocs/programs/mlp-plus (accessed November 3, 2023).
CMS (Centers for Medicare & Medicaid Services). 2023a. Calendar year (CY) 2024 Medicare physician fee schedule final rule. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-final-rule (accessed November 3, 2023).
CMS. 2023b. Making care primary (MCP) model. https://www.cms.gov/priorities/innovation/innovation-models/making-care-primary (accessed November 3, 2023).
HHS (U.S. Department of Health and Human Services). n.d.a. Strategic plan FY 2022-2026. https://www.hhs.gov/about/strategic-plan/2022-2026/index.html (accessed November 3, 2023).
HHS. n.d.b. Overdose prevention strategy. https://www.hhs.gov/overdose-prevention/ (accessed November 3, 2023).
HHS. 2022a. HHS roadmap for behavioral health integration. https://www.hhs.gov/about/news/2022/12/02/hhs-roadmap-for-behavioral-health-integration-fact-sheet.html (accessed November 3, 2023).
HHS. 2022b. HHS’s strategic approach to addressing social determinants of health to advance health equity – at a glance. https://aspe.hhs.gov/sites/default/files/documents/aabf48cbd391be21e5186eeae728ccd7/SDOH-Action-Plan-At-a-Glance.pdf (accessed November 3, 2023).
HHS. 2023. Primary care issue brief.
https://www.hhs.gov/sites/default/files/primary-care-issue-brief.pdf (accessed November 7, 2023).
HRSA (Health Resources and Services Administration). 2022. Primary care workforce: Projections, 2020-2035. Washington, DC: National Center for Health Workforce Analysis. https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/Primary-Care-Projections-Factsheet.pdf (accessed November 3, 2023).
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Mendel, P., C. A. Gidengil, A. Tomoaia-Cotisel, S. Mann, A. J. Rose, K. J. Leuschner, N. Qureshi, V. Kareddy, J. L. Sousa, and D. Kim. 2021. Heath services and primary care research study: Comprehensive report. Santa Monica, CA: RAND Corporation. https://www.rand.org/pubs/research_reports/RRA1503-1.html (accessed November 3, 2023).
NASEM (National Academies of Sciences, Engineering, and Medicine). 2021. Implementing high-quality primary care: Rebuilding the foundation of health care (Highlights). Washington, DC: The National Academies Press. https://nap.nationalacademies.org/resource/25983/Highlights_High-Quality%20Primary%20Care-4.23.21_final.pdf (accessed November 3, 2023).
SAMSHA (Substance Abuse and Mental Health Services Administration). 2023. SAMSHA’s 2023-2026 strategic plan. https://www.samhsa.gov/about-us/strategic-plan (accessed November 3, 2023).
Steinwald, B., P. B. Ginsburg, C. Brandt, S. Lee, and K. Patel. 2019. We need more primary care physicians: Here’s why and how. Washington, DC: The Brookings Institution. https://www.brookings.edu/articles/we-need-more-primary-care-physicians-heres-why-and-how (accessed November 3, 2023).
The White House. 2022. White House blueprint for addressing the maternal health crisis. https://www.whitehouse.gov/wp-content/uploads/2022/06/Maternal-Health-Blueprint.pdf (accessed November 3, 2023).
Levine, R., R. Burciaga Valdez, C. Brooks-LaSure, J. Hild, M. Tripathi, R. Tso, M. Delphin-Rittmon, and C. Johnson. 2023. The U.S. Department of Health and Human Services Is Taking Action to Strengthen Primary Care. NAM Perspectives. Commentary, National Academy of Medicine, Washington, DC. https://doi.org/10.31478/202311b.
ADM Rachel Levine, MD, is the U.S. Assistant Secretary for Health. R. Burciaga Valdez, PhD, MHSA, is Director of the Agency for Healthcare Research and Quality. Chiquita Brooks-LaSure, MPP, is Administrator, Centers for Medicare & Medicaid Services. Jeff Hild, JD, is Acting Assistant Secretary and Principal Deputy Assistant Secretary, Administration for Children and Families. Micky Tripathi, PhD, MPP, is the National Coordinator for Health Information Technology. Roselyn Tso, MS, is Director of the Indian Health Service. Miriam Delphin-Rittmon, PhD, is the U.S. Assistant Secretary for Mental Health and Substance Use. Carole Johnson, MA, is Administrator, Health Resources and Services Administration.
None to disclose.
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The views expressed in this paper are those of the authors and not necessarily of the authors’ organizations, the National Academy of Medicine (NAM), or the National Academies of Sciences, Engineering, and Medicine (the National Academies). The paper is intended to help inform and stimulate discussion. It is not a report of the NAM or the National Academies. Copyright by the National Academy of Sciences. All rights reserved.