August 23, 2024: Primary Care is an Investment, the Rest of Healthcare is a Payment (J. Constantz)
Moving from Fee for Service to Prospective Payment in Primary Care: Advanced Primary Care: The Future of Primary Care – Part 18
The message is clear: Investing in primary care is a powerful and effective strategy to improve healthcare outcomes, reduce costs, and promote equity. Decades of research have consistently shown that enhanced primary care leads to:
- Higher quality and more equitable care
- Lower healthcare costs
- Improved maternal and child health outcomes, particularly in Black and Latino communities
- Reduced all-cause mortality rates across various populations
- Increased lifespan
- Reduced health disparities across racial and socioeconomic groups
- Lower rates of hospitalization
- More appropriate use of special studies and pharmaceuticals
Focusing efforts and resources on primary care rather than trying to reduce spending on sub-specialty and hospital-based care is a more efficient approach. Strengthened primary care has a ripple effect, improving the entire healthcare system by forcing downstream players to adapt and improve their practices. This shift can lead to significant reductions in the administrative super-structure and overall costs.
Attempting to reduce costs by focusing on sub-specialty and hospital care is arriving at the dance too late. By the time patients require these high-level services, the opportunity to avoid, mitigate, or reverse disease has often passed. Here’s why:
- Reactive Rather Than Proactive: Sub-specialty and hospital care typically address issues after they have become severe or complex. At this stage, treatment is more costly and less effective at reversing disease progression. Primary care focuses on prevention, early detection, and management of chronic conditions, significantly reducing the need for more intensive care later on.
- Higher Costs: Hospital and sub-specialty care are inherently more expensive due to the advanced technologies, specialized skills, and infrastructure required. By the time a patient reaches this level of care, the cumulative costs of managing their condition have already escalated.
- Missed Opportunities for Early Intervention: Investing in primary care ensures that conditions are caught early when they are easier and less expensive to treat. Primary care providers play a crucial role in health maintenance, patient education, and the management of chronic diseases, preventing complications that necessitate higher-level care.
- Increased Burden on the Healthcare System: Emphasizing sub-specialty and hospital care creates a bottleneck, overburdening these services and leading to inefficiencies. Strengthening primary care can alleviate this pressure by managing more conditions in less intensive settings, freeing up resources for those who truly need specialized interventions.
- Limited Impact on Health Outcomes: Sub-specialty and hospital care often focus on acute and severe cases, which, while necessary, do not have the broad population health impact that primary care does. Enhancing primary care has a more significant overall effect on public health, reducing incidence rates and improving long-term outcomes.
- Delayed Systemic Benefits: Improvements in sub-specialty and hospital care can take years to manifest due to the complexity and advanced stages of diseases treated there. In contrast, strengthening primary care yields quicker returns on investment, as improvements in preventive care and chronic disease management can be seen within months.
For employers, investing in primary care can result in better health for their employees, effectively providing a pay raise and increasing payments to shareholders.
We have the evidence to support these claims. The data is clear: enhancing primary care is the key to a healthier, more equitable, and cost-effective healthcare system.
Scott Conard, MD Michael Tuggy, MD Susan Lindstrom Laurence Bauer, MSW, MEd
scott@scottconard.com MTuggy@converginghealth.com slindstrom@mypha.com laurence.bauer@gmail.com