Twice as much investment, patient access and physicians would be the primary care “Triple Double” that would lead to a healthier nation, advocates said.
Primary Care for America unveiled its “Triple Double” initiative, a campaign to raise awareness of the problems in the U.S. health care system — and explain why primary care is the foundation for improvement.
“The Triple Double is not a legislative package or a policy mandate. It's a unified national movement built on shared messaging and evidence, organized around shared goals, and designed to catalyze a political and community will that the evidence alone has not been sufficient to generate,” said Kyu Rhee, M.D., M.P.P, president and CEO of the National Association of Community Health Centers (NACHC). The organization is a lead campaign sponsor with the American Academy of Family Physicians and they announced the efforts in the annual Primary Care for America conference.
“It serves as a framework and a set of goals that we can all get behind,” he said. “In short, the triple double is a roadmap to strengthen and transform our U.S. health system.”
Why the Triple Double?
The primary care advocates looked to basketball for the name of the campaign, said Asaf Bitton, M.D., M.P.H., a primary care physician and executive director of Ariadne Labs, a health systems innovation center at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health.
He cited a question from his daughter, who as a young basketball player and fan did not understand the significance of the triple double. It happens when a player in a game gets double-digit figures in three of the five main statistical categories in basketball: points, rebounds, assists, blocks and steals.
Why is that important? People assume it stands as a mark of individual excellence on the court. But statistically, when a player reaches a triple double, their team has a greater than 75% chance of winning the game, Bitton said.
“You know, basal chance is 50/50, and so there's something about having three double-digit things that's really good,” Bitton said. “And that got us to thinking … if we were to think about the triple double for primary care, what would it be? What would that impressive thing, that if we doubled in a relatively short amount of time, what would it signify and what would show excellent system performance? It's really investment, access, and workforce.”
Bitton’s presentation was “Triple Double: Setting the Vision,” and he said the conversation about the future of primary care starts with simple math. Primary care cannot do what it needs to do with the available form and type of resources at hand, Bitton said.
“We get to the triple double, and the triple double is really based on the fact that that every American, every person here in the U.S. deserves a relationship that can produce these (positive health) outcomes, and that to do so, we cannot nibble around in the margins,” Bitton said. “We actually have to sort of make requisite, massive moves toward a couple of common goals, and understand that we're doing it because we want to make sure that the health system is on a foundation that's actually sustainable, that's equitable, and that's relational in a way that people want.”
There are three goals:
- Double the investment in primary care, from 5% to 10% of the nation’s health care spending
- Double the reach of primary care starting with community health centers (CHCs)
- Double the next generation of primary care physicians and other clinicians, from 20% to 40%
Diving into the goals
The first goal is to double the share of health care spending devoted to primary care, from 5% to 10% of total expenditures. The campaign also calls for shifting away from fee-for-service billing toward capitated payment models, with physicians receiving a set amount per patient to deliver coordinated, team-based care that emphasizes prevention, Rhee said.
The second goal is to double the reach of primary care by increasing the share of patients served annually at community health centers from roughly 14% of the U.S. population to 28%. That would mean community health centers serving one in three Americans overall and two in three people in rural areas, up from one in three today, Rhee said.
The third goal is to double the pipeline of new primary care physicians and other clinicians, raising the share of graduating physicians, physician assistants and nurse practitioners who enter primary care from 20% to 40%. Rhee said reaching that target will require changes to graduate medical education, an residencies, as well as expanded funding for teaching health centers, which train medical residents at community health center sites.
The case for change
NACHC and AAFP hosted the kickoff in Washington, D.C., and online. The daylong conference drew nearly 1,000 attendees in person and online, said Sean Martin, AAFP executive vice president and CEO.
Many of them were likely familiar with the issues Rhee described as evidence of a broken health care system structured around treating illness rather than preventing it. That continues as research shows that most chronic disease, including heart disease, diabetes and hypertension, is preventable. Those ailments drive up costs because of a fundamental mismatch: Primary care providers manage more than 35% of all health care visits nationally while receiving only about 5% of total health care spending, Rhee said.
Research shows that adults with a consistent primary care provider are more likely to receive preventive screenings, such as those for cardiovascular risk factors and cancer, and are less likely to need emergency room visits or hospitalization for conditions that could have been managed earlier, Rhee said. But more than 100 million Americans, almost one in three, lack reliable access to primary care, disproportionately affecting people in rural and geographically isolated communities, he said.
There’s room to get worse, with a projected shortage of about 70,000 primary care physicians nationally by 2036.
Community health centers by the numbers
Rhee, who described his own path into medicine as beginning as a National Health Service Corps scholar at a health center in Washington, D.C. As leader of NACHC, he has since visited 49 states and territories to observe the community health center model in practice.
CHCs, first established in 1965, have become the nation's largest primary care network. There are more than 17,000 sites serving 52 million Americans, including one in three people in rural areas, Rhee said. About one in four sites are located in elementary, middle or high schools, and one in 10 are mobile units, such as vans equipped for mammography, dental care, behavioral health or general primary care, he said.
The centers employ a primary care workforce of more than 330,000 full-time-equivalent staff and have created more than 500,000 additional local jobs, generating over $260 billion in economic output, Rhee said, citing an analysis from the Congressional Budget Office. He said the centers cost the health care system about $60 billion annually, approximately 1% of national health care spending, to serve 14% of the population. Rhee also noted that earlier this year, the federal government approved the largest funding increase for community health centers in a decade.
A five-year milestone
The campaign launch coincided with the fifth anniversary of Primary Care for America, a coalition Martin said has brought together community health centers, physicians, employers, health insurers, researchers and policymakers around shared goals for strengthening primary care. Rhee credited the coalition with elevating the visibility of primary care issues among policymakers and health care leaders over the past five years and said the Triple Double campaign represents the coalition's next phase.
