Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care

by Robert L. Phillips, Jr

A recent, national report on primary care in the United States of America finds that primary care is foundational to the health care system and critical to achieving health equity. The report, Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care, was published May 4th by the National Academies of Sciences, Engineering, and Medicine. The report was inspired by the Declaration of Astana and the resulting global effort to prioritize Primary Health Care. Several international advisors supported the planning committee for the consensus study, including WONCA past-presidents Chris van Weel and Michael Kidd. 

The report builds on the 1996 Institute of Medicine report, Primary Care in a New Era, for which Barbara Starfield was a contributor. An initial effort of the committee was to revisit and update the definition of primary care and produced this revision:  

High-quality primary care is the provision of whole-person, integrated, accessible, and equitable health care by interprofessional teams who are accountable for addressing the majority of an individual’s health and wellness needs across settings and through sustained relationships with patients, families, and communities.

The new report was not asked to relitigate the evidence for primary care but to update it and build on it. Some of the high-level findings:

• Primary care provides more than one-third of all health care visits and more than half of all outpatient visits in the U.S., but it faces chronic underinvestment, has no federal coordinating capacity, no dedicated research support, a shrinking workforce pipeline, and remains inaccessible to large portions of the population 
• Access to high quality primary care leads to a healthier population and more equitable outcomes; no other part of health care can make this claim  
• Primary care has no champion at the federal level which is likely the reason that it was not featured in the national epidemic plans and why primary care was not a part of the national COVID19 pandemic strategies. The report highlights that failure to incorporate primary care in pandemic response delayed necessary care and slowed vaccination in underserved, rural, and skeptical communities.

For these reasons, the Committee declared that primary care should be a common good, available to all individuals in the U.S., regardless of insurance status. As a common good, it should be promoted with responsible public policies and private sector action and be sufficiently resourced to drive health equity. 

The committee set five implementation objectives to make high-quality primary care available to all people living in the United States: 

1. Pay for primary care teams to care for people, not doctors to deliver services.
2. Ensure that high-quality primary care is available to every individual and family in every community. 
3. Train primary care teams where people live and work. 
4. Design information technology that serves the patient, family, and the interprofessional care team. 
5. Ensure that high-quality primary care is implemented in the United States.

Regarding the lack of a federal government primary care champion, the committee’s implementation objective calls for the creation of a Secretary’s Council for Primary under the auspices of the Secretary for Health and Human Services. It also calls for a Primary Care Advisory Committee to help the Council establish its priority agenda and to hold it accountable. 

The sixteen recommendations under each of these objectives and further details are available on the National Academies website. A series of 90 minute workshops featuring each of the five objectives will be held every Tuesday in June. A presentation of the report hosted by the Harvard Center for Primary Care can be found here.