The idea that increasing investment in primary care will reduce costs down the road makes intuitive sense, but a recent article in Health Affairs suggests that there’s “limited evidence that directly ties higher primary care spending to lower total spending.”
Primary care is the foundation of an effective healthcare system, with plenty of evidence supporting downstream benefits like fewer ED visits, hospital stays, and better outcomes.
- The secret sauce behind those benefits is the long-term relationships between patients and their PCPs, which brings a healthy dose of cohesiveness to otherwise fragmented care journeys.
- Despite primary care’s effectiveness, it only sees 5-7% of total U.S. healthcare spending, prompting over a third of states to pick up the slack with their own investments.
Now for the bad news. Better outcomes are obviously a worthwhile aim, but unfortunately most stakeholders would rather see savings to justify increased investment in primary care.
- Studies of Massachusetts’ Alternative Quality Contract and Rhode Island’s affordability standards – both examples of primary care investment that showed a slowdown in spending after several years – found that the savings were more closely tied to limits on price and total spending, rather than primary care itself.
Where does that leave us? Although it’s proven difficult to draw a straight line between primary care and its financial impact, some common threads are emerging between states that have tried.
- Accountability: States that rely on transparency and public pressure to increase primary care investment have generally been less successful than those that require payors to foot the bill. Provider orgs should also be held accountable for ensuring these investments reach primary care in tangible ways. The shared responsibility creates multi-stakeholder engagement.
- Long-term Lens: The benefits of high quality primary care accrue over time. Expectations for returns, shifting payor membership, and political winds don’t offer systems and payors enough patience for new policies to achieve their goals, so strong state leadership needs to sustain a long-term view.
- Sufficient Investment: Investments need to adequately fund advanced primary care capabilities that can actually improve the delivery of care and outcomes of interest.
The Takeaway
Primary care is the undeniable cornerstone of our healthcare system, and there’s a growing recognition that we should redirect more investment toward ensuring that it’s high quality and readily accessible. Policy makers need more evidence to support those investments, and articles like this one help get the ball rolling in that direction.
