Using Primary Care’s Potential to Improve Health Outcomes

For over a decade, revitalizing primary care has been a top priority for the Purchaser Business Group on Health (PBGH). Through successive initiatives and in collaboration with a diverse group of committed stakeholders, PBGH has spearheaded efforts to create a blueprint for “Advanced Primary Care.”

What Is Advanced Primary Care?

Advanced Primary Care places patients at the center of every interaction and prioritizes access to high-quality primary care to prevent higher acuity, costlier care and making for a healthier California.

Building off a statewide practice transformation initiative funded by the Centers for Medicare and Medicaid (CMS), PBGH’s California Quality Collaborative (CQC) began crafting definitions for ‘exemplar’ primary care practices with the goal of identifying, celebrating and learning from high-performing organizations within the program’s network. This led to a definition of “Advanced Primary Care.”

CQC defined Advanced Primary Care by high-performance attributes and a set of results-oriented measures that focus on how the care process is, or should be, experienced from the patient perspective. This set of measures is based on existing outcome measures widely in use by California and national payers that if collectively applied would enable medical practices to deliver Advanced Primary Care.

Why Is Primary Care So Important?

Primary care—long underfunded and woefully underutilized—remains the foundation upon which a high-performance, cost-effective health care system must be built.

Evidence shows that improved primary care translates into healthier, happier patients and lower overall health care costs:

• U.S. adults who regularly see a primary care physician have 33% lower health care costs and 19% lower odds of dying prematurely than those who see only a specialist.
• The U.S. could save $67 billion each year if everyone used a primary care provider as their principal source of care.
• Every $1 increase in primary care spending produces $13 in savings.

It is important to note that the development of the Advanced Primary Care model is as much about streamlining the practice of primary care as it is about improving outcomes, enhancing the patient experience and reducing costs. Simple and consistent definitions of optimized primary care across all payer contracts would reduce, if not eliminate, the bewildering array of sometimes-conflicting value-based requirements contained in multiple payer contracts.

Why Doesn’t Primary Care Work Better?

Funding arguably is the greatest hurdle to more effective primary care. Despite 55% of office visits taking place in primary care clinics, only 4-7% of health care dollars go toward primary care.

But misaligned financial incentives, infrastructure and technology barriers and poor integration with other elements of care all play a role in compromising quality and driving up costs.

Advanced Primary Care in Practice

One initiative that has come out of the primary care groundwork laid by CQC is a measurement pilot with Covered California and CalPERS. Both organizations agreed to pursue a pilot program starting January 2022 to test statewide practice-level measurement using CQC’s 11 Advanced Primary Care measures.

Covered California contracts with 11 health plans to provide coverage for 1.6 million Californians, and CalPERS manages pension and health benefits for more than 1.6 million California public employees, retirees and their families.

The goal of the pilot is to create the basis for extending the Advanced Primary Care criteria across PBGH’s membership and to other payers nationwide.

On September 30, 2021, more than 175 employers, public purchasers, health plans, providers and other stakeholders from across the country came together for a summit to discuss implementation of a common purchasing agreement based on CQC’s definition of Advanced Primary Care. Going forward, CQC plans to continue pursuing solutions to barriers that inhibit broader implementation of Advanced Primary Care.

For more about the journey to Advanced Primary Care, click here.