Never enough primary care: A physician’s approach to designing health benefits

There’s no way to sugarcoat it: Health care in America is in crisis. The average wait time for a physician appointment in 15 large metro areas is now 31 days, up 19% in the last three years. We have a shortage of primary care doctors. On top of it, the average annual family premium for employer-sponsored health insurance increased by 7% in 2024, according to KFF’s Employer Health Benefits Survey. More than ever, Americans are looking to their employers to ease the burden.

It’s a catch-22 for benefits leaders: balancing the dramatically rising costs of health care with the needs and demands of attracting (and keeping) top talent. It’s time to look outside the box of traditional health plans and consider a different way.

As leaders, physicians should actively promote two essential strategies around health care benefits. These strategies stand to shore up employer coverage and strengthen workforce well-being.

You can never have enough primary care

It’s been proven: Primary care is one of the few things in our health care system that actually improves outcomes. It should be radically prioritized.

A recent Milbank Memorial Fund analysis found that the United States spends under 5 cents of every health care dollar on primary care, while other large, wealthy countries generally invest about twice that share in care that prevents and manages chronic disease.

In my role as national medical director at Premise Health and having practiced in family medicine, urgent care and emergency room settings, I know firsthand how primary care makes a major difference. When employers enable access to primary care by providing it at a free or low cost, employees benefit from improved health and lower overall health care costs.

Primary care is the only type of health care where more of it systematically leads to better health, and if primary care is Step 1, then advanced primary care should be the end goal. While you’ll find varying definitions across the industry, advanced primary care brings together primary care, behavioral health, pharmacy and care coordination services to deliver whole-person care that helps people get, stay and be well.

Advanced primary care works. It works by encouraging people to go to the doctor before they are sick. It works by creating meaningful primary care relationships that allow for comprehensive delivery of care from caregivers that a patient knows and trusts and who know their patients. It works by coordinating care between providers to treat a person’s physical and mental needs. It is the foundation on which health care reform can be built.

It’s not enough to just have primary care — employees have to use it

We have reviewed primary care as the cornerstone to better health — now how do we encourage employees to seek it?

It’s simple: Make it easy and save people money.

The key to prioritizing primary care is making it accessible — accessible to everyone, no matter their demographic or geographic location — because if people cannot use it easily, they will not even try.

Milbank’s The Health of U.S. Primary Care: 2025 Scorecard Report — The Cost of Neglect underscores the effects of lack of access: rising rates of uncontrolled chronic disease, unprecedented health care costs and a crumbling primary care infrastructure. Organizations like the Primary Care Collaborative and Primary Care for America are spearheading efforts to make primary care more available, but it will take purposeful effort from government, employers and unions to create real traction.

In recent legislation, the telehealth safe harbor lets people with high-deductible health plans use telehealth even before hitting their deductible. Plus, the act permanently keeps HSA eligibility for direct primary care services. But there is still more work to be done.

In a perfect world, traditional health plans would prioritize primary care, but they often do not. That’s why employers are beginning to consider primary care-centered health plans as a way to make high-quality health care more affordable for their employees and themselves by encouraging members to access primary care beyond what you find in traditional plans.

Primary care-centered health plans do the very thing organizations like Primary Care Collaborative and Primary Care for America advocate for: They champion primary care by incentivizing members to use it.

Employers are embracing these news models because they know they encourage employees to care for themselves proactively, rather than only when an emergency hits. In fact, more than one-third of large employers are now utilizing high-performance networks or other alternative health plans, and 29% are considering it in the near term.

Patients do not want to have to jump through hoops in order to see a clinician, especially when their needs are not urgent. By pointing them directly to a conveniently located primary care provider and incentivizing preventive care like annual physicals and vaccines, employers can motivate their employees to care for themselves proactively, rather than only when an emergency hits.

Primary care-centered health plans are usually cheaper for members than traditional ones and offer better benefits. Monthly premiums and copays are lower and, often, these plans do not have a deductible.

Participants get a free annual exam and free primary care visits throughout the year, allowing focus on prevention and treatment of chronic disease when needed. They will be referred to the right specialists when they need them — specialists with a track record of delivering high-quality, cost-effective care. Referrals are made directly from the individual’s PCP, resulting in a smoother, more coordinated health care experience.

What’s more is that these plans are designed to help members build lasting relationships with their primary care providers.

The status quo won’t work anymore

With health care costing the United States a hefty $4.5 trillion a year, with annual increases of 7.5%, something has to give. This price tag is too high for a subpar system.

Employers have a vested interest in improving the health of their workforces, and by rethinking the role that primary care plays in their health care benefits strategies, they can deliver much-needed, positive change.

Edward W. Schwartz, M.D., national medical director of clinical affairs at Premise Health, is a physician and health care executive with more than 30 years of experience in family medicine, urgent care and employer-based health services. At Premise Health, he leads clinical strategy, product development and quality initiatives.