Primary Care is Undervalued. What Now?

By Michael J. Pramenko, MD

Stop the press. Public and private payers take note. Primary Care in the United States is undervalued.  Surely, and sarcastically speaking, primary care providers are shocked by this news.

In medicine and public policy, we like to believe that we follow the evidence and let facts guide the implementation of sound structural changes needed to build a better health care system here in America. Unfortunately, this is not always the case.

Longstanding payment modalities, entrenched big business, politics, and conflicts of interest have severely handicapped our country’s quest for a better health care system.

A change of course is long overdue.

With a growing body of evidence, both here at home and overseas, the case for greater investment in primary care lies right before us. The promise of proper chronic disease management, fewer ER visits, reduced hospitalization rates, and greater patient satisfaction are obtainable.  The evidence speaks for itself.

However, the fundamental benefits of high quality and accessible primary care cannot be achieved via anemic and underfunded primary care networks. Here in the U.S., while the insurance companies currently pay primary care practices $4.90 PMPM, the corresponding value of good care management to those same insurers is approximately $17 PMPM.

A United Healthcare analysis published in 2014 regarding care coordination within medical homes noted a return on investment of six to one.  As noted in the publication, “the costs of intervention were 1.2 percent of medical costs and they offset 16% of gross savings.”

There are places, both here and abroad, where health systems and government have figured this out. The lessons are there. The proof is well documented. And, the systems and countries that are investing in proper primary care are achieving an excellent return on their investment.

The Institute of Medicine declared primary care as the “logical foundation of an effective health care system” and “essential to achieving the objectives that together constitute value in health care”.

Integrated health systems here in the United States and countries with highly rated health care delivery ratings subscribe to this philosophy.  To facilitate their high value care, they invest in primary care. In fact, the literature suggests we should double primary care financing to facilitate our intended goals for a functional health care system.

We have underfunded and undervalued primary care in this country for decades. It has come with a significant price tag. Now, as we look to the future of value based reimbursement and a greater focus on patient centered care, the timing is right for bold investment in primary care.  An evidence based approach to health reform includes substantial increases in spending on primary care. An evidence based approach to patient centered care invests in patient centered medical homes, care coordination, and behavioral health integration.

Given the overwhelming evidence of the value of primary care, we should applaud the efforts of the Colorado Academy of Family Physicians to offer legislation that would enhance funding for primary care in Colorado.

Patients expect the latest technology and science to guide our medical practices. We should expect no less when determining the structure and course for our medical delivery system.  Acknowledge the value of primary care and end the chronic anemic funding of the foundation of our health care delivery system. An ounce of prevention is worth a pound of cure.

Michael J. Pramenko M.D. is the Executive Director of Primary Care Partners in Grand Junction. He is Chairman of the Board of Monument Health and is a Past President of the Colorado Medical Society.