Rethinking primary care reimbursements

| October 16, 2023

Raegan’s insights: Prioritizing a path to health equity

In honor of my recent trip to England to visit friends, I am sharing an article from The Commonwealth Fund discussing strengthening primary care and rethinking reimbursements for primary care to meet that goal while learning from mistakes made in Great Britain.  

Yes, without contradiction, every study across nations with good quality population health outcomes AND lower health care costs (i.e., NOT the United States) shows that the link between the two is investing in robust primary care. 

Unfortunately, in the US, decisions have been made (mainly by health systems and most of our competitors in the employer-sponsored health center space) to “widgetize” primary care by focusing on rewarding patient volume and, therefore, lessening its value.

As The Commonwealth Fund’s article states, “A large body of evidence links robust primary care with better and more equitable health outcomes, lower per capita costs, and higher patient satisfaction. Yet, compared with other high-income countries, primary care in the United States lags in access, quality, and comprehensiveness. To address these gaps — and advance health equity — policymakers are looking to strengthen primary care.”

To strengthen primary care, we must rethink reimbursement for primary care services. 

But how? 

Thinking through payments as incentives can be tricky. We do know that paying a per-visit fee, as is currently done, only incentives the assembly line of patients, sitting in crowded waiting rooms, making it difficult to get an appointment, and subsequently growing an overreliance on urgent care facilities and acute-specific reasons to see a provider rather than preventive and proactive, whole-person care.

Per-visit fees alone do not work. 

It has been discussed and, in some cases, poorly executed, adding in reimbursement for quality care and improved outcomes. Certainly, incentivizing providers to be invested in their patient’s long-term health and wellness is an excellent way to tie results to quality care and proper documentation. So far, standardizing those metrics, payment models, etc., has not happened, but we are on our way to satisfying the need to tie payment to outcomes.

Related resource:
Six essential elements of high-quality primary care

The aspect of this article that I find the most interesting and that we as a nation are only beginning to talk about is reimbursement based on the access and needs of the community. Using Britain as an exempt from the ramifications of neglecting to adjust their capitated rates paid based on the socioeconomic conditions of a community has led to a higher occurrence of care inequity, sending providers to the more affluent areas where older, wealthier people live and widening the gap of care in the areas that need it most.

WeCare tlc often partners with clients in more remote/rural areas to meet the known need of providing access where there is, usually, none. Health needs are the greatest in remote/rural areas with no access. 

At a time when we are only beginning to talk about health inequities, social determinants of health, and how they are directly tied to care and cost, it is vital that we also take these risk factors into account when rethinking payment models.

Article written by Raegan Garber Le Douaron, WeCare tlc President & CEO. 

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