Primary care investment could improve outcomes, lower costs

Investing in primary care as a preventative measure is associated with improved medical care quality, fewer hospital visits and lower spending overall, a study has found.

If all California providers spent as much on primary care as the highest investing health systems, they could avoid 25,000 acute hospital stays and 89,000 emergency department visits while saving $2.4 billion in healthcare spending a year, according to a study funded by the California Health Care Foundation, Covered California and the Milbank Memorial Fund.

The study focused on eight health plans that cover 80% of commercially insured adults in California—around 13.9 million people—and the primary care spending patterns of 180 provider organizations, which include 8.5 million commercially insured adults enrolled in health maintenance organization plans.

Primary care spending as a percentage of overall health plan spending varied from 4.9% to 11.4%. That range is lower than the recommended spending levels of 9% to 12% in other states.

“Decades of research have shown increased investments in primary care lead to higher quality and more equitable care,” Kathryn Phillips, senior program officer at the California Health Care Foundation, said in a news release. “Yet America, on average, spends only about five cents of every healthcare dollar on primary care.”

Researchers found that health systems spending more on primary care were more likely to meet care quality measures. A larger share of those systems’ members met diabetes care goals and received recommended screenings for breast cancer, cervical cancer and colorectal cancer, as well as the appropriate medications.

Higher primary care investment could also allow nearly 200,000 individuals on commercially insured plans in health maintenance organizations to receive recommended care, according to the study. Providers nationwide have made similar pushes as they look to use coordinated care to improve community health. Primary care providers can help patients avoid and check early for chronic diseases to lower medical expenses stemming from extensive treatment.

Although health systems have focused on primary care, U.S. adults remain among the least likely to have a primary care doctor compared to individuals in other developed countries. According to the U.S. Department of Health and Human Services, the country needs around 16,000 more primary-care physicians to meet the demand for consistent care, a demand the pandemic has only exacerbated with staff shortages.

The California Health Care Foundation, Covered California, the California Public Employees’ Retirement System, the California Department of Health Care Services and Health Access California and others have formed the Primary Care Investment Coordinating Group of California to encourage health plans and systems to increase their investments in primary care and change their primary care business models.

The California Public Employees’ Retirement System plans to require preferred provider organizations to match members with primary care providers later in 2022, and Covered California will require health plans to measure and report primary care spending beginning next year.

Starting in 2024, the Department of Health Care Services will use quality and equity measures to determine payments to health plans serving Medi-Cal managed care, and these plans will also be required to report their primary care spending.

Boosting primary care has the potential to provide more coordinated, cost-effective and quality care for California consumers, Anthony Wright, executive director of Health Access California, said in a news release.

“An insurance card is necessary but not sufficient,” Wright said. “Patients need a primary care provider, one who proactively prioritizes prevention upfront, and who can guide them through the health challenges they end up facing, through our complex health care system of different specialists and treatments.”