A new report finds spending on primary care services in the commercially insured population dropped from 2017 to 2019.
The report, released Wednesday from the not-for-profit coalition Primary Care Collaborative, defines primary care services in two ways and found a decline over the three-year period using both definitions. When only considering services rendered by physicians, primary care spending accounted for 4.67% of overall commercial insurance spending in 2019, a decline from 2017 when it accounted for 4.88% of spending. Similarly, when accounting for primary care services rendered by physician assistants and nurse practitioners in addition to physicians, overall spending in the specialty still dropped from 7.8% to 7.69% over the time period. The findings from the report are in line with other recent literature showing primary care spending in the U.S. has declined.
There is no consensus about what overall spending on primary care spending should be but research indicates other developed nations spend much more than the U.S. Additionally, the U.S. reports lower life expectancy compared to peer countries despite spending more on healthcare overall. Access to primary care services has been shown to improve health outcomes.
The findings are a signal to some healthcare leaders that more needs to be done industry-wide to invest in primary care services.
"There has got to be a better way to fund and perform than what we are doing now," said Dr. Howard Haft, executive director of the Maryland Primary Care Program, during an event Wednesday hosted by the Primary Care Collaborative discussing the findings. "This is absolutely a call to action."
There are actions the federal government and states can take to improve investment in primary care, said Dr. Kate Goodrich, senior vice president at Humana who participated in the discussion with Primary Care Collaborative.
The federal government should explore further investments in value-based payment models that support primary care practices as well as accelerate interoperability, she said.
"There needs to be probably some bolder moves than what we have seen so far," Goodrich added.
At the state level, Haft said there are opportunities to set fixed increases in primary care investments that are prescriptive, which has been done in some states already. State insurance commissioners should also be given the flexibility to influence commercial payers, he said.
"There needs to be an intention and leaders in each state saying, 'This is what we want to do,' and they need to build coalitions," Haft said.
Additionally, primary care clinicians need to be meaningfully part of policy changes to ensure it makes sense for them, said Dr. Darilyn Moyer, chair of the Primary Care Collaborative board of directors and CEO of the American College of Physicians.
The report found primary care spending declined from 2017 to 2019 in the majority of states. Primary care spending fell in 39 states using the narrow definition of the specialty and fell in 30 states using a broad definition. A narrow definition accounts for only physicians in family, general, internal and pediatric medicine. The broad definition includes everyone in the narrow definition in addition to nurse practitioners, physician assistants, geriatricians, adolescent specialists and gynecologists.
The report uses data from the not-for-profit Fair Health, which has a repository of commercial claims across all 50 states including from Medicare Advantage. The data excludes claims that were not paid, which is a limitation of the study, said Ann Kempski, advisor at the Primary Care Collaborative. There is also evidence that primary care spending may be on a decline because overall health spending rose faster over the time period analyzed, she added.