Given the known benefits of primary care, health organizations and policymakers should refocus resources to the services that will serve patients best.
Amid rising health care costs and worsening outcomes, primary care remains the foundation for improved health in the United States. The 2026 Primary Care Scorecard confirms what we have known for more than one-half a century: primary care is essential to good health and the solution to the health care crisis in the United States.1,2 However, primary care remains under resourced and challenged to maintain its workforce, both in the United States and globally.3 In this joint editorial by U.S.-based family medicine journal editors, we aim to highlight critical impacts of primary care on health and chronic disease, discuss long-standing barriers, unify the primary care community, and create momentum to influence policy and health.
THE IMPACT OF PRIMARY CARE
Family medicine emerged in the 1960s due to the need for holistic, person- and community-centered care to counter hyper-specialization and pathology-focused trends in medicine.4 The specialty is the cornerstone of primary care, a counterculture movement away from fragmented care in mainstream medicine, and the key to delivering whole-person care.5 Despite public perceptions of primary care, indisputable data of the benefits of primary care on health, and a clear roadmap to high-quality primary care provided by the National Academies of Sciences, Engineering, and Medicine (NASEM) in 2021 and subsequent reports (Table 1), the United States spends under 5% of total health expenditures on primary care.6 Yet it continues to have higher health care costs, more chronic disease, and lower life expectancy than peer nations.7–10
TABLE 1. POLICY REPORTS TO SUPPORT AND TRANSFORM PRIMARY CARE
| Themes of key reports on primary care | Investing in primary care report (Milbank 2026)11 | National objectives for high-quality primary care (NASEM 2021)7 | State objectives for high-quality primary care (NASHP 2025)9 | National objectives for whole health (NASEM 2023)8 |
|---|---|---|---|---|
| Payment reform | Medicare should pay more for primary care and define all services from primary care clinicians as preventive and covered for patients. Large employers should purchase health care plans to promote primary care. Medicaid should increase reimbursement for primary care to support children and families. States should commit to increased primary care spending. | Pay for primary care teams to care for people. The nation gets what it pays for, and payment reform that supports and encourages high-quality primary care, rather than actively discouraging it, is fundamental to the committee's vision of high-quality primary care. | Pay primary care more and differently. Increase the portion of health care spending going toward primary care and promote non-fee-for-service reimbursement approaches that incentivize high-quality, team-based, whole-person care across all communities. | Design public- and private-sector policies and payment to support whole health as a common good and whole health care as a way of achieving whole health. Scaling and spreading whole health care throughout the United States will not be possible without realigning infrastructure, policies, and payment to support, promote, and fund the provision of the foundational elements of whole health care. |
| Access | Federal and state policies should prioritize expanding primary care capacity in underserved areas, with a goal of ensuring every patient has a usual source of primary care. | Ensure that high-quality primary care is available to every individual and family. Everyone in the country should have easy access to high-quality primary care that is person-centered, relationship-oriented, and responsive to the needs of the community. | Make it easier for people to access their primary care clinician. Implement targeted approaches to address individual, community, and market-level barriers to primary care access. | Integrate across systems, services, and time to support whole health care throughout the lifespan. Achieving whole health will require support in all settings throughout people's lifespan, and within and across the communities to ensure holistic and comprehensive care. |
| Education | Federal and state graduate medical education (GME) policies should transform how we pay for GME. | Train primary care teams where people live and work. When primary care training is interprofessional and located in community settings, it is more effective at developing the skills that will keep people connected and healthy. | Expand and support the current and future primary care workforce. Expand the primary care pipeline, reduce barriers to joining the primary care workforce, and strengthen recruitment, training, and retention. | Prepare for a whole health approach to care. Interprofessional teams, organizations, and systems need to understand where they are developmentally on the trajectory to delivering whole health care and what they need to change to deliver whole health care. |
| Transformation | Design information technology that serves the patient, family, and interprofessional care team. New health information technology standards should prioritize and facilitate integrated care that is person-centered, supports relationships, and is responsive to the needs of the community. | Build clinician capacity to provide patient-centered, whole-person care. Support practice transformation and facilitate the development of resources, tools, and technology to strengthen the ability of primary care clinicians to provide whole-person care, including behavioral and social supports. | Evaluate to iteratively refine whole health care systems and create generalizable knowledge. The understanding of how to best deliver whole health care is evolving rapidly, so evaluating, adapting approaches efficiently, and sharing learnings will be essential for national success. | |
| Prioritization | Funding for primary care should be prioritized. | Ensure that high-quality primary care is implemented in the United States. Implementing high-quality primary care requires clear and meaningful measures of whole-person care, ongoing research, and leadership in the federal government to ensure policies support its development. | Make and keep primary care a top policy priority. Develop a statewide vision, convene key stakeholders, incorporate community voices, set goals, establish priorities and accountability, and measure progress. | Commit to the shared purpose of helping people achieve whole health. Engagement, support, buy-in, and prioritization from the bottom up and top down are needed to enable the cultural and structural transformations necessary to scale and spread a system of whole health care. Deliver all foundational elements of whole health care across the lifespan. Each foundational element of whole health care is essential and interdependent, and successful whole health systems need to attend to all elements. |
NASEM – National Academies of Sciences, Engineering, and Medicine; NASHP – National Academy for State Health Policy.
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