Strengthening primary care: HHS asks for ideas, Commonwealth Fund answers

Money, payments, collaboration with public health and social services are among the suggestions.

More money, changing payment methods, and integrating public health and social services all would bolster primary care in the United States.

The Commonwealth Fund, a health care research and advocacy organization, proposed those in three strategies sent to the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Health (OASH). This summer, OASH asked for suggestions on the HHS Initiative to Strengthen Primary Health Care, which “aims to establish a federal foundation for the provision of primary health care for all that supports improved health outcomes and advanced health equity.”

“The first task is to develop an initial HHS plan for strengthening primary health care that will delineate specific actions that HHS agencies and offices may take to achieve the aims, within the current legislation and funding environment,” the HHS request said. It did not have an exact schedule for a plan, but asked for realistic timing for implementation, ranging from less than two years to the next six to 10 years.

There are at least three things to do, said Commonwealth Fund authors Corinne Lewis, program officer for delivery system reform; Celli Horstman, senior research associate for delivery system reform; and Christina Ramsay, program officer for federal and state health policy.

According to the Commonwealth Fund:

“Increase Financial Investment in Primary Care.”

Primary care physicians (PCPs) are paid less than specialists and the United States spent 4.7% of total health care expenditures on primary care as of 2019. That is down from an estimated 6.5% in 2002 and below the average of 14% in other high-income countries.

To remedy that, the federal Centers for Medicare and Medicaid Services (CMS) should revise its process for setting physician fee schedules, using independent data-collection procedures.

“Shift to Hybrid or Capitated Payment Approaches.”

Paying for health care through fee-for-service payments incentivizes physicians to order more tests and procedures that may be unnecessary or of little value, and to see as many patients as possible. HHS could engage multiple agencies, including CMS and the federal Center for Medicare and Medicaid Innovation (CMI), to create hybrid payments.

“Support Integration of Primary Care with Behavioral Health, Social Services, and Public Health.”

PCPs with patients who have behavioral health needs are hampered by lack of funding, staffing shortages, and unclear billing practices. Adding behavioral health will need new care models and staff, so CMS and HHS should support those efforts financially and by promoting a diverse workforce.

For social service integration, CMI could add measures for drivers of health, also known as social determinants of health, to primary care delivery models to collect data that guides investments for serving communities at risk.

PCPs were a trusted source of information for patients during the COVID-19 pandemic, so HHS could promote collaboration between PCPs and public health departments so providers contribute to routine public health activities.

“Evidence-Based Strategies for Strengthening Primary Care in the U.S.” was published Aug. 5 on the Commonwealth Fund blog.