Primary Care Spending in the United States, 2002-2016

Martin, Sara; Phillips, Robert L.; Petterson, Stephen; Levin, Zachary; Bazemore, Andrew

doi:10.1001/jamainternmed.2020.1360

Cited by 21 publications

(18 citation statements)

References 4 publications

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“… 4 In addition, our estimates are below what many states have set as targets (>10% of spending on primary care) to improve outcomes and lower total costs of care. 5 Study limitations include that veterans may receive care outside the VHA. Current estimates of costs of care obtained outside the VHA range from $8.2 billion in 2014 to $14.9 billion in 2018.…”

Section: Discussionmentioning

confidence: 99%

Primary Care Spending in the Veterans Health Administration in 2014 and 2018

2021

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Section: Discussionmentioning

confidence: 99%

Primary Care Spending in the Veterans Health Administration in 2014 and 2018

2021

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“…Although PCMHs have demonstrated some improvements in cost and quality, many experts believe that the model is underpowered because payment structures do not support team-based care. 47 Primary care is still largely fee-for-service and makes up only 5% to 7% of total US health care spending, 48,49,50 so organizations' investment in primary care is low. More than 60% of primary care practices' revenue must come from prospective payments in order to substantially reform care delivery without fiscal loss.…”

Section: Shortages and Needmentioning

confidence: 99%

What Primary Care Innovation Teaches Us About Oral Health Integration

Greiner¹,

Glicken²

2022

AMA Journal of Ethics

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Integrating primary and oral health care is critical to improving population health and addressing health inequity exacerbated by the COVID-19 pandemic. Leaders of the patient-centered medical home (PCMH) movement focused on building consensus for the PCMH model among diverse stakeholders in order to enhance infrastructure investment, care innovation, and payment reforms that support access and equity. This article offers 5 lessons from the PCMH movement to inform primary and oral health care integration.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity. Patient-Centered Medical HomesConsumers want primary care that is accessible, comprehensive, coordinated, and responsive to overall health and well-being and that integrates oral and behavioral services. 1 However, despite the fact that comprehensive primary care improves population health and reduces inequity, 2,3,4 this care is hard for patients to find because of siloed payment, insurance, and delivery streams. The COVID-19 pandemic has further weakened primary care and exacerbated inequity. 5,6 Yet primary care innovators who have built momentum over the last decade might still help increase access to comprehensive care by creating patient-centered medical homes (PCMHs) 7 that can connect silos. PCMHs offer advanced primary care models that do the following:• Strengthen partnerships between primary care clinicians and patients • Deliver comprehensive services through team-based, proactive approaches • Leverage technology to track, target, and evaluate interventionsPCMHs have been widely adopted by commercial health plans, states, and federally qualified health centers (FQHCs). As of 2010, 44 states and the District of Columbia had passed 330 laws to support and incentivize medical homes. 8 White and Twiddy reported in 2017 that 45% of family physicians practice in a PCMH, 9 and the American Medical Association showed that 32% of physicians in 2018 participated in a medical home. 10,11

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“…While other nations have heeded Declaration of Alma Ata guidance that primary care is "essential health care" and should be the "central feature and main focus" of all countries' health systems, the United States has consistently underinvested in primary care and its workforce, which currently constitutes only 30% of all practicing physicians despite decades of efforts to reverse its steady declines. [6][7][8][9] Ominously, despite nearly $18 billion in public investment and federal advisory board calls to push primary care above 40% of the total workforce, only 25% of the products of US graduate medical education enter primary care. 10,11 Pediatrics and internal medicine produce increasing proportions of subspecialty graduates each year, their primary care outputs further compounded by growing entry into hospitalists careers.…”

Section: Articlesmentioning

confidence: 99%

Sailing the 7C’s: Starfield Revisited as a Foundation of Family Medicine Residency Redesign

Bazemore

Grunert

2021

Fam Med

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Amidst a pandemic that has acutely highlighted longstanding failings of the US health care system and the graduate medical education (GME) enterprise that serves it, educators prepare to embark on another revision of the program requirements for family medicine GME. We propose in this article a conceptual framework to guide this endeavor, built on a foundation of the core functions that Barbara Starfield suggested might explain primary care’s salutary effects. We first revisit these “4C’s”—first Contact, Continuity, Comprehensiveness, and Coordination—and how they might inform design thinking in primary care GME guideline revision. We also propose the addition of Community engagement, patient-Centeredness, and Complexity. Training residents to deliver on these “7C’s,” functions critical to the delivery of high-performing primary care, is essential if family medicine residency graduates are to serve the clearly articulated, but unrealized, quadruple aim for US health care: improved patient experience and population health at lower costs while preserving clinician well-being. Finally, we highlight and illustrate examples of four critical enablers of these 7C core functions of primary care that must be accommodated in training guidelines and reform, suggesting a need for resident competencies in Team-based, Tool- and Technology-enabled, Tailored (“4T’s”) care of patients and populations.

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Primary Care Spending in the United States, 2002-2016

Cited by 21 publications

References 4 publications

Primary Care Spending in the Veterans Health Administration in 2014 and 2018

Primary Care Spending in the Veterans Health Administration in 2014 and 2018

What Primary Care Innovation Teaches Us About Oral Health Integration

Sailing the 7C’s: Starfield Revisited as a Foundation of Family Medicine Residency Redesign

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