NASEM Releases Report on the Future of Primary Care in the US

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ACP was a sponsor of the report, which provides an implementation plan for strengthening primary care and aligns with many of ACP's advocacy goals

May 7, 2021 (ACP) -- The National Academies of Sciences, Engineering and Medicine (NASEM) released a new report this week that makes recommendations about the future of primary care in the United States. The American College of Physicians was a sponsor of the report, which aligns with many of the College's goals for U.S. health care.

“We know that general internal medicine specialists and other primary care physicians deliver high-quality care, reduce mortality, provide continuity of care, and reduce overall health care costs,” said Dr. George M. Abraham, president of ACP. “In the United States, our health care system has long undervalued primary care. We need changes that better support primary care physicians and recognize the value they bring to patients and our health system. We look forward to working with NASEM and other stakeholders to identify the best ways to carry out the report's recommendations.”

Shari Erickson, ACP vice president for governmental affairs and medical practice, said the report, which was released on May 4, “speaks to the significant importance of high-quality primary care to the United States health care system and the patients it serves. ACP is very supportive of innovative thinking about how we can improve primary care.”

As she noted, many of the report's recommendations reflect goals that ACP supports in its 2020 “Vision for the U.S. Health Care System.”

The new NASEM report, “Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care,” analyzes the challenges facing primary care and lays out an implementation plan for strengthening primary care medicine. “Unequal access to primary care remains a concern, and the COVID-19 pandemic amplified pervasive economic, mental health, and social health disparities that ubiquitous, high-quality primary care might have reduced,” the report says. “Primary care is the only health care component where an increased supply is associated with better population health and more equitable outcomes. For this reason, primary care is a common good, making the strength and quality of the country's primary care services a public concern.”

The committee set five objectives and makes suggestions about ways to achieve the goals:

1. Pay for primary care teams to care for people, not doctors to deliver services.

The Centers for Disease Control & Prevention should spend a higher percentage of its outlay on primary care, and fee-for-service payment models should shift primary care payment toward hybrid models and make them the default. “Implementing high-quality primary care requires committing to pay primary care more and differently given its capacity to improve population health and health equity for all society, not because it generates short-term returns on investment for payers,” the report says.

2. Ensure that high-quality primary care is available to every individual and family in every community.

The report says: “CMS should permanently support the COVID-era rule revisions and Medicaid and Medicare benefits interpretations that have facilitated integrated team-based care, enabled more equitable access to telephone and virtual visits, provided equitable payment for non-in-person visits, eased documentation requirements, expanded the role of interprofessional care team members, and eliminated other barriers to high-quality primary care.”

3. Train primary care teams where people live and work.

“Organizations that train, hire, and finance primary care clinicians should ensure that the demographic composition of their primary care workforce reflects the communities they serve and that the care delivered is culturally appropriate,” the report says.

4. Design information technology that serves the patient, family and the interprofessional care team.

Health information technology “create[s] opportunities for improving care coordination and person-centeredness,” the report says. “The committee supports federal standards-setting but current certification requirements are a barrier to high-quality primary care. Creating and implementing these changes requires innovation by vendors and state and national support agencies, and accomplishing these goals will not be easy to ascertain.”

5. Ensure that high-quality primary care is implemented in the United States.

The report recommends that primary care professional societies and consumer organizations assemble and release a “high-quality primary care implementation scorecard” to ensure the goals in the report are being met.

“We're delighted to have sponsored this crucial roadmap that's helping to guide the nation toward the future of primary care,” Erickson said. “We look forward to working together to help these goals become reality.”

More Information

The report, “Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care,” is available on the NASEM website.

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