National Academies of Sciences, Engineering, and Medicine, a nationally renowned scientific institution, He recently emphasized that “primary care is a public good” And he went on to picture what the United States would look like if people no longer had access to high-quality primary care. In this dismal picture, “minor health problems can turn into chronic diseases, chronic disease management becomes difficult and uncoordinated, emergency department visits increase, preventive care delays, and healthcare spending reaches unsustainable levels.”
NASEM’s assertion that primary care is the only specialty improving life expectancy and reducing health disparities may not have come as a surprise to many. However, what is surprising is how little people care about how bad primary care is and how we may be spiraling into the bleak picture of a health care system that lacks quality primary care.
While patients and those of us on the front lines have many ideas about how local and federal investments can transform to improve primary care delivery, the traditional measures for assessing the strength of primary care are outcomes on measures of health for patients. Measuring how well primary care is controlling a patient’s diabetes, high blood pressure, or depression is really critical, but it’s only one side of the equation. In order for patients, caregivers, policymakers and leaders to fully understand how to proceed in primary care, we also need tools to assess and track the health of entities that provide primary care services.
Health Quality Partners of MassachusettsInc., a nonprofit organization originally founded to measure and publicly report comparable hospital quality information, has been closely tracking the patient experience and clinical performance of primary care practices in Massachusetts since 2006. The fragility of primary care was evident even before the devastating impact of COVID-19. These practices are increasingly required to accommodate growing patient volume, respond to more patient contacts through patient portals, succeed on a greater number of measures of health quality, meet new requirements for monitoring and addressing patients’ social and behavioral health needs, and efficiently care for patients with highly complex care needs. All this while primary care continues to receive the same financial support and simultaneously faces emerging competition from concierge practices and companies like Amazon and CVS, which offer patients an exit from traditional primary care.
Forced to highlight the instability of our primary care system, Health Quality Partners set up a series of meetings with primary care physicians, patients, community leaders, and organizations and asked for hundreds of ideas on how to measure the health of the primary care system. during this time, Health information and analysis centerInc., an independent government agency, began tracking primary care spending in response to a legislative proposal by then-Governor Charlie Baker to increase investments in primary care and behavioral health. Asking some of the same questions, MHQP and CHIA have become partners in this work and have developed a dashboard, the first of its kind in the country, to be released this week, that will measure and monitor the health of Massachusetts’ primary care system.
The dashboard tracks metrics from several publicly available sources in four key dimensions of primary care, with examples below:
Finance: spending on primary care services at the system level. spending on primary care It accounted for less than 8 percent of total medical spending and fell across all insurance classes from 2019 to 2020.
Capacity: Primary care and pipeline workforce. in 2020, 33.7% are primary care physicians In Massachusetts they were 60 or older, up from 31.8 percent in 2018.
Performance: Care and Access. More than a third of the population in 2021 reported that they had been infected Difficulty obtaining the necessary health care in the past 12 months, an increase from in 2019.
Equality: Racial and Ethnic Disparities in the Massachusetts Health Care System. In 2021, only 64 percent of the Hispanic population reported that they did Preventive care visit Last year, against 81 percent of the white population.
Over the past 15 years, MHQP’s statewide benchmarking efforts have highlighted how successful Massachusetts primary care practices are in managing patients’ chronic diseases and providing preventive care services. However, the dashboard is already showing us that performance in achieving health metrics is trending downward, with continued lack of financial investment in primary care, diminishing primary care capacity, and increasing equity gaps.
As a public good, primary care deserves our collective attention, however, and this requires a basic understanding of its weaknesses. For effective primary care advocacy, healthcare leaders, policy makers, and patients need to be held accountable so that advocacy is evidence-based. Dashboards such as those developed by MHQP and CHIA will shed light on how our system is performing and provide key data needed to monitor progress. While this dashboard will continue to evolve over time, it provides an important accountability tool that can be used to improve our primary care system and maintain it as a truly valuable resource for future generations.
Barbara G. Rapson is president and CEO of Massachusetts Health Quality Partners. Dr. Katherine Jergen Barnett is Vice President of Primary Care Innovation and Transformation in the Department of Family Medicine at Boston Medical Center, Clinical Associate Professor at Boston University Tchobanian and Avedissian School of Medicine, Associate Professor at Harvard Primary Care, and Health Innovator Fellow at the Aspen Institute.