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Last June, the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Health (OASH) requested input from the public — including providers, payers, purchasers, advocates, researchers, and others — about the federal government’s role in strengthening primary health care. The input may also inform the HHS Initiative to Strengthen Primary Health Care’s two-to-three-year plan that will outline HHS agency and office actions to improve primary care and ways to establish a primary health care infrastructure in HHS. In its request for information, OASH asked respondents for “information 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 received several hundred responses to their request for information. The Milbank Memorial Fund was able to collect 40 of these to identify and analyze any emerging trends. These responses came from a diverse range of advocacy groups, professional societies, philanthropic foundations, and non-profit organizations. Below, some of the proposed recommendations for HHS are categorized by the objectives mentioned in the 2021 National Academies of Sciences, Engineering, and Medicine (NASEM) report on Strengthening Primary Health Care (Payment, Access, Workforce, Health Information Technology, and Measurement/Accountability) and federal HHS authority (Medicare, Medicaid, and other).
The most frequently proposed recommendation, with 34 mentions, was that the Centers for Medicare & Medicaid Services (CMS) increase its investment in primary care or establish a primary care spend target. In the US, primary care receives 5% to 7% of total health care spending, with an even lower percentage spent in Medicare, despite primary care accounting for approximately 35% of all health care visits each year. According to the responses, this lack of funding is potentially linked to inadequate access, low-quality care, and worse patient outcomes, particularly for underserved populations.
Other popular recommendations included “collaborating with state efforts” and new Centers for Medicare and Medicaid Innovation payment models that align with the NASEM report’s recommendation of shifting payers from a fee-for-service (FFS) model to hybrid models that provide primary care providers with additional flexibility and financial stability.
A number of respondents called for the adoption of a federal definition of primary care and creation of a standard for researching, measuring, and reporting primary care spending, ideally through a central federal office or agency. Such standardization would facilitate the dissemination of information between states and the federal government about new payment models, successful approaches, and progress. Relatedly, multiple groups expressed a desire for a technical assistance program or support for electronic health record (EHR) system implementation to ease information sharing between health care professionals, state health agencies, and federal agencies.
Several advocacy groups and professional organizations supported the integration of primary care with behavioral health, social services, and public health to promote whole-person care and health equity. These groups reported that although primary care providers encounter patients with behavioral health needs, they are often ill-equipped to treat them because of a lack of resources and staff. The respondents called for support for interprofessional primary care teams that may include registered nurses, pharmacists, physical therapists, community health workers, and mental health workers, among others. These workers would add capacity to primary care practices while reducing personnel burnout.
Some respondents also expressed support for telehealth or virtual care to provide more equitable access to primary care, especially for those in rural areas. Furthermore, there was significant interest in creating incentives for careers in primary care and reforming graduate medical education financing to allow for more primary care training opportunities in community-based practice environments.
Overall, based on the responses reviewed, there appears to be significant interest in the HHS Initiative to Strengthen Primary Health Care. This feedback should inform HHS policies and actions that will move the US health system toward strengthening its high-quality primary care foundation.
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