Robust primary care gets us closer to the outcomes we want to achieve

Health care outcomes improve and unnecessary spending declines when we can get ahead of problems rather than reacting to them after they have spiraled out of control. For a woman with metastatic cervical cancer, we have hospitals with PET scanners that can find the spreading cancer, best-in-the-world surgeons to remove the cancer metastases and new, less toxic chemotherapies. These treatments fall under the category of tertiary prevention. But it is reasonable to assume that most people would prefer if we stopped the cervical cancer at its earliest phase (secondary prevention), or better yet, used a vaccine to prevent cervical cancer from even starting (primary prevention).

The U.S. may be the best in the world at tertiary prevention. We have lots of PET scanners, state-of-the-art hospitals with very highly trained staff and superb specialists and super-fancy pharmaceuticals. What we lack is robust primary prevention. 

“Relative to its international counterparts, the United States underinvests in primary care, as reflected in spending by both public and private payers. On average, the United States spends 5-7 percent on primary care as a percentage of total health care spending. By comparison, Organisation for Economic Co-operation and Development (OECD) countries average 14 percent spending on primary care.”^[1]

This means we don’t do as good a job as we could at preventing problems in the first place, but we’re pretty good at throwing a ton of resources at problems when they occur. We pay a high price for this---not just money, but also in needless human suffering.

What if we allocated more resources to primary care? Busy medical practices might be able to investigate technologies that help track clinical conditions and improved management of diseases (better secondary prevention).^[2]

Where can we find these resources to pay for a robust primary care system? One example is in the Center for Medicare and Medicaid Services (CMS) Medicare Shared Savings Program---a program designed to explore the impact of new payment models better aligned with the outcomes we want.  In one study, groups that were invested in robust primary care outperformed the rest of the participants.^[3]

On the Inside Angle podcast, Dr. Jen Brull describes taking her practice in Plainville, Kansas on a journey of continual improvement that led her to a national role as vice president of clinical engagement for Aledade---a company that supports primary care practices with a similar interest in being supported in their work. You can listen to my conversation with Dr. Brull on our podcast page.

L. Gordon Moore, MD, is senior medical director, Clinical Strategy and Value-based Care for 3M Health Information Systems.

[1] Investing in Primary Care: A State-Level Report: https://www.graham-center.org/content/dam/rgc/documents/publications-reports/reports/Investing-Primary-Care-State-Level-PCMH-Report.pdf Accessed 2/15/21

[2] http://www.improvingchroniccare.org/

[3] McWilliams, J. Michael, Laura A. Hatfield, Bruce E. Landon, Pasha Hamed, and Michael E. Chernew. “Medicare Spending after 3 Years of the Medicare Shared Savings Program.” New England Journal of Medicine 379, no. 12 (September 20, 2018): 1139–49. https://doi.org/10.1056/NEJMsa1803388.