Getting More for Our Money in Health Care

T.R. Reid and Glen Stream, MD

As we look to the future of health care in America, one thing we can all agree on is the critical role of primary care in controlling costs and safeguarding the nation’s health. There is a wealth of evidence showing that a strong foundation of primary care is what the health care system needs to deliver on the “triple aim” of better health, better care and lower costs.

Unfortunately, current spending on primary care represents just 6% of total health care spending in the United States. Increasing it to 12%, according to the American Academy of Family Physicians (AAFP), would cut per-patient costs and lead to a decrease in overall health care expenditures.

Cutting costs, of course, is not our only priority – more important is keeping people healthy. That is what is happening around the country in places where there are more primary care clinicians. Access to primary care reduces death rates for cancer, heart disease, stroke, and other diseases. In addition, patients with primary care access are less likely to be hospitalized. That is evident in the actions of a number of states that have adopted policies that prioritize primary care.

State initiatives include new value-based payment models that reward doctors and hospitals, not for the number of procedures they perform, but instead for improving the health of their patients. The theme of value-based payment has been consistent across virtually every event held this year by the Alliance for Health Policy as part of the Future of Health Care series.

In Oregon, a new law will require all coordinated care organizations and commercial insurers to spend at least 12% of their total medical expenditures on primary care by 2023. This legislation was inspired in part by Oregon’s Patient-Centered Primary Care Home initiative, which saved an estimated $240 million between 2012 and 2014, achieving $13 in savings for every $1 increase in primary care spending.

A similar program in Michigan involving about 4,500 primary care doctors has helped transform care in the state, resulting in a 15% decrease in adult visits to emergency departments and a 21% decrease in ambulatory care sensitive inpatient stays.

As Oregon, Michigan, and other states have recognized, investment in primary care can help fix a system that is both expensive and underperforming, and too often driven by volume over value. The emphasis is well-placed, given that visits to primary care doctors account for more than 25% of all visits to doctors regardless of specialty.

As the “first line of defense” in the health care system, primary care should be at the heart of any national policy. That will go a long way toward providing Americans with quality and affordable health coverage.

Everyone in Washington should be able to agree on that.

T.R. Reid is a journalist, documentary film correspondent and the author of “Healing in America.” Glen R. Stream, MD, MBI is a family physician in La Quinta, CA and president and board chair of Family Medicine for America’s Health, which sponsors Health is Primary.