The hidden value in primary care

Primary care is the key to lowering health care spending. That’s the conclusion of a new study released Sept. 30 by the UnitedHealth Center for Health Reform & Modernization. The challenge for policymakers, medical providers and other health care stakeholders: Unlocking the hidden value in primary care will require expanding primary care capacity and changing the way care providers are paid.  

Primary care practices are often the first place patients go for routine preventive care or when they are sick. When primary care works well, it promotes continuity of care and coordination across services, improves quality and health outcomes, and contains costs by helping patients get the right services at the right time rather than more costly care, including unnecessary tests and avoidable hospitalizations.      

Unfortunately, fewer Americans are taking advantage of primary care services. The number of primary care office visits has fallen. Nationally, we spend about $200 to $250 billion annually on primary care – well under 10 percent of our overall health care costs.  We need more primary care for two reasons: one, it’s the most effective way to safeguard a person’s health; and two, millions of American don’t have access to a regular primary care provider. 

In addition to increasing the number of primary care providers, payment models have to change. Today most primary care physicians are paid according to an outdated formula. The more services they perform, and the more complex those services are, the more money they are paid. Health costs will continue to rise on this “more services, more spending” merry-go-round. Plus, this approach fails to promote high-quality care based on best practices, care coordination, and better management of chronic conditions. Volume and complexity of care is rewarded, not the value of the services being performed.