August 15, 2019, 04:18 pm Scott Wilson – Family physicians know better than just about anyone how difficult it is to do more with less.
Now a July report from the Patient-Centered Primary Care Collaborative and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care helps make the case about how much more FPs may be able to do for patients when they are supported by greater investment in primary care.
"Health insurance companies and public payers who spend more on primary care services likely spend less on expensive care in emergency rooms, hospitals and other settings," the Graham Center said in a press release summarizing the report.
"Investing in Primary Care: A State-level Analysis" examined the primary care spend -- the money that private and public payers earmark for primary care each year -- in 29 states, as well as that funding's association with ER use, ambulatory care-sensitive hospitalizations and total hospitalizations. The authors set out to report a national average for primary care spending and examine that rate in association with key patient outcomes.
"Between 2011 and 2016, spending on primary care as a percentage of overall health care expenditures was low," the report said, adding that the spending varied considerably across states, payer types and age groups. The national average for the primary care spend across public and private payers over that span turned out to be 5.6% using a narrow definition and 10.2% using a broad definition. (The former includes primary care physicians in office and outpatient settings; the latter additionally factors in members of primary care clinical teams, including OB/Gyn physicians, as well as nurses, nurse practitioners, physician assistants and behavioral health professionals.)
"An association was found between increased primary care spend and fewer emergency department visits, total hospitalizations and hospitalizations for ambulatory care-sensitive conditions," the study said.
The study is the first of its kind, according to the Graham Center, although it builds on other work that shows the benefits of increased spending on primary care. (A Milbank Memorial Fund study published in April also analyzed state primary care spending but it focused on Medicare patients.) For that reason, the authors noted that further research is needed to determine how best to define and measure primary care spending and quantify the impacts of that investment.
But the work of increasing the primary care spend is well under way in one of the states discussed in the study: Minnesota, which had the highest primary care investment rate among the states researched.
"This study will be a big help," Renée Crichlow, M.D., president of the Minnesota Academy of Family Physicians, told AAFP News.
"As we work with our department of health and gather our numbers this summer and understand the data, then find our base and engage the stakeholders, we'll start with a significant increase in that investment," she said.
Minnesota's spend rate was 7.6% under the narrow definition and 14% under the broad definition.
The study also pointed to Rhode Island and Oregon as "pioneers" that have codified a primary care definition and mandated primary care spending levels, and Crichlow said the former would be a close template for her own chapter's efforts at the legislative bargaining table.
"We're engaging with the Rhode Island chapter and asking, 'If you could do it again in 2019, what would you do differently?'" (One answer to that question, she added, has already come back: "They probably would have tried to get the payers involved earlier.")
"We'd like for Minnesota to be a model for the next round of people who do this," Crichlow added. "One state legislator asked what the right amount of spend is. It's the number that gets the outcomes that you're looking for. What we've been seeing in different reports is that 12% is a good start. But double the initial spend is what works."
Confirming that will depend on ongoing measurement of primary care spend at the state and national levels, which, the study said, will "heighten visibility of how public and private payers value primary care over time and by comparison to their other health care expenditures."
"The robust and growing evidence base about the value of primary care underscores the importance of reporting such measures," it added.
The authors noted that policymakers seem to be increasing momentum to invest in primary care, with efforts to boost spending getting under way this year in at least seven states.
Such momentum is crucial, Crichlow said.
"Every dollar spent in primary care results in decreased cost of care for systems and better outcomes for patients, but we're seeing a decrease in primary care doctors," she said. "We've demonstrated our efficacy, but the payments don't demonstrate our value."
Investing in prevention and strong physician-patient relationships, she added, will lead to better overall outcomes for patients.
"Where we find our best way to ally with folks and create a place that values the culture of family medicine is to reinforce our position with data such as reports like this. This is the path we need to take to take."