Primary care in crisis: comments from 3 experts

Earlier this year, several organizations collaborated to publish “The Health of U.S. Primary Care: 2025 Scorecard Report — The Cost of Neglect.”

It’s a national examination of the U.S. health care system and its financing, workforce and access, training, technology, and research. The 2025 report had a spotlight on “the downward cycle of financing for primary care.” The United States spends billions of dollars on health care each year, so the problem is not about not having enough money, but about how and where it is spent.

In these videos, three experts introduce the scorecard, discuss some of the findings, and make the connection between health care financing and primary care.

Yalda Jabbarpour, MD, is a family physician based in Washington, D.C., and director of the Robert Graham Center, which is supported as the policy research affiliate of the American Academy of Family Physicians.

Christopher F. Koller is president of the Milbank Memorial Fund, a 120-year-old foundation that “aims to improve population health and health equity by connecting leaders with sound evidence and experience.” He is the former health insurance commissioner for the state of Rhode Island.

Ann Greiner, MCP, is president and CEO of the Primary Care Collaborative, a national, nonpartisan, multi-stakeholder organization that advocates for better health and well-being through improved primary care.

Spoiler alert: If you suspect Medicare physician reimbursement primary could be a major factor in changing American health care, you’re on the right track.

This transcript has been edited lightly for style and flow.

Part 1 — Primary care ‘in complete crisis’

Yalda Jabbarpour, MD: I think speaking as a both a primary care physician who continues to see patients, but also on the patient end of it, I think primary care today is in complete crisis.

Creating the Primary Care Scorecard

Yalda Jabbarpour, MD: The National Academies of Science, Engineering and Medicine (NASEM) had a committee on implementing high quality primary care, which we were not a part of, but that committee published a pretty landmark report on what we have to do as a nation to get towards implementation of high quality primary care. They one of their recommendations, of course, was for accountability, that we should have some sort of way of tracking, year after year, the metrics related to the country's support for primary care. And that's how this work hard came along. We, along with Milbank Memorial Fund and The Physicians Foundation, felt that we wanted to create this accountability metric that was being called for in the NASEM report.

Christopher F. Koller: And the idea is to look at available measures and measure the performance of the country and individual states in areas of financing, workforce, access, information technology and administrative burden, and finally, in accountability and research.

How do you describe the state of primary care in the United States today? ‘It is fragile …’

Christopher F. Koller: It is fragile. I'm greatly concerned about it, I'm even more concerned than when the National Academies of Science, Engineering and Medicine released their report in 2021 because the indicators as we are following them, whether it is financing or workforce, or access the ability of people to access primary care, they’re not particularly good, and they're documented in our scorecard. And so I'm gravely concerned about it.

Yalda Jabbarpour, MD: It's almost impossible for patients to get timely appointments to see primary care. I know that patients often feel rushed when they are in the primary care office, and on the other side of that, clinicians are struggling too. We're struggling to get our long-term patients in the doors, even though we're working longer hours, I would say, since the COVID-19 pandemic. We're also struggling because we want to spend quality time with our patients to be able to answer all their questions. But unfortunately, the way that we invest and pay for primary care just isn't allowing that to happen.

Ann Greiner, MCP: I think it's a tale of two cities, to quote Dickens. There's a lot of innovation, particularly in spaces where there's value-based payment, and some incredible results that are being achieved. And at the same time, there's also many communities that are really suffering in terms of their ability to get primary care. So a lot of primary care access issues across the country. W spend twice what the Europeans spend on health care, and our life expectancy is five years below theirs, so clearly we've got to do more to get more value for our expenditures.

Part 2 — Primary care in crisis: Connecting health care financing and patient care

Findings from the 2025 Primary Care Scorecard

Christopher F. Koller: The most surprising finding — I would start with the fact that almost 30% of adults now report that they do not have access to a usual source of care. So that means almost one in three people do not have a regular place that they can go to to get advice about their medical conditions, to stay healthy, and then to seek treatment.

Why is that relationship so beneficial?

Yalda Jabbarpour, MD: From the patient's perspective, I think they don't want to be repeating the story of their life over and over again to a new doctor, and I think patients really appreciate when they can have that continuous relationship, so they don't have to repeat every piece of the puzzle over and over again. I also think that that continuous relationship develops trust between the patient and the physician.

A scorecard finding

Financing: Declining investment and fee-for-service payment are hindering primary care clinicians’ ability to meet growing patient needs

Why is financing so important to physicians and patients in primary care?

Ann Greiner, MCP: Why we talk so much about payment is that it has such an outsized effect on the kind of care that patients are able to receive, and the kind of care that doctors and other clinicians can deliver. And I think if you asked people, they want to be known, they want to have more time with their primary care clinician to discuss, you know, the various medical and behavioral issues they may have, and they want to have a partnership so they can get better, and a system that pushes folks through very rapidly and is referring out to a lot of different specialists, and is really not able to spend the time to get to know you and help you improve your health, is not a system that any of us want. And so we want to get back to relationship-based primary care, and it's going to take the right financial model to get there.

Is there a better way to pay for primary care? What is the best financial model?

Yalda Jabbarpour, MD: A purely fee-for-service payment model does not serve primary care. Primary care is not a specialty that is transaction-based. A lot of what we do in primary care is the interstitium that doesn't get paid for in a fee-for-service system things like, you know, maintaining that continuity, that comprehensiveness, the coordination of care. All those things that take a lot of time, take a lot of effort, don't get adequately reimbursed in our current fee schedule. So I think it's a combination of implementing programs to move away from purely fee-for-service, but also, honestly, a complete overhaul of the Medicare Fee Schedule and how we are valuing services in there.

Why is Medicare so important in valuing primary care?

Christopher F. Koller: I used to work for an insurance company I know how they negotiate rates. The first question they ask is, what does Medicare pay? So Medicare really is the standard setter for the rest of the health care industry, and Medicare systematically undervalues primary care. We documented in the report, but it an hour of a primary care physician’s time is worth significantly less than an hour of a medical specialist’s time, say, a gastroenterologist, a cardiologist, let alone surgeon, and comes to how Medicare pays for things.