The nonprofit Primary Care Collaborative (PCC), has launched the “Better Health – Now” campaign to advocate for broader support for community-based primary care.
The PCC said it expects to announce its support of specific legislation or regulations later in the campaign. The organization has championed integration of mental healthcare and primary care, which is one area within whole-person health that PCC may consider for supporting new policies.
At the launch, the PCC also publicly announced the organizations—members of the PCC and several others—that have joined the campaign as signatories to a set of principles laid out in PCC’s Concordance Recommendations for Primary Care Payment and Investment. The recommendations that will serve as the guiding principles of the campaign are derived from a landmark 2021 report of the National Academies of Sciences, Engineering, and Medicine, Implementing High-Quality Primary Care.
A March 29 webinar launch featured a talk by Asaf Bitton, M.D., M.P.H., the 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 said the evidence and lived experience of health plans and provider communities are converging on a series of steps that can make possible what the PCC concordance recommendations are putting forth.
He said the PCC’s recommendations have found that primary care is the only part of the healthcare system in which investments regularly and predictably result in both improved outcomes and improved equity. “That clearly is our mandate in the wake of this part of COVID,” Bitton added.
He said we should work to ensure that high-quality primary care is available to every person and family in every community. “That's going to require a workforce in which we train primary care teams where people live and work. We also have to redesign health information technology to better serve patients, families and providers.”
Bitton then spoke about payment reform. “We started with payment, because one of our central learnings in reviewing the evidence over the last 25 years in the United States and abroad, but particularly the United States, is that our efforts to improve primary care, principally through team-based models, like the patient-centered medical home, had for understandable reasons focused on the delivery side of the equations,” he said. “What the evidence shows is that primary care can change. Primary care can deliver improved team-based, relationship-focused, information technology-enabled care to populations. That can happen. But it cannot happen easily, predictably or sustainably within a fee-for-service system.”
Bitton said the evidence shows that the fee-for-service method of paying for healthcare does not work for the kind of proactive, population-based preventative care that primary care provides. “We need to move toward hybrid-based reimbursement models, which do not overnight completely abandon all the systems that have been attuned to paying for primary care, but really start to move us meaningfully toward a combination of some fee-for-service and a lot more prospective population-based payments to pay for the kind of longitudinal relationships over time that can really build on the best that primary care has to offer.”
He added that we need to evaluate and disseminate payment models, not based on their ability to produce a return on investment in 18 months to one stakeholder in healthcare in the form of reduced costs, but rather on their ability to promote the delivery of equitable, high-quality primary care.
“Over the long term, six or seven or 10 years, the evidence is clear that primary care-based systems paid for in a different, better and higher way do produce overall system changes in terms of improved health equity and stabilized and reduced cost, but they don't happen overnight,” Bitton said. “It is not going to turn around costs overnight, and that's not the reason to do it. The reason to do it is because of improved outcomes, equity, and cost stabilization over time.”
