Spending more on primary care translates to better patient outcomes, report says

States that spend more on primary care have better patient outcomes, including fewer hospitalizations and emergency department visits, a new study concluded.

However, spending on primary care remains low throughout the country, according to an analysis by the Patient-Centered Primary Care Collaborative (PCPCC), which undertook a state-by-state look at spending.

The collaborative released its report Wednesday that included the first-ever state-level analysis of primary care spending and also looked at commercial and public payers.

“When spending on primary care is higher, the outcomes are better,” said Jill Hummel, chair of the PCPCC board and president and general manager of Anthem Blue Cross Blue Shield of Connecticut, during a briefing about the report in Washington, D.C.

While spending on primary care varies across states, overall, it is low throughout the entire country, said Yalda Jabbarpour, M.D., a family physician and medical director of the Robert Graham Center, who helped author the report.

“We know that improving primary care improves outcomes, yet we only spend 5% to 7% of total healthcare expenditures on primary care,” Jabbarpour said.

chart of healthcare spending
PCPCC report: Investing in Primary Care: A State-Level Analysis

It’s time the healthcare industry stopped spending on building new facilities and put money into primary care, said Frederick Isasi, executive director of Families USA, a non-partisan health care advocacy group.

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“Primary care is the backbone of an efficient, effective healthcare system, and it is important to see what we are spending on and make that shift to primary care,” Isasi said. Healthcare systems need to move employees from the hospital to create a primary care-centric base, he said.

The researchers were able to calculate primary care spending for the U.S. and for 29 states using data from the Medical Expenditure Panel Survey. In 21 states, mostly in the rural Midwest, there was not enough data for analysis.

Minnesota has the highest percentage of primary care investment, while Connecticut and New Jersey had the lowest spending rate.

Claire Neely, M.D., president and CEO of the Institute for Clinical System Improvement, a healthcare improvement non-profit in Minnesota, said a number of factors have allowed the state to invest in primary care. Among them, the employer community has advocated for better primary care and with two medical schools in the state, there are a lot of primary care physicians who train there and remain in the state.

Legislation has also supported the patient-centered medical home model where patient treatment is coordinated through primary care physicians and the state publicly reports healthcare measures from rates of diabetes to depression, she said.

“Leadership for many years has understood the importance of primary care,” she said.

States are catching on that investing in primary care can result in better patient care. To date, 10 states have introduced legislation to report on primary care spending and eventually increase investment in primary care. “It was a banner year for primary care legislation. Seven states proposed legislation [in 2019] and five have passed,” said Ann Greiner, president and CEO of 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 cost,” she said.