Primary Care During the COVID-19 Pandemic: The Impact and Opportunities

The COVID-19 pandemic dramatically altered primary care delivery worldwide. Closures of clinics and delays in seeking medical care due to COVID-19 threatened primary care’s essential societal functions of delivering care for routine chronic conditions such as heart failure, diabetes, and hypertension, and preventive activities, such as cancer screening and routine vaccination. The availability of telemedicine still varies, as does patients’ capacity to engage in virtual care. As a result, loss of revenue has endangered many primary care practices, with small independent practices at greatest risk.

The weakening of primary care has come at a time when it is most needed to prevent and treat COVID-19. Moreover, minority and marginalized communities that are disproportionately at risk for COVID-19 and least likely to have access to regular primary care, have been most affected.

We at the Harvard Medical School Center for Primary Care, with support from the Milbank Memorial Fund and the CareQuest Institute for Oral Health, have assembled a report authored by dozens of leading thinkers to document and analyze trends in primary care in the United States and other countries and make recommendations to primary care team members, health care industry leaders, and policy experts. The report aims to achieve three goals: (1) describe how access to high-quality primary care is being preserved or improved during the COVID-19 pandemic; (2) determine lessons learned from the COVID-19 pandemic that can accelerate transitions to new forms of payment and care delivery, such as virtual care and value-based payments for population health; and (3) identify the care strategies that can best address health disparities underscored by the COVID-19 pandemic.

It remains unclear how primary care can constructively and sustainably recover from COVID-19–related disruptions; address underlying social inequalities, including racism and poverty, that create barriers to positive outcomes for patients; and transform itself. How will primary care manage the demand and supply of virtual visits? How will it transition from fee-for-service to capitation payment models, in the United States in particular? What kind of public, corporate, or patient interest exists in how these issues are addressed?

While considering these questions and others, each chapter in the report provides a thoughtful overview of an aspect of primary care or population affected by COVID-19 and summarizes the evidence to date on access, opportunities, and care strategies. The authors also offer a critical viewpoint on that evidence and make focused recommendations for primary care professionals, organizations, and governing bodies.

The report covers such issues as:

• How primary care practices have addressed disparities in telemedicine access to reach underserved populations
• How health care systems around the world organized their primary care responses to COVID-19, as well as to diseases neglected because of attention to COVID-19
• What strategies have worked to improve primary care finances and sustainability
• How we can proceed during and after COVID-19 with the integration of primary medical care and attendant services, including oral health, behavioral health, and community-based services

We hope this report will not only serve as a retrospective of the COVID-19 experience from the perspective of primary care providers, but also address how primary care providers and their support networks can proactively deliver the future of primary care, even as COVID-19 continues to affect communities worldwide.

The report can be downloaded as a free, open-access PDF.