Primary care makes a difference for patients and the nation


This week is National Primary Care Week, an opportunity to engage medical students and healthcare stakeholders in a national discussion around the tremendous role that primary care plays in our health care system.

With so much debate about the high price of health care in the United States, too often one of the most effective methods of controlling costs is overlooked: primary care. A wealth of research continues to show that primary care not only reduces costs, but also helps achieve high-quality care that effectively manages population health. It is key to delivering on the “triple aim” of better health, better care, at lower costs.

Primary care is truly the best buy in health care and, with the right investments, it has the potential to provide even greater value to the health care system.

As we prepare the next generation of health care professionals for the responsibility of keeping America healthy, we emphasize that the primary care team is critical to ensuring that preventive care is implemented well, leading to positive benefits across the health care continuum. And when patients do need care, we’re often the first in line and may be the difference between a well-managed condition and costly downstream complications.

Unfortunately, we aren’t utilizing primary care for the full value it could bring to the health care system.

Today, nationwide spending on primary care represents just 6 percent of total health care spending. According to the American Academy of Family Physicians, if that percentage were increased to 12 percent, it would cut per-patient costs and lead to a decrease in overall health care expenditures — an outcome we can all agree would be beneficial for our country. In fact, one notable experiment in Oregon — the Patient-Centered Primary Care Home initiative — saved an estimated $240 million between 2012 and 2014, achieving $13 in savings for every $1 increase in primary care spending.

While primary care is working, it is by no means perfect. It needs to continually evolve to keep up with the demands of the population and the system and to deliver its full value.

One area of innovation is in the transition to value-based payments. Experience shows that health care providers can control costs and offer better care to their patients when they’re paid based on quality and comprehensiveness of care, rather than on the volume of care provided. Value-based arrangements represent a profound shift in our health care system, and primary care physicians should embrace this change.

Indeed, changes in payment models can spur the integration of mental and behavioral health services into primary care. The National Alliance on Mental Illness estimates that about one in five adults experience mental illness each year and an estimated 43 to 60 percent of psychological issues are treated in primary care settings. Despite this, little progress has been made toward the full integration of these services into primary care under the fee-for-service system.

However, we’ve seen encouraging success in pilot programs, such as those at Community Health of Central Washington (CHCW), which have worked to take a holistic approach to mental health integration. For example, CHCW provides what it calls a “primary care home” where its 30,000 patients can go for annual check-ups or when they “feel sick or sad.” Primary care physicians in the system can also refer patients to a full-time social worker known as a “behavioral health consultant,” who works with the patient on a specific mental health concern and develops a plan to address it.

Shifting to value-based care will encourage further integration like this and will finally align incentives for primary care physicians with the health of the population.

Looking forward, I am optimistic about the future of primary care. The value provided for patients and the health care system is resonating with policymakers and advocates, and the shared commitment to strengthening population health is encouraging.

Every year, the enthusiasm around National Primary Care Week within the health care community reenergizes my own commitment to the potential of primary care to help make the nation healthier and to save money in the process. For anyone interested in making a difference for patients and for their country, primary care is an increasingly good choice.

Glen R. Stream is a family physician and president and board chair, Family Medicine for America’s Health, sponsor of Health is Primary.

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