NASEM REPORT HERALDS PRIMARY CARE EVOLUTION, URGES ACTION

doi:10.1370/afm.2724

A comprehensive report published in May by the National Academies of Sciences, Engineering and Medicine strengthens the case for primary care as the foundation of the US health care system. It also makes policy recommendations that reinforce several of the AAFP’s long-standing advocacy positions.

“Primary care is the only health care component where an increased supply is associated with better population health and more equitable outcomes,” concludes the 448-page Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care, which reflects some 18 months of research. The report is available at https://www.nap.edu/catalog/25983/implementing-high-quality-primary-care-rebuilding-the-foundation-of-health.

The Academy was among the 17 co-sponsors of the study and will participate in stakeholder and lawmaker briefings accompanying its publication.

As a snapshot of how the authors define “better” and “more equitable” in the context of primary care, Americans, per capita, spend more than twice what citizens in Australia, France, Canada, New Zealand, and the United Kingdom pay for health care but experience worse health outcomes than people in those countries, the report notes. These nations, like the United States, are part of the Organization for Economic Cooperation and Development, whose members devote an average of 14% of all health care spending to primary care. In the United States, primary care visits account for 35% of health care visits yet make up only about 5% of health care expenditures.

The report echoes and extends a 1996 Institute of Medicine report, starting with an updated definition of high-quality primary care as the “provision of whole-person, integrated, accessible and equitable health care by interprofessional teams who are accountable for addressing the majority of an individual’s health and wellness needs across settings and through sustained relationships with patients, families and communities.”

That earlier document, “Primary Care: America’s Health in a New Era,” (which the Academy also cosponsored), made a similar call to prioritize primary care. But it was less definite in establishing accountability methods for its proposals, which went largely unheeded by legislators and policymakers. In the generation since, several of the issues it identified — including the limitations of fee-for-service medicine and the need to buttress the primary care workforce — have grown more acute.

NASEM’s study acknowledges that urgency with a 5-pronged implementation plan to make high-quality primary care available and accessible nationwide. Specifically, it calls for policies that

Pay for primary care teams to care for people, not doctors to deliver services
Ensure that high-quality primary care is available to every individual and family in every community
Train primary care teams where people live and work
Design information technology that serves the patient, the family, and the interprofessional care team
Ensure that high-quality primary care is implemented in the United States

The report’s findings and recommendations support the Academy’s position that the country’s fee-for-service health care design promotes misaligned incentives and prizes “sick care” at the expense of population wellness. This dangerous gap was exposed and exacerbated by the COVID-19 pandemic.

AAFP EVP and CEO Shawn Martin said in a statement that coincided with publication of the report, “We look forward to working with policymakers, payers and our other partners in primary care to make the study recommendations a reality—the health of our nation depends on it.”

Academy President Ada Stewart, MD, of Columbia, South Carolina, added: “The NASEM report clearly spells out the case for increased investment in our primary care system and ensuring everyone in our country has access to high-quality primary care, something the AAFP has long advocated for. The COVID-19 pandemic further exposed flaws in our current health care system, including those related to many years of underinvestment in primary care.”