As horrific as the COVID-19 pandemic has been, it is bringing to bear what leaders and practitioners in health care already knew: our system has a glaring weakness in primary care delivery.
A new in-depth report from the National Academies of Sciences, Engineering, and Medicine (NASEM) provides a crucial roadmap to how we can learn from this moment to create and finance a system of care that will make us a healthier nation for generations to come.
COVID-19 has dramatized our longstanding flaws: our health care system is set up to treat, but not prevent, disease. For example, patient visits to primary care physicians account for 35 percent of medical care but represent only five percent of the expenditures. On the flip side, only three percent of medical care happens as in-patient hospital visits, but they account for a whopping 26 percent of expenditures.
We’ve got the equation wrong. We’re paying five times as much to correct problems that could potentially be mitigated if we focus on high-quality primary care, which NASEM now defines as integrated, accessible, and equitable care that is sustained over time by a team who is focused on the whole patient—their health and wellbeing, not just their resulting aches and pains.
While the financial burden of our current misalignment of resources has been evident for some time, COVID-19 created a body count of almost 600,000 people in the U.S. It zeroed in on those with chronic, yet preventable diseases such as obesity, diabetes, and hypertension, at increased risk.
We need to stop this downward spiral. NASEM’s report released last month outlines a blueprint for re-creating the structure, philosophy, and financing of primary care. Advanced primary care and robust public health investments are proven solutions for these problems. The change described in this report provides great hope and promise – if our political leaders, my fellow physicians, and the public can embrace its science-based, common-sense prescription for change.
I have been practicing and researching primary care for 40 years, and I have seen firsthand how care can be advanced to create good health and wellbeing. This happens when patients are treated as a whole person with increased access to a team of providers—not just physicians.
An approach like this offers—and pays for—interdisciplinary medical teams of doctors, nurses, health coaches, behavioral and mental health specialists, nutritionists, and others trained to educate, empower, and support patients to develop and maintain the healthy habits that prevent disease in the first place. Patients are more proactive and engaged in their own health, rather than asking their doctors for the newest drug they saw advertised on TV.
The system integrates all forms of medicine including proven non-pharmacological treatments like yoga, meditation, acupuncture, and various mind-body practices with the best evidence-based pills and procedures and eliminated ineffective treatments so often pushed for commercial reasons.
This is not a pie-in-the-sky idea. Indeed, it is already being employed in regional health systems, and by the Veterans Health Administration, which adopted an integrative “Whole Health” model using interdisciplinary teams in 2018. The VA pilot study followed 130,000 veterans for two years and found that it improved outcomes—with a cost reduction of 20 percent or $4,500 per veteran while improving health outcomes and the experience of care.
The models of health promotion exist, but how can we make them universal? America can make this happen, primarily through new models of care and financial incentives to make them spread. It’s time to change financing models so that they offer opportunities for a new kind of care, rather than boxing us into old-school models. In fact, the National Academies of Medicine is picking up this topic in another set of workshops focused on changing the health care payments systems to focus on health and wellbeing this month.
From here, the Biden administration’s Health and Human Services officials must lead the way by incentivizing advanced primary care, particularly at federal community health clinics that treat 30 million underserved Americans. Medicare and Medicaid systems need to accelerate the use of monetary drivers shown to improve preventive care. States and private insurers must be encouraged to act upon measures that are proven to prevent illness, save money and measure what matters.
Roadblocks stand in the way. Under the current models of care many systems have profited from the rise in healthcare costs. With the proper financial incentives, we can change this. As we take our next steps forward, we must embrace truly transformative change. We need to pay not for healthcare but for health and wellbeing.
Note: Samueli Foundation was proud to be a sponsor of the study. Other sponsors included: the American College of Physicians, American Academy of Family Physicians, American Academy of Pediatrics, Agency for Healthcare Research and Quality, U.S. Department of Veterans Affairs, and others.
Citation: National Academies of Sciences, Engineering, and Medicine. 2021. Implementing high-quality primary care: Rebuilding the foundation of health care. Washington, DC: The National Academies Press. https://doi.org/10.17226/25983.
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