The Future of High Quality Primary Care – Recommendations from the National Academies of Science, Engineering, and Medicine’s 2021 Report

ByErica Pike

The National Academies of Sciences, Engineering and Medicine provide expert advice on pressing challenges facing the nation and world. They advise and shape policies, inform public opinion, and advance the pursuit of science, engineering, and medicine.

In 1996, NASEM released an initial report on primary care that had strong recommendations for changes that would advance the field, but there was little momentum and action to implement those recommendations in the last twenty five years. The latest report, Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care, published in July 2021, provides actionable policy and systems-level recommendations to establish sustainable, high quality primary care in the United States. 

The Colorado Academy of Family Physicians and the American Academy of Family Physicians are intentionally engaging their members and partners in reflections on the recommendations and actions to take on a state and national level that will improve primary care and patient health.

Report Overview

Five major objectives were proposed in the report. They are listed below along with suggested actions for implementation. 

Pay for primary care teams to care for people, not doctors to deliver services
  • The report recommends a low burden payment model that enables sustainable, team and relationship-based, high quality, integrated primary care
  • To achieve this, the authors suggest: 
    1. Payers should evaluate and disseminate payment models based on their ability to promote the delivery of high quality primary care – not their ability to achieve short-term cost savings 
    2. Payers using a Fee For Service (FFS) model for primary care should shift towards a hybrid (part capitation, part FFS) 
    3. Centers for Medicare and Medicaid Services (CMS) should increase the overall portion of spending going to primary care
    4. States should implement primary care payment reform by facilitating multi-payer collaboration and measuring and increasing the portion of spending going to primary care
Ensure that high-quality primary care is available to every individual and family in every community
  • The report recommends that all individuals should have the opportunity to have a usual source of primary care
  • To achieve this, the authors suggest:
    1. Encourage all payers to declare a usual source of primary care annually for members and should assign non-responding enrollees, and practices who treat uninsured individuals assume and track their ongoing clinical relationship
    2. Create new health centers with target sustained investment from the  U.S. Department of Health and Human Services
    3. Revise access standards to primary care in Medicaid population 
    4. Eliminate barriers to primary care access by permanently supporting COVID-era rule revisions
    5. Embed primary care practices within the community by including community members in their governance and practice design and partnering with community-based organizations.
Train primary care teams where people live and work
  • The report recommends that interprofessional primary care teams address race- and ethnicity based treatment disparities, their members should reflect the lived experience of the people and families they serve.
  • To achieve this, the authors suggest:
    1. Care teams should reflect the diversity of the communities they serve by  expanding supports and resources to diversify an expanded primary care workforce
    2. Reorganize how funding is deployed to support interprofessional training in community settings and in-patient settings
    3. Redesign the graduate medical education (GME) payment 
Design information technology that serves the patient, family, and interprofessional care team
  • The report recommends a well-designed health information technology (HIT) to make high-quality primary care more accessible, convenient, and efficient for patients, families, and interprofessional care teams
  • To achieve this, the authors suggest:
    1. The Office of the National Coordinator for Health Information Technology (ONC) and CMS should develop the next phase of electronic health record certification standards
    2. ONC and CMS should plan for and adopt a patient data system that acknowledges access issues for populations with hesitancy, privacy concerns, or lack of broadband, to easily access the comprehensive data needed to provide whole-person care. 
Ensure that high-quality primary care is implemented in the United States 
  • The report recommends assigning accountability to objectives and actions
  • To achieve this, the authors suggest:
    1. Establish a Secretary’s Council on Primary Care within the  Secretary of the U.S. Department of Health and Human Services 
    2. Form an Office of Primary Care Research at the National Institutes of Health and prioritize primary care research at Agency for Healthcare Research and Quality
    3. Primary care professional societies, employers, consumer groups and other stakeholders should regularly compile and disseminate a high quality primary care implementation scorecard 

CAFP hosted an overview discussion of the report on September 15 via Zoom. You can watch the recording here. 

We will be following up on the summary of the report with actionable steps and local take-aways, so stay tuned.