Health Care Experts Describe the Benefits of Primary Care

Public and private payers should recognize the value of primary care services by compensating family physicians for providing patient-centered medical homes and implementing electronic health information systems that promote quality, efficiency and safety, said a noted health care analyst during a forum here May 31.

"Primary care is foundational to a high-quality, efficient and effective health care delivery system," said Helen Darling, president of the National Business Group on Health during a forum on big business and primary care sponsored by the AAFP's Robert Graham Center. "Payment polices that recognize the value of primary care and primary care services are essential," she added.

Darling and health care policy expert Robert Berenson, M.D., a senior fellow at the Urban Institute, each spoke at the forum, explaining the role of primary care in reducing costs and improving health care while underscoring the impact of payment policies on the provision of primary care.

"If you want to have an effective and efficient health care system, it has to be founded on a strong system with appropriate primary care and appropriate referrals to (sub)specialty care," Darling said.

Berenson told the audience that "primary care is dying in this country," mainly because of public and private payment policies that fail to adequately compensate family physicians for their services.

"The decline of people going into primary care positions has been pretty dramatic, (and has been) seriously affected by Medicare's payment system," said Berenson. "As it happens, Medicare's payment system for physicians is increasingly and consistently adopted by private health plans."

Physicians, like other members of American society, "go where the money is," he added.

The National Business Group on Health says it is the nation's only nonprofit organization devoted to representing the perspectives of large employers on national health policy issues and finding solutions to those issues. In early 2002, the organization started a group composed of its own members called the Institute on Health Care Costs and Solutions to find ways to contain health care costs while improving quality.

The National Business Group also launched a group called the National Committee on Evidence-Based Benefit Design, which is made up of members from the business group and outside organizations, including the AAFP. The objective of this committee is to create a health care benefits framework that uses evidence-based medicine and relies heavily on care coordination and the medical home, Darling said.

"We are working with a number of groups to support the joint principles of the patient-centered medical home," Darling said. "We are holding meetings and working in various ways to try and support this from the business side and from the employer side."

The National Committee on Evidence-Based Benefit Design has developed a Framework for Action using "four levers" to encourage the appropriate use of health care and to ultimately change the health care system, Darling said. The four levers include benefit plan design; consumer engagement; purchasing and public policy, which includes supporting primary care demonstrations; and initiatives.

As part of the process, the committee is promoting compensation for electronic visits, group visits, care coordination and care management, among other things. This particular policy raised objections from Berenson, who said, "Fee-for-service is not a good payment vehicle for supporting what a good primary practice should be doing in the medical home."

"Fee-for-service is dysfunctional," asserted Berenson. "I think it is uniquely dysfunctional in primary care."

Darling agreed with Berenson's overall assessment that the "current fee-for-service system is dysfunctional."

"It rewards activities that can be overused and undervalues services that are foundational to quality care and essential to patient-centered primary care," she said. "We want to pay for the right kind of care and reward care that serves patients."

"We are on the same wavelength in terms of physician payment reform," added Darling.