Primary care is ‘the missing strategy’ to combat chronic disease epidemic, analysts say

Greater investment in primary care could be one of the remedies to help the epidemic of chronic conditions dragging down the health of Americans, according to a new analysis.

The Milbank Memorial Fund, The Physicians Foundation and the Robert Graham Center, the policy and research organization of the American Academy of Family Physicians, published “Investing in Primary Care: The Missing Strategy in America’s Fight Against Chronic Disease.” It’s a thematic report that follows “The Health of U.S. Primary Care: 2025 Scorecard Report — The Cost of Neglect.” Both offer bleak views of a specialty vital to the health of the nation, but that is undervalued and underfunded.

Chronic disease and cancer are taking a heavy toll on the health of Americans, with cardiovascular disease a leading contributor of death from chronic disease. But the news is nota all grim.

“In response to the health and economic toll of chronic disease, the U.S. Department of Health and Human Services’ Make America Healthy Again agenda calls for a shift toward preventing chronic disease, or stopping it before it starts, and slowing its progression when it appears,” the report said.

“Primary care is the specialty best positioned to lead this shift,” the report said. “Defined by the comprehensiveness of its care and its focus on prevention, primary care enables patients to build trusting, long-term relationships with clinicians who understand all their health needs.”

The report outlines evidence supporting greater investment in primary care, and the preventive services and screenings it offers, to prevent ailments or catch them early. Then, patients enjoy better health while avoiding costly hospitalizations and emergency department visits to handle health issues that could have been dealt with earlier.

In the United States, more people should have access to a usual source of primary care, but fewer and fewer people have a source, the report said. The primary care workforce is overburdened and dwindling, and medical schools are not replenishing the system.

By the numbers

The report included figures for preventive care services for adults and children.

When adults have a regular doctor:

• 95.5% have had a blood pressure check in the last 24 months, compared with 67.6% of adults with no usual source of care (USC)
• 89.2% had a cholesterol check in the last five years, vs. 56.7% of adults with no USC
• 74.4% had a physician ask about tobacco use, vs. 48.6% of adults with no USC

Rates for adults with a USC also are greater for mammograms (83.8% vs. 54.2%), colon cancer screenings (79% vs. 59.5%) and pap smears (84.4% vs. 70.5%).

For children, preventive screenings all are greater when there is a USC: preventive vision screenings (73.7% vs. 20.9%), accident-injury prevention (43.7% vs. 21.7%), secondhand smoke prevention (37.1% vs. 20.9%) and obesity (95.6% vs. 80.6%).

Possible solutions

The report outlined at least seven recommendations to improve U.S. health care:

• Medicare should pay more for primary care and prioritize use of the Advance Primary Care Management codes added in the 2025 Medicare Physician Fee Schedule (MPFS).
• Large employers should purchase health plans with benefits that promote primary care.
• Medicare should define primary care services as preventive. CMS sought comments about that in its proposed 2026 MPFS and should follow through.
• Reform federal and state Medicaid policy to reset Medicaid reimbursement on par with Medicare.
• States must measure primary care spending to ensure it gets to primary care practices, not upstream health systems and insurers.
• Set a goal that every American has a usual source of primary care, especially through greater investment in community health centers in underserved areas.
• Federal and state graduate medical education policies should go to community-based training programs. For graduate medical education, approximately $25.2 billion from Medicare and Medicaid go to large academic hospitals, although they see less than 0.1% of the U.S. population. Community-based training programs such as the Teaching Health Center Program are more likely to produce graduates that work in primary care and underserved settings.

The report authors are: Yalda Jabbarpour, M.D.; Anuradha Jetty, M.P.H.; Hoon Byun, DrPH; Anam Siddiqi, M.P.H.; and Jeongyoung Park, Ph.D., of the Robert Graham Center; and Christopher Koller, former president of Milbank Memorial Fund and now professor at the Brown University School of Public Health.