Background
Background
Research continues to show that primary care is critical to the health of individuals, improves health outcomes, and is associated with a more equitable distribution of health in populations.(1) Patients who identified a primary care physician as their usual source of care had lower five-year mortality rates than patients who identified a specialist physician as their usual source of care. The populations of countries with higher ratings of “primary care orientation” experience better health outcomes and incur lower health care costs than populations in countries with lower degrees of primary care orientation. Primary care spending lags in the United States compared to similar investment in most other high-income countries.(2) Across payers, including both public and private insurance, primary care spending in the United States amounts to approximately five to eight percent of all health spending, (3) with an even lower percentage in Medicare, (4) compared to approximately fourteen percent of all health spending in most high-income nations. Nations with greater investment in primary care reported better patient outcomes and lower health care costs.1 Significant variation in primary care investment also exists within the states, as states with higher levels of investment also report better patient outcomes. (5)
More information and citations can be found here.
UDOH - Primary Care Spend Calculation Project
UDOH - Primary Care Spend Calculation Project
The Utah Department of Health, Office of Health Care Statistics (OHCS) produced this primary care spend report for the Utah Academy of Family Physicians (UAFP). In late 2020, the Office of Health Care Statistics was tasked with using the Utah All Payer Claims Database (APCD) to calculate the total amount of spending on primary health care services as a percentage of all healthcare expenditures, using data from 2018 and 2019 as two separate calculations, while using the Maine Quality Forum’s definition of primary care. (1) As part of this project, OHCS was also tasked with providing the UAFP with a description of the methodology used to perform the calculations, a description of the limitations, a breakout of primary care spending across payer types for each year, and a breakout by age cohorts and outcomes data for the aforementioned years, leveraging the Utah Healthcare Facility Database.
Supporting Research
Invest In Utah’s Health, Invest In Primary Care
Invest In Utah’s Health, Invest In Primary Care
By Sarah Woolsey, MD, MPH, FAAFP Director Family Health and Preparedness, Utah Department of Health and
Michael K. Magill, MD Chairman, American Board of Family Medicine
Jeff Chappell, M.D., is the Medical Director of the Wayne Community Health Center, a federally qualified health center located in Bicknell, Utah, the most remote health care delivery site in our state. Dr. Chappell has served in the Bicknell area for over 30 years and has a large geriatric panel. Over time, he had begun to experience a clear, disincentive need to see medically complex patients … the PA’s (physician assistants) would see lots of colds, sore throats and UTIs, and their numbers looked better – my numbers were lower.”
In 2018, Dr. Chappell’s practice started participating in an alternative payment model with Medicare that pays the clinic to focus on preventive care and deliver most care to Medicare patients in the family practice clinic setting. By investing in high quality care coordination and nursing contact with patients at risk for worsening health, the practice prevents unneeded hospital visits or expensive specialty services. These savings support payment to the health center for staff that helped Dr. Chappell and the PAs manage their Medicare patients with complex health needs more closely. The switch in focus to paying for prevention also enhanced Dr. Chappell’s experience of his leadership role as a highly-trained family physician to his system: “My value is as a resource to the mid-levels. In a few minutes of discussion [with the PA] I can avoid a $1,500 MRI or a $3,000 ER visit. My value to my organization has increased.”
What if all payers paid for primary care prevention and fostered value for the experience and broad scope of family medicine physicians leading their teams?
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