PCPCC Releases 2019 Evidence Report

“Investing in Primary Care: A State-Level Analysis” Shows State Variation in Primary Care Investment and an Association Between Increased Primary Care Spending and Fewer ED Visits and Hospitalizations

July 17, 2019 (Washington, D.C.) – Increased spending on primary care is associated with decreases in emergency department visits and hospitalizations, according to The Patient-Centered Primary Care Collaborative’s (PCPCC) 2019 Evidence Report, "Investing in Primary Care: A State-Level Analysis,” made possible by support from the Milbank Memorial Fund. The first-of-its-kind study, which was released today at a briefing in Washington, D.C., examines states’ primary care spending patterns—including across payer types—and the implications for patient outcomes.

Consistent and growing evidence shows that primary care-oriented systems achieve better health outcomes, more health equity, and lower costs. Despite strong evidence that primary care is associated with the outcomes that policymakers and patients seek, such care has been chronically underfunded. In comparison to international counterparts, the United States spends an average of 5%-7% on primary care as a percentage of total health care spending whereas Organization for Economic Co-operation and Development (OECD) countries average 14% on primary care as a percentage of total healthcare spend.

More specifically, the report finds:

  • Data points that demonstrate variability across states using a narrow and broad definition - the narrow definition focuses on spending related to primary care physicians in offices and outpatient settings. The broad definition includes all of the above, plus other members of the primary care clinical team, including nurses, nurse practitioners (NPs), physician assistants (PAs), OB/GYNs, and behavioral health professionals (i.e., psychiatrists, psychologists, and social workers).
  • Increased primary care spend is associated with fewer emergency department visits, total hospitalizations, and hospitalizations for ambulatory care-sensitive conditions.
  • Minnesota had the highest percentage of primary care investment and performed well with respect to patient outcomes. Connecticut had the lowest primary care spend using a narrow definition of primary care spend. New Jersey’s primary care spend was lowest with a broad definition.

There is growing interest by state leaders to use legislative and regulatory authority to measure and report on primary care spend and, in some cases, to set targets for increasing investment in primary care over the coming years within their jurisdictions.

“This report provides a high-level description of such efforts in 10 states, seven of which initiated their efforts in 2019,” said Ann Greiner, President and CEO, PCPCC. “This activity suggests that there is some momentum at the state level to shift the U.S. delivery system back to its primary care foundation to achieve better patient outcomes, fewer inequities, and lower costs.”

“The report’s finding of an association between primary care investment and reduction of hospitalizations and emergency department visits is in line with existing research on the benefits of robust primary care to a healthcare system.,” said Yalda Jabbarpour, MD, Medical Director, Robert Graham Center, “Although this is an important finding we cannot determine causality or directionality of this association.”

“This report demonstrates yet again that increased primary care spending is associated with better outcomes, yet the U.S. still underinvests in primary care,” said Christopher F. Koller, President, Milbank Memorial Fund. “Tracking primary care investment is critical so that we can better understand where dollars are flowing and, most importantly, the implications for key patient outcomes.”  

Given the growing number of states that have recently introduced bills, enacted legislation, or issued executive orders to measure primary care spend with the goal of increasing such investment, the findings in this report—both analytic and descriptive—are timely and relevant.

Speakers at the briefing included Jill Hummel, Chair of the PCPCC Board and President & General Manager, Anthem BCBS of Connecticut, Yalda Jabbarpour, MD, Medical Director, Robert Graham Center, Ann Greiner, President and CEO, PCPCC, Christopher F. Koller, President, Milbank Memorial Fund, Claire Neely, MD, FAAP, President and CEO, Institute for Clinical Systems Improvement, David Keller, MD, Professor & Vice Chair, Clinical Strategy & Transformation, University of Colorado, School of Medicine, Frederick Asasi, Executive Director, Families USA, Mark Miller, Executive Vice President of Health Care, Arnold Ventures, Pauline Lapin, Director of Seamless Care, Center for Medicare and Medicaid Innovation, Brian Marcotte, President and CEO, National Business Group on Health, Tich Changamire, MD, PhD, MBA, Medical Director, Office of the Chief Medical Officer, Humana, and Melinda Abrams, Vice President and Director, Delivery System Reform, The Commonwealth Fund.

About the PCPCC

Founded in 2006, the Patient-Centered Primary Care Collaborative (PCPCC) is a not-for-profit multi-stakeholder membership organization dedicated to advancing an effective and efficient health system built on a strong foundation of primary care and the patient-centered medical home. Representing a broad group of public and private organizations, PCPCC’s mission is to unify and engage diverse stakeholders in promoting policies and sharing best practices that support growth of high-performing primary care and achieve the “Quadruple Aim”: better care, better health, lower costs, and greater joy for clinicians and staff in delivery of care. For more information about PCPCC, visit www.pcpcc.org

The Robert Graham Center

The Robert Graham Center aims to improve individual and population healthcare delivery through the generation or synthesis of evidence that brings a family medicine and primary care perspective to health policy deliberations from the local to international levels.

Milbank Memorial Fund

The Milbank Memorial Fund is an endowed operating foundation that engages in nonpartisan analysis, study, research, and communication on significant issues in health policy. In the Fund’s own publications, in reports, films, or books it publishes with other organizations, and in articles it commissions for publication by other organizations, the Fund endeavors to maintain the highest standards for accuracy and fairness. Statements by individual authors, however, do not necessarily reflect opinions or factual determinations of the Fund.

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