By Sarah Woolsey, MD, MPH, FAAFP
Director Family Health and Preparedness, Utah Department of Health
After 20-plus years as a family physician, I continue to strive to create communities where all people, all Americans, all Utahans have access to an affordable primary care team and have their health and well-being needs met. I want to share that some exciting activity has been happening both nationally and in the state. As members of the AAFP and UAFP we can take advantage of this momentum and work to advance the payment systems to make this happen!
First, I was thrilled to see that what family physicians do and how we are paid is getting attention at the highest levels. The National Academy of Sciences, Engineering, and Medicine (NSEM) just published a report, “Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care” (1). This federally funded report states, “Primary care is the only component of health care where an increased supply is associated with better population health and more equitable outcomes,” and argues for more funding, research, and workforce development. Despite the fact that primary care provides 55% of ambulatory services in the US, it represents only 5% of total health care spending (1). Despite our ability to manage the increasing numbers of patients with complex chronic conditions, we are not reimbursed to outfit the kinds of offices and teams that proffer the best quality services. The report calls for action.
Steps to advance primary care include paying for teams of caregivers that deliver the long-term high-quality outcomes our patients deserve, increasing access with an emphasis on telemedicine, and training a primary care workforce where they will practice (rural areas, underserved urban areas, FQHCs). They also call for health IT systems that meet the interoperability needs of primary care, a much higher bar than the current design delivers.
The report is relatively concise (at 499 pages) and directional. Primary care access is described as foundational to reaching the goals of equity and success for ALL Americans. Sign me up.
As I reviewed the NSEM document, the scorecard for success also caught my eye. The first measure asks for measuring primary care spending as a percentage of all health care spending—a task that we have begun in Utah. In case you have not yet heard, this spring the UAFP brought together multiple stakeholders and used national standards to calculate our own Utah Primary Care spend level. The calculation was completed using 2018 and 2019 All Payer Claims Data collected by the Utah Department of Health.
The results show that Utah is only spending 6.5% of all health care dollars on primary care services rendered by primary care practitioners. This is half of the typical spend in Organization for Economic Co-operation and Development (OECD) countries that use an average of 14% of their healthcare spending on primary care services (2). If you want to see the Utah Primary Care Spend Calculation Project report, reach out to Maryann.
Why do we care about all of this? The NSEM report also encourages states to advance multi-payer initiatives to increase this spend. This is next. Watch for opportunities to jump in and help UAFP take our next steps to make lawmakers aware of what we provide as primary care doctors and to advocate for new ways to increase investment in what we do. This might be loan repayment, more pay from insurers, or new population-based payments that INVEST in us and our teams. Watch for more to come. Jump in.