Confronting America’s Primary Care Shortage

By Janet Firshein, May 13, 2010

• 
• 
• 

Now that health reform is the law of the land, a massive challenge remains: how can we deliver primary care to the tens of millions of Americans who will soon gain insurance coverage?

The shortage of primary care providers is well-publicized. But, as studies in the May issue of the health policy journal Health Affairs (a Burness client) point out, recruiting more primary care doctors, nurse practitioners, and physician’s assistants to fill that void is only part of the solution. That was a message echoed by a number of health care experts at a May 4 Health Affairs briefing in Washington D.C.

Here are a few highlights:

• “Horribly broken.” That’s Health Affairs Editor-in-Chief Susan Dentzer, describing the state of primary care in the U.S in the journal’s May issue. Last Tuesday’s participants agreed: US Department of Health and Human Services Secretary Kathleen Sebelius noted that 75 cents of every dollar spent on health care goes toward paying for chronic disease – compared to a mere 8 cents going toward prevention and wellness care.  That has to change, according to Sebelius, who says “we need to be rewarding providers to keep patients healthy in the first place.”
• Josiah Macy Jr. Foundation President George Thibault, pointing to research in the May issue of Health Affairs showing that countries that invest in primary care achieve better care at lower cost, delivered a stark warning: “this is a golden moment…if we don’t seize this, we’re going to be frozen in time.” A Macy-funded report presented on the 4^th, “Who Will Provide Primary Care and How Will They Be Trained,” elaborates, stressing the need to go beyond simply increasing primary care funding to reconfigure the way care is delivered. (The Macy Foundation is also a Burness client.) According to the report, payment reform that rewards comprehensive primary care and provides incentives for good outcomes are key – as is education and investment in primary care infrastructure like Health Information Technology (HIT). Failure to make these changes, Thibault warned, will make it much harder to attract and retain enough providers to deliver needed care.
• Whether consumers are even paying the slightest attention to the idea of redesigning of primary care remains to be seen. But as John Santa, director of Consumer Reports Health Ratings Center (a Burness client as well) wrote on the Consumer Reports Health blog in response to a study in the May Health Affairs issue, clinicians and consumers need to “figure out how to hold hands and together tell the health care industry what we all want and what we will give up to get it.” Santa points to research showing that consumers place great trust in their physicians, adding that if we’re going to redesign primary care, a good place to start engaging consumers in that discussion is where decisions are made about their health – the doctor’s office.