Shawna Hudson, Rutgers Robert Wood Johnson Medical School professor, contributes recommendations on implementing high-quality primary care

The National Academies of Sciences, Engineering and Medicine has released a  report that evaluated the state of primary care today to develop a plan to strengthen primary care services in the United States, especially in underserved communities.

The report, Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care, was written by a committee of experts including Shawna Hudson, professor and research division chief in the Department of Family Medicine and Community Health at Rutgers Robert Wood Johnson Medical School.

According to the report, ensuring access to high-quality primary care for all people in the United States will require reforming payment models, expanding telehealth services and supporting integrated, team-based care that includes physician assistants, nurse practitioners, medical assistants, community health workers and behavioral health specialists.

Since no federal agency currently has oversight of primary care and no dedicated research funding is available, the report recommends the U.S. Department of Health and Human Services establish a Secretary’s Council on Primary Care and make it the accountable entity for primary care, as well as an Office of Primary Care Research at the National Institutes of Health.

“Primary care is a common good. High-quality primary care means care that is accessible to individuals and families in a community,” said Hudson. “For many people in underserved communities primary care is the entry point to the health care system and pivotal to achieving health equity. This care should be provided constantly regardless of insurance status. Practices should build community partnerships and source primary care teams from the community to reflect its values.”

Building on the recommendations of a 1996 report by the Institute of Medicine, the new report provides an implementation plan for high-quality primary care in the U.S. The committee found that in the 25 years since the report, primary care systems remain under-resourced, with only about 5 percent of health care expenditures going to primary care, a shrinking workforce that is associated with a loss of 85 lives per day and unequal access to care.

The report recommends several policy changes to strengthen care delivery and payment. Current payment models will need to move away from fee-for-service in favor of payment models that better support independent practices, enable team-based care, and address the social determinants of health. As the largest payer in the country, Medicare should be prioritized for payment reform, since its payment policies set the tone for other public and commercial payers.

Also, health insurance providers should ask all covered individuals to declare that source of primary care annually, so they can track this information and use it for accountability measures. Community health centers, hospitals, and primary care practices should assume an ongoing clinical relationship with the uninsured individuals they treat.

Several COVID-era policy changes should be made permanent, the report adds. “Our recommendations were based on how they would be implemented based on the system we have today,” Hudson said. “Medicare and Medicaid Services interpretations should continue to enable telehealth and virtual visits, ease physician documentation requirements, and eliminate other barriers to high-quality primary care.