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We need to continue progress in primary care


This year, Washington, D.C., was once again the epicenter of the debate about the future of healthcare in America.

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Glen Stream, MD, FAAFP, MBI, a family physician practicing in La Quinta, California, who is also past president of the American Academy of Family Physicians. He serves as the president and board chair of Family Medicine for America’s Health. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.


This year, Washington, D.C., was once again the epicenter of the debate about the future of healthcare in America. However, often unrecognized amid all the noise are a number of remarkable advancements made across the country that strengthened and advanced primary care.

Dr. Stream

From state-level innovations to ground-breaking research, primary care systems continued to deliver on the Triple Aim of providing better quality healthcare that improves population health while lowering costs. Since we’ve wrapped up 2017, I wanted to share what I believe were the top five achievements made in primary care last year:

1.    States Increased Investment in Primary Care

States are important innovators in primary care and this year they have been at the forefront of investing in innovative systems that place patients at the center of care. For example, new legislation in Oregon requires all commercial insurers in the state to invest at least 12 percent of their total medical expenditures into primary care by the year 2023. Proponents of the law pointed to the success of the Patient-Centered Primary Care Home (PCPCH) program to bring the bill over the finish line. The PCPCH program has been in place for several years and has saved Oregon millions of dollars-roughly $13 in savings for every $1 increase in primary care spending.

California is working with 11 health plans to promote and enhance primary care for the 1.4 million individuals currently enrolled in the state’s official health insurance exchange, Covered California. This year, Covered California began requiring all enrollees to be matched with a primary care clinician to serve as a “patient advocate” and first point of contact to the healthcare system.


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Other states including Rhode Island and Michigan are also championing initiatives to transform primary care practice and delivery.

2.    Home-Based Primary Care Saved Millions for Medicare

This year, the CMS Innovation Center released initial findings of its Independence at Home Demonstration, a program that provides chronically ill patients with access to primary care services within the comfort of their own home. Home-based primary care “allows health care providers to spend more time with their patients, perform assessments in a patient’s home environment, and assume greater accountability for all aspects of the patient’s care.” As of January 2017, the initiative saved participating practices over $7 million, an average of $746 in savings per Medicare beneficiary. The initial results of this program reiterate the value of home-based primary care and its ability to improve the overall quality of care and life for patients served while reducing costs.

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3.    CMS’ Comprehensive Primary Care Plus Program Spurred Care Delivery Transformation

A unique public-private partnership, the Comprehensive Primary Care Plus (CPC+) initiative is a five-year, multi-payer program that aims to strengthen primary care in America through the expansion of Advanced Primary Care Medical Homes. This year, participating practices began receiving the “financial resources and flexibility to make investments, improve quality of care, and reduce the number of unnecessary services their patients receive.” This medical home model has been shown to transform health care delivery and improve quality and experience of care for patients.

4.    Primary Care Practices Embraced the “All-Under-One-Roof” Model and Integration of Services

In communities across the county, primary care practices are continuing to serve as a home-base for medical care. As the first stop-and in many cases a one-stop shop-primary care practices are embracing the medial home model, where health care professionals are able to work collaboratively as “partners in care” to treat traditional acute and chronic conditions but also offer behavioral and mental health services.


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In Michigan, Blue Cross Blue Shield leads one of the largest patient-centered medical home programs. Its 4,534 primary care doctors at 1,638 practices have led a transformation of care that has resulted in a 15 percent decrease in adult visits to emergency departments and a 21 percent decrease in ambulatory care-sensitive inpatient stays, according to a report by the Patient-Centered Primary Care Collaborative.

5.    Record Number of Sign-Ups During First Weeks of Open Enrollment

Open enrollment for 2018 had a record start this November, with nearly 1.5 million Americans signing up for health coverage within the first 11 days. Last year, just over 1 million Americans enrolled in one of the Affordable Care Act’s insurance marketplaces during the same time period. As open enrollment continues, we must continue to encourage patients to fully utilize their primary care benefits and choose health plans that prioritize primary care.

Last year’s achievements show that as we continue into 2018, primary care should be at the heart of our healthcare system. The new year provides new opportunities to put patients at the center of their care and improve the health of all Americans by making health primary. For 2018, I am hopeful that there will be even more reasons to celebrate primary care!


Glen R. Stream is a family physician in La Quinta, Calif., and president of Family Medicine for America’s Health, which sponsors the Health is Primary campaign.

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