Synthesis of the STARFIELD Summit III

As documented by Starfield and others, health care systems based on primary care have healthier populations, greater equity, and lower cost. However, current quality measures do not reflect most of the mechanisms hypothesized to provide this value. Incorrectly focused measurement and incentives risk burning out the workforce and diminishing the value of primary care for people and populations.

Starfield III brought together diverse stakeholders to grapple with understanding what matters in primary care, and how it can be measured. We began with advance work that included crowdsourced surveys of nearly two thousand people, and five commissioned issue briefs. These efforts culminated in a 2½ day facilitated conversation among 70 national and international leaders.

By sharing personal, research and policy experiences, Starfield III participants surfaced multifaceted mechanisms by which primary care fosters health, healing and systemic value. We discovered that the apparent simplicity of primary care masks the complexity of integrating, personalizing, and prioritizing care for people and communities. We struggled to fit this interrelated complexity into usual reductionist classification systems that assume that the whole is merely the sum of its parts.

In post-conference analyses of notes and transcripts from small and large group discussion, we identified two complementary ways of understanding and assessing primary care: