Primary care is dying: Why that should scare every large employer


Primary care is on life support. COVID-19’s toll on American health care extends beyond the hospitals and medical workers besieged by infection. An equally insidious but less-visible crisis is engulfing primary care, the long-neglected foundation of our health care system. Given the role of America’s largest corporations in providing health care benefits, the C-suite should be on high alert.

As growing numbers of patients postpone appointments over concerns about contracting the virus, the ensuing economic damage is certain to have lasting consequences. A recent industry survey found that nearly eight in 10 primary care clinicians reported their practice was under “severe” or “close to severe” financial strain.

The survey results underscore just how vulnerable primary care doctors were even before the pandemic arrived. Routine preventive care and testing have long been underfunded and inadequately supported in the U.S.

Few understand better than America’s largest employers just how dysfunctional our health system has become. Year after year, they’ve been called upon to help foot the bill for unrelenting increases in costs for health care coverage. Over the past ten years, average premiums for employer-sponsored family health plans have climbed by 54 percent to $20,576 a year. These high costs produce substandard care when compared to other, far less expensive health care systems worldwide, and in any case, they’re simply unsustainable for employers and employees alike.

Employers know that primary care is essential to a healthy workforce. Without support, primary care practices will either close or be bought up by larger health care systems or private equity groups. We know from historical evidence that this will drive market consolidation and increase costs without any increase in quality or improvement in patient experience.

What’s more, both the COVID-19 crisis and social unrest in the aftermath of George Floyd’s death has highlighted the glaring inequities in our country and our health care system. Failure to save frontline, community-based physicians limits access to essential preventive services and chronic disease management, leaving communities of color who face a higher burden of chronic illnesses, more vulnerable to the worst health outcomes of COVID-19, and other conditions.

If there’s one positive to emerge from the current catastrophe, it’s that a unique opportunity now exists to reorganize primary care and address long-festering problems at the heart of our health care system. That’s why employers are banding together to use their leverage as purchasers of health care to strengthen and redefine primary care.

Here are the critical changes America’s largest employers are pushing right now:

Increase payment for primary care immediately. To ensure that primary care practices are financially viable, they should be given advance payments during the next several months to keep their doors open.

End fee-for-service for primary care. Primary care simply cannot change without changes to the way we pay for it. Insurance companies need to shift from paying doctors for each visit and procedure they perform to a per-patient, per-month rate – along the lines of a monthly budget. This approach would immediately bolster primary care finances and give doctors much-needed flexibility to fully address the needs of individual patients, working to keep them healthy rather than treating them just when they’re sick.

Expand access through telehealth and digital capacity. COVID-19 has underscored that it’s well past time to ramp up existing technologies that make it easier for patients to access care and are more efficient for doctors. We need to develop policies to ensure that patients continue to have access to telehealth services during and after the COVID crisis, and that providers are paid appropriately for these virtual visits.

Integrate mental health and primary care. Twenty percent of primary care visits relate to mental health concerns, and 79 percent of antidepressants are prescribed by primary care providers. A growing body of evidence shows that by integrating mental health into primary care services, we can increase Americans’ access to needed care while improving health and reducing costs.

Hold health plans accountable. The country’s largest employers are increasingly coming together to require health plans to be more transparent about how their health care dollars are being spent and to incentivize structural change that will benefit workers’ health. Understanding primary care’s relationship to lower costs and better health, employers are demanding health plans prioritize it.

Working together, we can harness the lessons learned from the COVID-19 outbreak to fundamentally reorganize primary care and reinvent our health system. If we’re successful, the benefits will stand as one of the most valuable and lasting consequences to emerge from this dark and difficult time.

Elizabeth Mitchell is chief executive officer, Pacific Business Group on Health.

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