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Primary Care as a Public Utility, GLP-1s, and the U.S. Falls Short
June 1, 2026
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Together with
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“Feeling like there is common cause between primary care physicians and journalists as endangered species. Please support primary care for all and support your local independent news media! Both are vital to a healthy society and healthy democracy.”
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UCSF Professor Kevin Grumbach, MD
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Today’s DHW unpacks a beautiful pitch to treat primary care like a public utility. It might take a little magic to make happen, but watching Wemby pull a rabbit out of his hat in the Western Conference Finals has us feeling like anything is possible.
Go Lakers, but Go Wemby too.
Jason
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What happens if primary care gets treated like a public utility – something that everyone can access as easily as running water?
A new article in JAMA paints a beautiful picture of what that might look like, and even colors it in with a roadmap for how to get there.
Primary care is a critical component of healthcare. It’s also far from universal.
- More than a third of U.S. adults lack access to primary care, an eye-popping number that unfortunately makes more sense knowing primary care only sees 5 cents of every federal dollar spent on healthcare.
The authors frame up the issue perfectly.
- “Primary care has long fit awkwardly as an insurable risk in the marketplace. Insurance is designed to protect against large, unpredictable expenses. Yet primary care is largely predictable, similar to food, housing, and other common necessities.”
The proposed solution? A primary care common fund, which pools primary care spending from public and private purchasers and pays practices directly. Here’s the basic outline:
- The common fund would comprise current primary care spending from payors, and include the additional spending that states invest into primary care in the future.
- A state authority – much like a public utility – would administer the funds and pay practices directly.
- The “pluralistic financing” of primary care would remain intact. Employers and individuals would continue to pay premiums for commercial plans, and Medicaid would continue to be financed by federal and state funds. On the back end, the state would redirect the primary care portion of payor premiums (their contribution) to the common fund.
- A key point is that the common fund starts with no “new money.” Baseline contributions equal what purchasers are already spending on primary care (ex. Oregon has a primary care spending target of 12%, and would assess 12% of plan premiums).
- Payors would no longer need to compete on prices and benefits for primary care, but they’d still compete on their specialty and other lines of business.
- People remain enrolled in coverage for non-primary care services, but the common fund “assumes responsibility for coverage and payment of primary care and accountability for its spending.”
The Takeaway
If the U.S. wants everyone to have access to the benefits of primary care, a good start might be making sure everyone has access to primary care. This paper charts a path to get there straight down the middle of single-payor and free-market approaches, and a “Medicare Advantage for Primary Care” feels more doable than ripping and replacing the entire system.
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- Garner Mega-Round: Care navigation startup Garner Health hauled in $100M of Series E funding at a $2.74B valuation, and it did it less than six months after we dove into the company for its nine-figure Series D. The announcement has Garner’s latest count at 800 customers generating $200M of ARR, a number that’s doubled five years in a row. No matter how you slice it, employers seem to be loving Garner’s provider-ranking engine, which helps patients find the best doctors for their needs, then creates financial incentives to actually go and see them.
- Top Healthcare Concerns: Economic issues continued to dominate Americans’ ranking of the top problems facing the country in the latest data from Pew Research. The survey of 5.1k U.S. adults showed that 73% now view healthcare affordability as a very big problem for the country (up 6 percentage points from February 2025), a decent gap above the 64% that said the same about the federal budget deficit (up 7pp). Healthcare costs transcended party lines as a major concern for both Democrats (85%) and Republicans (60%), outranking both inflation and unemployment for both groups.
- Ambience Goes Inpatient: Ambience Healthcare is taking its “chart-aware intelligence” to every step of the inpatient workflow, from pre-visit patient summaries all the way through discharge. Recently introduced chart awareness capabilities allows Ambience’s AI to reason over the full patient record – labs, imaging, medications, prior notes, vitals – rather than relying on notes from a single encounter. This is fueling a big push in the inpatient setting, where evaluations across four health systems have shown that Ambience’s overhauled discharge summaries resolved 91% of information gaps missed by standard documentation.
- Kin Raises $9M: Kin Health raised a $9M seed round to make sure patients can benefit from AI scribes as much as their doctors. The startup was co-founded by two physicians and three founding members of GoodRx, which are setting out to build an AI notetaking app that patients can use to record their appointments, share visit summaries, and prepare for any follow-ups. Any patient can have those capabilities just by downloading the app, since Kin is taking a page out of the GoodRx playbook and monetizing through referrals to specialists and labs.
- Docs Question Quality Metrics: Mass General Brigham says fewer people are dying at its hospitals, but an investigation by the Boston Globe suggests that its own doctors aren’t convinced. Keeping people alive is probably a hospital’s most important job, and MGB points to metrics like “observed-to-expected mortality” to prove it’s doing a good one. The catch? Some clinicians seem to think that MGB’s updated quality metrics are more of a “propaganda campaign” than a real driver of better outcomes at the bedside.
- U.S. vs. the World: The Commonwealth Fund piled onto last week’s doom-and-gloom theme with more data showing that the U.S. healthcare system continues to have “uniquely poor performance” relative to its peers. Weak primary care infrastructure, high out-of-pocket costs, and a complex insurance system contributed to the worst health data out of 19 peer nations. The U.S. lowlights included having 0.3 primary care doctors per 1,000 people (less than half the peer average of 1.1 per 1,000 people), the highest healthcare spending at 18% of GDP (double the average), and little to show for the spending with life expectancy hovering at 79 years (consistently among the lowest).
- Copilot Health Preview: Microsoft launched a preview version of Copilot Health to any U.S. adults with an active subscription to Microsoft 365. It makes sense that the company known for flexing its distribution muscle is flexing its distribution muscle, and about 100M Americans just gained the ability to have their health questions answered with data from their own medical records, wearables, and personal health profiles. Copilot Health was first announced back in March.
- GLP-1s Don’t Move the Needle? Epic Research put out an interesting analysis of BMI trends over the past five years, which were surprisingly flat given all the commotion over GLP-1s. Individuals with healthy BMIs have increased by just 0.5% over the past five years, while overweight and obese BMIs decreased by the same amount to 72.5% of the population. Even after zooming in on GLP-1 users, they only saw a 2% uptick in healthy BMIs from 2024 to 2026.
- Spero Teams Up With UnityAI: Spero Health is teaming up with UnityAI’s to streamline access to addiction treatment and substance use disorder services at 60+ locations in the U.S. UnityAI’s PatientOps platform will serve as the first point of contact between patients and providers, answering inbound calls, scheduling appointments, either resolving patient needs or intelligently routing them to the appropriate next step. The initial deployment focuses on inbound, but it sounds like “outbound communication and longitudinal patient engagement” won’t be trailing too far behind.
- Federal No Surprises Reform: The No Surprises Act was meant to prevent patients from taking unexpected hits from out-of-network care, but the act’s independent dispute resolution process has spun out of control (to the tune of more than 5M payor-provider disputes over reimbursement since 2022. CMS last week finalized a series of reforms to streamline the process, such as a batched dispute resolution mechanism and a centralized IDR Gateway for tracking claims. Medical societies applauded the change.
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DoxGPT Nabs a New Name – and Big Upgrades
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- Redefining Patient Monitoring for Obesity & Diabetes: Weight management programs live and die by adherence. Discover why partners like Calibrate, 9am Health, and Wondr Health trust Withings to keep members weighing in, with cellular-connected scales that deliver instant weight insights, full body composition data, and the lowest possible barrier to action throughout their weight loss journey.
- Why Ambient Alone Isn’t Enough in Clinical Care: Clinicians were promised that AI would save them time, yet ambient scribes often leave them manually piecing together missing data after the visit. Navina’s new study found that combining ambient transcripts with the patient’s longitudinal history doubled documentation completeness, underscoring the limits of recording conversation alone. Explore the findings to learn why AI’s real value comes from uniting ambient notes with clinical context and connected workflows.
- State of Payor Enrollment and Credentialing: Over half of provider orgs are losing revenue due to credentialing delays – with many missing out on over $1M annually. Medallion’s new report unpacks the forces quietly undermining operational and financial performance, and how leaders across the industry are addressing them. Head over to the full report to get insights tailored to your role and org type.
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