When it comes to healthcare in the United States, the adage of “you get what you pay for” does not apply. The U.S. spends more on healthcare than any other country, but we have lower-quality care and worse outcomes than many nations that spend considerably less.
Low Spending on Primary Care
The disconnect stems from how we spend our money. Research confirms that advanced primary care, such as patient-centered medical homes and other accountable care models, help fulfill the “quadruple aim”: high-quality care, better health, lower costs, and improved experience for clinicians and staff in the delivery of care.
Despite this understanding, the best available estimates indicate that the percentage of healthcare spending devoted to primary care varies across the states, from an anemic 3.14% to a more robust 9.48%. In a recent study, RAND Corporation researchers estimated that just 2.12% to 4.88% of total Medicare fee-for-service medical and prescription drug spending goes toward primary care. High-performing healthcare systems in other countries spend double or triple that amount.
New Payment Methodologies Prioritize Value Over Volume
One way to bridge this gap, which Elevance Health and the Primary Care Collaborative (PCC) both support, is to promote new approaches to support primary care, such as value-based payment models. The Center for Medicare and Medicaid Innovation’s five new voluntary primary care payment models is a significant step toward paying for value rather than volume.
Elevance Health has found that these value-based arrangements can lower costs and improve quality of care. They enable advanced primary care practices to provide integrated, patient-centered, team-based care, and to begin to get off the fee-for-service treadmill by receiving compensation for work they do between office visits, such as care coordination and care planning. The next generation of value-based care models will also reward population health management and prevention, while incentivizing coordination between primary care providers and medical specialists—expanding value-based care across the medical neighborhood.
A State-by-State Approach
A key focus of the PCC’s advocacy agenda is helping to facilitate state efforts to invest more in advanced primary care models. The PCC 2020 Evidence Report provides a look at state spending on primary care by both commercial and public payers. This report, which also shows an association between increased primary care spending and reduced hospitalizations and emergency department visits, provides important information for state leaders as they prioritize spending and focus on both improving population health and keeping costs in check.