Commentary Urges Employers to Rally Around Primary Care

Employers should fight to prevent the demise of primary care because primary care is associated with reduced costs and better health outcomes, according to the abstract of a commentary in the January/February Health Affairs.

"Primary Care: Can It Solve Employers' Health Care Dilemma?" was written by Martin Sepulveda, M.D., M.P.H., IBM's vice president for global well-being services and health benefits; Thomas Bodenheimer, M.D., professor of family and community medicine at the University of California, San Francisco; and Paul Grundy, M.D., IBM's director for health care technology and strategic initiatives. Grundy also is chair of the Patient-Centered Primary Care Collaborative, or PCPCC. IBM and the AAFP are founding members of the PCPCC.

The Health Affairs commentary notes that during the past 20 years, employers have dealt with health care costs and quality using such strategies as managed care, wellness and health promotion, free preventive care, value-based tiered networks, nurse advice lines, disease management, employee cost-sharing, and low-premium/high-deductible plans tied to health savings accounts.

"Each of these strategies contains major flaws, and none is likely to eliminate employers' pain," the commentary says. "Yet one strategy -- adopted by the health systems of virtually every developed country -- is rarely discussed in the United States: investing in primary care."

Research has demonstrated that a strong primary care foundation can reduce health costs and improve quality. "Yet U.S. primary care is underfunded and undervalued, which limits its effectiveness in cost and quality spheres," the commentary says. "With a common voice, employers have the clout to change health care priorities by demanding a strong primary care foundation. Over time, employers would reap benefits through stabilization of health care costs and increased worker productivity."

In its discussion of what employers can do to address the primary care crisis, the commentary describes IBM's activities as an example of what an individual employer can do. IBM has engaged primary care providers in Texas and Pennsylvania in an effort to transform their practices and the payment structure to deliver improved access, counseling/coaching, preventive care, care coordination and chronic disease management within primary care medical homes. "The American Academy of Family Physicians' TransforMED initiative and the American College of Physicians' Center for Practice Improvement are leading the practice transformation, change management and evaluation components of the initiative," the commentary says.

The authors also note that some employers are examining primary care physician, or PCP, reimbursement in private health plans' contracting arrangements to understand how they have, perhaps inadvertently, reduced income for primary care doctors. "The failure of PCPs' income to keep pace with that of specialists -- aggravated by diminished influence in contracting negotiations compared to their specialist colleagues -- contributes to driving down the supply of PCPs," the authors write. "Employers can help stem the tide by building a more balanced allocation of spending between primary and specialty care into their health plan partner network and contracting strategies."