Recent events have challenged all of us and our organizations to ask if we can do more to accelerate the transformation to an equitable, sustainable healthcare system that produces better outcomes for all communities.
Earlier this year, the National Academies of Sciences, Engineering, and Medicine (NASEM) provided a blueprint to achieve this vision: Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. In this landmark report, NASEM calls for paying for primary care teams to care for people and ensuring high-quality primary care is available to every individual and family in every community, as well as training primary care teams where people live and work. The report also calls for making investments in primary care as a common good and paying prospectively to support prevention and proactive community-oriented care, supported by technology that serves the patient, family, and interprofessional care team.
It’s up to us as health and healthcare leaders to make NASEM’s recommendations a reality in all of our communities. How can we build a primary care system that is responsive and accountable to the needs of diverse communities? What investments and policy changes are needed to reach and lift up all communities?
The PCC believes it is time for bold action, and so it is convening leading practitioners, patient advocates, payers, and other stakeholders for an invitation-only online working summit to reimagine and chart a course for primary care that produces better health outcomes for all communities:
The summit will kick off a multi-year PCC effort to reform primary care payment and investment. This event of community and organizational leaders will connect the power of local innovations with the scale of policy, payment and programs to achieve the care envisioned by the Shared Principles of Primary Care.
While space at the summit is limited in order to enable close interactions among participants, the PCC will communicate about the event to PCC partners, supporters and friends and the wider healthcare community. Following the summit, as the PCC builds a coalition and campaign aimed at payment and investment changes, there will be opportunities for other organizations to connect with these efforts. I hope you will stay tuned and join us in these efforts!
Kind regards,
PCC’s Annual Evidence Report for 2021 Looks at Primary Care, Public Health and Social Assets During COVID
The PCC will debut its annual evidence-based report in an online release event on Oct. 18. The event is open to all members of the healthcare/primary care community, and registration information will be emailed next week.
Primary Care and COVID-19: It’s Complicated—Leveraging Primary Care, Public Health, and Social Assets examines community factors at the county level—starting with primary care but also including local public health and social assets—that we hypothesize can help mitigate the effects of this pandemic and other health emergencies.
To establish an understanding of the capacity of primary care to provide care to a population – especially during the pandemic – the report’s first section presents trends in primary care service delivery. Among those findings:
Who provides care? From 2002 to 2018, visits to primary care physicians (general pediatrics, general internal medicine, family medicine, and general practitioners) declined slightly, whereas visits to non-primary care physicians and nurse practitioners and physician assistants (NP/PA) increased. Because the data set that was used does not delineate what specialty NPs/PAs are working in, it is unclear if this rise is due to primary care visits or non-primary care visits. Within primary care, visits to general internal medicine decreased over the time period studied, but visits to general pediatricians, family physicians, and geriatricians remained stable over time. Family physicians provided the highest number of office visits, ranging from 287.69 million in 2002 to 294.89 million visits in 2018.
What types of services does primary care provide and to whom? For children, primary care provides nearly two-thirds of the office visits (65%), yet this number has fallen over time from 118.84 million visits in 2002 to 95.91 million visits in 2018. In contrast, a majority of the office visits (52%) for patients older than 65 were to non-primary care physicians. Within primary care physicians, the majority of office visits for patients older than 65 were to family physicians, and these rose over time (73 million in 2002 to 102 million in 2018). Office visits to general internists and geriatricians remained stable.
PCC’s 2021 Evidence Report includes more analysis of the trends above, with the heart of the report examining factors contributing to mitigation of COVID-19 in communities. Stay tuned for more information on the report release event!
Primary Care Priorities Included in Infrastructure, Reconciliation Bills; Timing and Outcome is Uncertain
As this newsletter is being sent, the fate of the U.S. House of Representatives’ reconciliation package is uncertain. The timing and outcome of a promised House vote on the Senate-passed bipartisan infrastructure bill, the Infrastructure Investment and Jobs Act (IIJA), also remains unclear. Together, the bills could have significant impacts for the under-resourced primary care delivery system.
Primary Care Provisions in the Reconciliation and Infrastructure Bills
The reconciliation bill, the Build Back Better Act, includes investments that could shape the future of primary care, with a clear focus on communities facing health inequities. Provisions include:
New health coverage options for low-income adults in states that have not expanded Medicaid
$10 billion in funding for Community Health Center capital projects
Workforce investments including $6 billion in funding for Teaching Health Center Graduate Medical Education and $1.3 billion for nursing education and loan repayment
A new Medicare dental benefit, inclusive of preventive, minor and major dental care as well as dentures, scheduled for 2028
The IIJA includes $65 billion to expand broadband access and increase affordability of broadband services for low-income families – improvements with the potential to increase access to digitally-enabled primary care.
Although the bipartisan IIJA has passed the Senate, the larger reconciliation bill has yet to see Senate mark-up or floor action – where changes to both detailed provisions and overall size of the package are possible. The ultimate fate of its primary care-relevant provisions hinges on unanimous support of the legislation across all 50 members of the Senate’s Democratic majority.
Two other top PCC policy aims - Medicaid primary care pay parity and Medicare telehealth reforms - remain largely unaddressed by the infrastructure and reconciliation bills. PCC proudly supports the Kids Access to Primary Care Act and the CONNECT for Health Act. Working with its Executive Members, PCC will be pressing Congress for action on these issues.
Behavioral Health Integration Legislation Possible this Congress
Exacerbated by the pandemic and associated economic disruptions, the prevalence of substance use disorders and mental health disorders is growing, particularly in communities of color. The Senate Finance Committee is moving toward a legislative package during this congress. Meanwhile, House legislators have introduced a variety of bills that may move independently or as part of an evolving bipartisan CURES 2.0 package.
PCC’s Behavioral Health Integration Workgroup is developing federal policy recommendations to advance behavioral health integration in federal payment models. Workgroup meetings occur bimonthly and are open to all PCC Executive Members. To ensure your organization is represented, please contact PCC’s Policy Director, Larry McNeely, at lmcneely@thepcc.org.
COVID-19 Vaccination Campaign Update
On Sept. 24, the Centers for Disease Control and Prevention (CDC) authorized COVID-19 vaccine booster shots for recipients of the Pfizer COVID-19 vaccines at least six months following their shot. The CDC recommendations open a third booster shot to individuals age 65 and older, adults at risk of serious illness due to underlying conditions, and adults at higher risk due to their job or institutional setting.
Since the launch of the vaccination campaign, PCC has called for greater recognition and support for primary care’s fundamental role in expanding vaccination and increasing vaccine acceptance. PCC has continued to engage with the administration, including both administrative agencies and the Executive Office of the President. Most recently, PCC’s Medicare fee schedule comments urged CMS to increase vaccination and counseling reimbursement for COVID-19 and other diseases.
PCC Medicare PFS Comments Stress Investment in Primary Care, Health Equity
PCC urged CMS to embrace transformative primary care investments and payment reforms in a Sept. 13 response to the annual Medicare Part B Physician Fee Schedule (PFS) proposed rule.
Noting that the COVID-19 pandemic and associated economic disruption hit hardest in communities weathering decades of underinvestment and inequity, PCC called out continuing underinvestment in primary care and called for “pathways to rapidly transition away from a predominantly fee-for-service system.”
However, as the letter acknowledges, “the Medicare Physician Fee Schedule and associated Part B policies continue to structure today’s primary care delivery system.” The letter therefore offered comments on more incremental telehealth tele-mental health, vaccination, and health equity policy changes.
PCC’s Sept. 21 Policy and Advocacy Meeting included a discussion of upcoming comment opportunities including the annual Medicare Advantage Advance Notice and Draft Call Letter and Medicaid and CHIP Adult and Child Core Measure Sets. PCC’s president and CEO, Ann Greiner, thanked the numerous Executive Member organizations whose perspective and feedback helped shape the submitted comment letter.
Share your thoughts and ideas on the submitted Medicare comments and future regulatory comment opportunities with Larry McNeely, PCC’s Policy Director, at lmcneely@thepcc.org
HealthTeamWorks has been a PCC Executive Member and actively engaged in the PCC for over a decade, co-chairing committees, teaming to author publications, and co-hosting its 2014 Western Regional Conference in Denver.
This year marks 25 years since leaders in Colorado convened HealthTeamWorks’ forerunner, the Colorado Clinical Guidelines Collaborative (CCGC). In 2011, the CCGC was renamed HealthTeamWorks to better align with evolving efforts to improve healthcare payment, performance and experience.
Today, HealthTeamWorks continues to move upstream to strengthen value-based care, with a mission to solve complex healthcare problems and led by a vision for Health. Equity. Resilience.
Offering wide-ranging programs in performance improvement, organization development, and training, HealthTeamWorks works with primary care, integrated networks, hospital health systems, departments of health, academic organizations, commercial and public payers, and other health-related and community organizations. The team focuses on strategic alignment across payment categories, compensation, measures, and initiatives to refine implementation efforts.
From early work in Colorado Multi-Payer Collaborative and Multi-Stakeholder Initiatives, HealthTeamWorks has continued a high level of engagement in CMMI model tests such as Comprehensive Primary Care (CPC) and Comprehensive Primary Care Plus (CPC+), providing national learning, technical assistance, system redesign, regional learning sessions, and direct practice transformation support. As CPC+ comes to a close, HealthTeamWorks is participating on the Primary Care First (PCF) Practice Network Team fostering peer-to-peer learning across regions.
Drawing on proven experience in national programs as well as those centered in Colorado, HealthTeamWorks created a living interactive change package oriented by drivers of key aims such as culturally responsive care, improved quality, affordability, patient experience, team vitality, and thriving business models (primary care resilience).
In alignment with a vision for equity and the aim to realize culturally responsive whole-person care, HealthTeamWorks is providing:
Allyship training
Training and strategies for health coaches, care managers, and care team members to identify and reduce individual and institutional bias
Support to reduce stigma hindering treatment for substance use disorders
Additionally, HealthTeamWorks contributes subject-matter expertise on the Colorado All-Payer Claims Database (APCD) Advisory Committee and APM Alignment Workgroups and works across the U.S. assessing risk readiness, building the infrastructure needed to transition to APMs, and delivering training such as the Essentials of Care Management and Facilitating Quality Improvement.
Membership in the PCC Has Its Benefits
The PCC welcomes leading organizations like yours that are dedicated to advancing an effective and efficient health system built on a strong foundation of primary care and the patient-centered medical home.
Executive Membership in PCC comes with many benefits. Becoming an Executive Member allows you to:
Connect and network with organizations and individuals from different stakeholder groups who share a common commitment to furthering primary care
Contribute to the PCC’s policy and advocacy work
Receive the monthly member-only e-newsletter that highlights policy developments, upcoming events, and key issues related to primary care
Join and become an active participant in PCC's four workgroups
Receive discounts on event registrations
Sponsor events and initiatives
Do much more
Visit the Executive Member pagefor more information, and watch the short (less than 2 minutes) videobelow that features organizations and why they chose to become Executive Members.
If you have questions about the membership process or benefits or would like to schedule a conversation about joining the PCC, please contact:
This is a regular feature of PCC’s newsletter. Each issue features a short profile of an individual who works in primary care. It is a way of recognizing the dedication and passion that clinicians, advocates, and others have for primary care and connecting readers of this newsletter to people like them.
Allan H. Goroll, MD, MACP
Professor of Medicine
Harvard Medical School
Physician, Medical Service
Massachusetts General Hospital
Boston, Mass.
Why are you passionate about primary care?
There is no greater privilege than to be considered and referred to by a patient as “my doctor.” This results from having established a trusting, healing relationship over time based on delivery of personalized, comprehensive care. It serves as a source of much professional satisfaction. Intellectually, for those of us with broad interests in both science and the humanities, the primary care role provides the opportunity to be the first on the scene to solve problems requiring consideration of both biologic and psychosocial dimensions of care. Yes, being on the front lines and promising to offer accurate diagnosis and efficient, comprehensive, personalized care can be challenging, but welcome for those of us who enjoy solving complex human problems, especially with the help of a well-functioning primary care team. The primary care physician’s job description is one of the best in medicine and the reason I am passionate about it.
If you had a magic wand that you could wave to change one thing in primary care, what would it be?
I would change how and how much primary care is paid for in the U.S. As a nation, we grossly underinvest in primary care compared to other nations (only 5% of total health expenditures vs. 15%-20% for other nations). The consequences include high per capita healthcare costs, poor health status, and unacceptable disparities in access to care. We should be paid comprehensively and prospectively rather than in the current piecemeal and retrospective way, because we provide comprehensive care and need to have the teams and technology in place to deliver it. Low per-visit reimbursement rates force rushed visits, financial distress in practices, clinician burnout, and poor recruitment and retention. We should be paid according to the value we create – we are quarterbacks but get paid at the rate of gatekeepers. The wealthy understand the value we create and are willing to pay large sums to primary care physicians who leave their former patients and go “concierge,” catering to a limited number of well-off individuals. This only exacerbates disparities in care, which ultimately leads to social instability.
What one thing about your work do you want people working outside primary care to know or understand?
As noted, I am a quarterback, not a gatekeeper. I am a highly trained healthcare professional devoted to the wellbeing of my patients, not a “provider” of a commodity. Referring to primary care physicians as “providers” should cease. If your son or daughter went to medical school and planned to enter primary care, would you say to your family and friends he or she is studying to become a “primary care provider”?
Looking back on your career, what’s the most significant contribution to primary care that you or your team have made?
My most important contribution, as a practicing primary care general internist, has been to the health and well-being of my patients. Putting that aside, I and my colleagues at the Massachusetts General Hospital authored the first textbook of primary care internal medicine (Primary Care Medicine), now in its eight edition and often referred to as the seminal text of the field. We also founded the first primary care internal medicine residency program in the U.S., which became the model for the nation and recently celebrated over 40 years of training future leaders and reformers of primary care internal medicine. As a medical educator, I co-led a national reform of medical school curricula, introducing primary care into the core clinical curriculum. More recently, I have been championing reform of payment for primary care, which, I am glad to see, has become a national priority. For these efforts I was honored by the Society for General Internal Medicine with its career achievement award in medical education and by the American College of Physicians with a “master” designation and its Philips Award for career achievement in clinical medicine.
Attend the Oct. 7 PCC Lunch and Learn Discussion on Primary Care Research
New Discussion Series is Part of a Project to Translate Research and Evidence into Action
Lunch and Learn discussions bring together primary care researchers, advocates, policymakers and others to discuss key findings and policy implications of important primary care research, with the goal of having seminal research findings inform primary care delivery and policy.
Meetings are open to all PCC members and non-members who are interested in engaging in conversation with the authors of leading publications.
Jack Westfall, MD, MPH, Director, Robert Graham Center
With the support of the Research Dissemination Workgroup (RDWG), the PCC is producing a curated list of approximately 25 seminal primary care clinical and health-services research articles.
As a means of sharing relevant health services and clinical research more widely, the PCC is convening the Lunch and Learn discussions quarterly and creating a resource “hub” on its website.
For more information about the overall project or Lunch and Learn, contact Noah Westfall.
Ask any sports coach about working with a team, and they will tell you there are many considerations, including which skill sets to assemble and how to manage and motivate a group of people toward a common goal. Team-based care is one of the Shared Principles of Primary Care, PCC’s vision for advanced primary care, which more than 350 organizations have embraced, and a necessary feature to achieve comprehensiveness and equity, among other principles. In a practice setting, leaders need to assess how a team meets patients’ needs and consider related logistical, infrastructure and payment frameworks. Who are the players on a primary care team, from physicians, nurses and other clinicians to behavioral health specialists, pharmacists and care coordinators? How can team members play well together and provide high-quality, comprehensive and equitable care for their patients? Who leads the team, and does leadership shift depending upon the context? What is the latest evidence about what contributes to team effectiveness? We’ll explore these questions and more with a diverse panel of experts on team-based care.
August 17, 2021
Robert Pearl, MD, is a former CEO of The Permanente Medical Group who has written two books on the dysfunction of health care. Mistreated: Why We Think We’re Getting Good Health Care—And Why We’re Usually Wrong focuses on the systemic issues of the healthcare system that result in poor health outcomes. Uncaring: How the Culture of Medicine Kills Doctors & Patients focuses on the culture and how it undermines physician-patient relationships and causes other harm. Christine Bechtel, MA, is the co-founder of X4 Health and a longtime patient advocate who runs 3rd Conversation, a national program that helps patients and clinicians see each other in a new light, addressing clinician wellbeing and patients’ experiences. In this webinar, these two had a conversation, moderated by Ann Greiner, PCC's president and CEO, in which they shared their insights and lessons about the culture of health care, system design flaws, and the role of relationships in health care.
The PCC hosted this conversation with special guests from the White House and state government, who talked about the role of primary care in the administration of and education on the COVID vaccines. They also discussed the strategies the Biden administration and state public health departments have used to boost confidence in the vaccines and help Americans get vaccinated, from the administration’s Month of Action in June to state innovations such as involving barber shops in vaccine outreach. The U.S. has not reached its vaccination goals yet, and this discussion provided some insights on how we can get there by leveraging primary care.
Panelists:
Bechara Choucair, MD, Vaccinations Coordinator, White House COVID Response Team
Howard Haft, MD, MMM, CPE, FACPE,Executive Director, Maryland Primary Care Program, Maryland Department of Health
Moderator: Ann Greiner, President and CEO, Primary Care Collaborative
Harvey W. Kaufman, MD; Zhen Chen, MS; Justin K. Niles, MA; Yuri A. Fesko, MD
The results of this research, published Aug. 31, 2021, in JAMA Network, indicate a significant decline in newly identified patients with 8 common types of cancer in the first and third pandemic periods (winter months) but not in the second period (summer months). Because the number of newly identified patients with cancer in the third pandemic period did not exceed the prepandemic value, as would be expected if patients with delayed care returned for care, many cancers may remain undiagnosed. The impact of delayed diagnosis may vary with the type of cancer and the extent of delay but could lead to presentation at more advanced stages, with potentially poorer clinical outcomes. The findings call for planning to address the consequences of delayed diagnoses, including strengthened clinical telehealth offerings supporting patient-clinician interactions.
Published June 19, 2021, in the Journal of Climate Change and Health
“The rapid and widespread adoption of telehealth during the COVID-19 pandemic has had significant environmental health benefits, primarily through reduction in transportation-associated emissions,” the authors wrote. “If the U.S. health care system were to maintain or expand upon current levels of telehealth utilization, additional reductions in GHG emissions would potentially be achieved through impacts on practice design.”
Published Sept. 19 by the Duke-Margolis Center for Health Policy
Employer-sponsored health coverage remains the main source of healthcare support for working families, but it faces increasingly difficult challenges: barriers to many employees in getting the care they need to stay well, persistent inequities in health care and health, and rising costs. A key reason is that care depends on fee-for-service payment, leading to poor coordination, insufficient support for staying well, inconvenient access, and lack of transparency about quality and cost. But evidence on emerging reforms shows how to overcome these challenges and deliver high-quality, coordinated and affordable care for employees and their families.
Published Aug. 25 at NEJM.org; by Kevin Grumbach, MD, Thomas Bodenheimer, MD, MPH, Deborah Cohen, PhD, Robert L. Phillips, MD, MSPH, Kurt C. Stange, MD, PhD, and John M. Westfall, MD, MPH
“Among the many factors contributing to the neglect of primary care, including current payment systems, one critical deficit could be readily addressed: the absence of a government entity that is responsible for defining and overseeing implementation of a coordinated national primary care strategy.”
Ishani Ganguli, MD, MPH; Nancy E. Morden, MD, MPH; Ching-Wen Wendy Yang, MSPH; Maia Crawford, MS; Carrie H. Colla, PhD
Published Sept. 27 in JAMA Internal Medicine
This cohort study measured and reported the use of 41 individual low-value services and a composite measure of 28 services for 556 health systems serving a total of 11,637,763 Medicare beneficiaries across the US. Systems varied widely in the provision of low-value care; those with a smaller proportion of primary care physicians, without a major teaching hospital, serving a larger proportion of non-White patients, headquartered in the South and West, and serving areas with higher health care spending delivered more low-value care. The findings suggest that system-level measurement and reporting of specific low-value services is feasible, enables cross-system comparisons, and reveals a broad range of low-value care use.
Upcoming Conferences, Webinars & Events
PCC's Online Event Calendar These and other webinars and conferences are listed on PCC's event calendar on its website. Updated regularly, the calendar lists events of interest to the primary care community.
at the Center for Primary Care, Harvard Medical School
1st Thursday of each month, 10:00 a.m.-1:00 p.m. ET and 3rd Thursday of each month, 12:00 p.m.-1:00 pm ET, running Oct. 7, 2021-March 3, 2022
A six-month virtual program that provides healthcare leaders with critical skills to thrive in their role, achieve organizational goals, and manage during times of uncertainty. The program features a half-day interactive and didactic session at the beginning of each month followed by an hour-long coaching call mid-month. Designed and taught by medical directors and healthcare leaders, this program equips participants with concrete tools, strategies, and techniques to tackle the challenges and uncertainties ahead.
This webinar, which is being held during National Hispanic Heritage Month, will feature an analysis of recent data to raise awareness about the increase in uninsurance rates for Latino children, outreach strategies to effectively target this population, and a new resource available on InsureKidsNow.gov for organizations working with immigrant families. The webinar will also address recent federal guidance to inform states and stakeholders that the 2019 Public Charge Final Rule was vacated and is no longer in effect, and that applying for or receiving Medicaid or CHIP benefits does not make someone a “public charge.” The Department of Homeland Security’s Advance Notice of Proposed Rulemaking requesting public feedback on the public charge ground of inadmissibility will also be covered.
A space for dialogue and collective learning. Participants from broad and diverse backgrounds across the public health and healthcare spectrum will gather virtually to address the challenges of putting primary care front and center in our healthcare system. Participants will leave the summit with a more comprehensive understanding of today's healthcare challenges, best practices, lessons learned, and available resources — feeling supported and more equipped than ever to improve the health of Texans.
Ann Greiner, PCC's president and CEO, will deliver the event's opening Keynote – "Primary Care Post-Pandemic: Value, Vulnerability, and Next Steps" on Oct. 14, 9:00-10:30 a.m.
Nov. 9, 2021
Virtual Summit: 4:00–5:00 p.m. ET
In-Person Gala: 5:00–8:00 p.m. ET
This virtual summit will feature national policy leaders discussing how community investment in primary care can help close the equity gap (speakers to be announced shortly). And afterwards, for those in the New York City area, PCDC invitse you to join them in person at their gala!
Crystal Gateway Marriott, Arlington, VA
Brings together hundreds of people from across the country (employers, coalition leaders, and other healthcare stakeholders) to learn and network with one another and discover effective approaches to managing their overall healthcare strategy.
Why attend?
Pause and Recharge. The Annual Forum offers an outstanding opportunity to pause and recharge after 18 months of relentless change that's showing no sign of abatement.
Tackle the Challenges of our Times. Even before the pandemic, the U.S. healthcare system was in crisis with higher costs and poorer outcomes than any of the 11 wealthiest countries, despite spending the most.
Learn from the Experts. National and international thought leaders share actionable ideas for adopting and optimizing proven and emerging healthcare and benefits trends to drive sustainable change.
Collaborate with Peers. Attendees have the influence, commitment and resources to drive shared priorities and alter the trends that will drive our realities for the next decade or more.
The Health Care Payment Learning & Action Network (LAN) was created to bring together partners in the private, public, and nonprofit sectors to transform the nation’s healthcare system to one that emphasizes high-quality, efficient, and affordable care via alternative payment models (APMs).
Since its inception in 2015, decision-makers from these stakeholder groups have worked together through the LAN to align efforts, capture best practices, disseminate information, and apply lessons learned to advance their shared goal for a revitalized healthcare system that works for everyone.
The LAN Summit has been instrumental in bringing physicians, payers, government leaders, professional associations, academic leaders, consultants, patient advocacy representatives, and other healthcare thought leaders together for a dynamic schedule of networking, robust discussions, and knowledge exchange that fosters collaboration and collective action.
The goal of the LAN generally and the LAN Summit is to collaborate and act on strategies to accelerate the transition to innovative, patient-centric payment models by focusing on equity and access, high-quality, affordable care, engagement of patients, and reduced provider burden.
Registration coming soon at the link provided.
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