The U.S. Department of Health & Human Services is seeking to strengthen primary care by working across HHS agencies and offices as well as with other federal offices and departments. A new publication from the Milbank Memorial Fund argues that for this effort to be successful, it will require congressional support for the creation of a robust Office of Primary Care, with dedicated funding and staffing.
In June 2022, the HHS Office of the Assistant Secretary for Health (OASH) put out a request for information seeking input from the public about innovations, models, solutions to barriers, and possible HHS actions that may strengthen primary health care to promote health equity, reduce health disparities, improve health care access, and improve health outcomes.
OASH will use the responses to this RFI to inform the development of an initial HHS Action Plan to Strengthen Primary Health Care and subsequent steps for the initiative that identify key strategies and priority actions to build a federal foundation for strong primary health care for all.
The National Academies of Sciences, Engineering, and Medicine Report, Implementing High Quality Primary Care: Rebuilding the Foundation of Health Care will also inform the development of the HHS Action Plan.
The Milbank report authors are Robert L. Phillips Jr., M.D., Christopher Koller, and Alice Hm Chen, M.D.
Phillips directs the Center for Professionalism and Value in Health Care, which aims to create space in which patients, health professionals, payers, and policymakers can work to renegotiate the social contract. He is also responsible for overseeing the American Board of Family Medicine’s (ABFM) research and related collaborations, as well as the policy relationships related to family medicine and primary care. Chen is the chief medical officer at Covered California, the state’s health insurance marketplace. She previously served as deputy secretary for policy and planning and chief of clinical affairs for the California Health and Human Services Agency. Koller is president of the Milbank Memorial Fund, a foundation that improves population health by connecting leaders with the best information and experience. Before joining the Fund, he served the State of Rhode Island as the country’s first health insurance commissioner.
The authors say that the timing of this opportunity is critical, because primary care has been losing ground in federal policy and in investment across all payers. “There are powerful industry pressures on Congress and federal agencies to maintain the status quo, which makes primary care a perpetual financial loss leader,” they note, adding that “the primary care payment model experiments advanced by the Center for Medicare and Medicaid Innovation (CMMI), hampered by strict statutory language on cost effectiveness, struggle to achieve broader implementation. As a result, the portion of dollars in Medicare going to primary care relative to other specialties is decreasing, and health systems increasingly orient their services and physician training to higher-margin specialty services.”
The Milbank report authors note that HHS’ multi-agency effort will likely support a Secretary’s Council on Primary Care. “HHS commitment of staffing and resources to a council will be critical to coordinating primary care strategy on payment, workforce, research, technology use, and measurement. NASEM is prepared to support an advisory committee to help the council achieve success in its early stages. But sustaining this effort will eventually require congressional support for the creation of a robust Office of Primary Care, with dedicated funding and staffing to support a more permanent infrastructure,” they write.
They suggest that without the triad of a coordinating council in HHS, an advisory committee, and an Office of Primary Care, “the country is unlikely to be successful in addressing four of its most important health challenges: health inequities, pandemic response and resilience, the opioid epidemic, and access to mental health services.”
For example, the authors make the case that the failure to proactively address primary care workforce shortfalls, and the erosion of the primary care workforce in rural areas, has contributed to persistent health inequities and the reversal of life expectancy gains in this country over the last two decades. “The federal government’s investments in primary care payment, workforce training, and data collection and analysis have been vital, but the strategies have been siloed, with the whole being less than the sum of its parts.”
They make similar arguments about better support, coordination and data gathering around primary care’s role in the pandemic, the opioid epidemic, and mental health crisis.
While Secretary’s councils are important for short-term efforts to coordinate policy, they are at risk of eventually running out of funding. An Office of Primary Care, on the other hand, would prioritize primary care on the HHS agenda and provide ongoing support to the council, including relevant analysis and evidence synthesis, the authors say. “An Office of Primary Care would support the Secretary’s Council on Primary Care and the Primary Care Advisory Committee, forming a potent triad for coordinating, managing, and advising HHS primary care strategy and policy,” they conclude.
