Michael Lewis, let me tell you about primary care physicians.
Over the past several months, a series of studies have showed the declining health of Americans, the exorbitant costs the U.S. pays for health care and how these and other factors are leading to a dramatic decrease in life expectancy. These studies are always startling due to the confusion associated with how the people living in the wealthiest nation find themselves in such a position and, more concerning, why we aren’t more aggressive in reversing these trends. For me, the answer is simple: we continue to turn to the same solutions that continue to misidentify and misvalue the true drivers of health. Oddly, this brings me to Michael Lewis.
I recently listened to an episode of the Freakonomics Radio Podcast featuring author Michael Lewis. The episode, revisits his bestselling book, “Moneyball.” In the book, Mr. Lewis writes, “If gross miscalculations of a person’s value could occur on a baseball field before a live audience of 30,000 and a television audience of millions more, what did that say about the measurement of performance in other lines of work? If professional baseball players could be over or undervalued valued, who couldn’t?”
Well, Mr. Lewis, let me tell you about primary care physicians.
Just as was the case in baseball, our health care system is prioritizing and investing in the wrong things. As a result, we aren’t winning games. In fact, we are losing games at an alarming rate. One recent analysis shows per capita spending on health care increased even while new data from the Centers for Disease Control and Prevention show that life expectancy continues to decrease in the United States. Not to mention the proliferation of chronic disease and our alarming maternal mortality rates.
These two studies aren’t outliers. Each year, the Commonwealth Fund publishes a report that shows the same two distinct results: the U.S. underperforms in most categories associated with quality and patient outcomes; and we spend far more money on health care than any other country – in some cases, twice as much.
Our health care marketplace and those who design benefits continue to grossly misvalue primary care and, some would argue, overvalue other disciplines of medicine. In the United States, on the best of days, we spend about 5% of our health care resources on primary care. Despite research demonstrating that communities who invest in primary care have better health outcomes we continue to operate a benefit structure that disincentivizes the utilization of primary care. This approach has consequences, and those consequences are poorer health outcomes and excessive per-capita spending on health care.
In “Moneyball,” Mr. Lewis explains that the main reason many baseball players were misvalued or overvalued was “vividness bias,” “the tendency to overweight the vivid and prestigious attributes of a decision and underweight less impressive issues.” Vividness bias is widely present in health care as well, we just don’t talk about it.
At risk of upsetting many people, I get it. The work done by primary care physicians isn’t always “exciting.” In fact, primary care is to health care what the sixth pitch at bat is to baseball – slow, methodical, not flashy yet fundamentally consequential to long-term, sustained success. In our case, long-term, sustained success is better health. As individuals and as a society, we glamorize actions we perceive to be heroic. We celebrate those actions that produce immediate results and have a visible risk/reward calculation. These are the home run hitters in medicine, and we need them. They do amazing things that produce immediate results and benefit patients.
However, what we don’t celebrate is the 40-minute visit during which a primary care physician methodically works with a patient to discuss their four chronic conditions, makes certain they are up to date on cancer screenings and vaccinations, takes the necessary steps to ensure the patient has housing and food security, and counsels them on how to deal with a challenging life situation that is making their health conditions worsen. This is primary care – slow, methodical, and foundational to the health of the individual and our communities.
Comprehensive and continuous primary care has been proven to facilitate better health, but we continue to focus our spending on the homerun hitters of medicine. This may seem appropriate to some, but there is a cost being paid. That cost is the health of our fellow citizens and our communities.
Mr. Lewis noted in the interview that over the past two decades there have been endless efforts to “Moneyball” every industry in our economy. However, he also noted that there are people and industries that “are finding better data, analyzing it in different ways and coming to pretty radical different conclusions about how this should be done.”
This describes primary care perfectly. We have found better data, we have analyzed it differently, and we have come to radically different conclusions about how health care should be provided and financed. An ongoing, continuous relationship with primary care increases life expectancy and reduces health care costs. Primary care is associated with reductions in health disparities and a more equitable health care system.
The hero of Moneyball is Billy Beane, the former general manager of the Oakland Athletics who challenged the legacy model in baseball to pursue a different approach. The good news for primary care is there are a lot of Billy Beanes out there pursuing a better, more patient-centered approach to health care. Many of these leaders and their organizations have come together through Primary Care for America, a collaboration where innovators, disrupters and primary care pioneers are in pursuit of implementing our “radically different conclusions about health care.” We believe we can do better, that we should do better.
R. Shawn Martin is executive vice president and CEO of the American Academy of Family Physicians.