achieve its goals, Covered California this year began requiring all enrollees to be matched with a primary care physician, nurse practitioner or another primary care clinician as a patient advocate and first point of contact.
Enhanced primary care is also having an impact in Rhode Island where Medicaid accounts for about one-third of the state’s budget. The state saw a significant drop in total medical spending after its health insurance commissioner required all commercial plans to increase spending on primary care by 1% of total spending per year over a five-year period. Between 2008 and 2012, Rhode Island’s three largest commercial insurers increased spending on primary care by 37% while total medical spending fell 14%.
Also in Rhode Island, a pilot primary care project sent nurse practitioners and graduate students to the homes of financially disadvantaged patients with chronic health issues, resulting in decreases of more than 60% in both hospitalization rates and emergency department visits over a six-month period in 2016.
Despite the proven potential of primary care to deliver higher-quality and lower-cost care, a number of obstacles stand in the way of delivering on that promise. Current spending on primary care represents just 6% of total health care spending, half the 12% minimum amount the American Academy of Family Physicians says is needed.
There’s also a shortage of primary care specialists, a situation that’s projected to worsen over the next several years even as the demand for primary care services increases.
It’s not hyperbole to assert that these are life-and-death issues. Increasing the number of physicians specializing in primary care could save the lives of more than 100,000 Americans deaths a year.
For that, and many other reasons, the primary care initiatives in Oregon and the other states represent important leadership that others can follow. We need to do a lot more to support and promote primary care to ensure it realizes its full potential as the underpinning of the nation’s health care system.
Glen R. Stream is a family physician in La Quinta, California, and president of Family Medicine for America’s Health, which sponsors the Health is Primary campaign.