The promise of primary care: Lessons from four states

Published November 21, 2016

For decades, our country’s healthcare system has grown increasingly specialized. However, studies show that primary care is more effective at maintaining good health. In fact, the World Health Organization has called good primary care "a global imperative."

Primary care visits account for 55 percent of the 1 billion physician office visits each year in the U.S., yet these visits represent just 6 to 8 percent of our national healthcare spending ($200 to $250 billion annually).

Data shows that a major investment in patient-focused care, particularly primary care, could improve patient healthcare while reining in costs. The vast majority of peer-reviewed studies show that patient-focused care programs reduce costs, according to the Patient-Centered Primary Care Collaborative

"The decisions made in the primary care setting have important implications for downstream medical care. A group of 100 adult primary care physicians could potentially influence almost $1 billion in spending."

- Mostashari, et al.

Journal of the American Medical Association, 2014

Public and private sector investment in primary care

Building on this insight, both the public and private sectors are investing significantly in primary care:

In April 2016, the Centers for Medicare & Medicaid Services (CMS) expanded a major federal program, the Comprehensive Primary Care Plus (CPC+) model—the largest ever multi-payer initiative to improve primary care in the U.S. The program will support primary care in up to 20 regions and 5,000 physician practices, encompassing more than 20,000 doctors and 25 million patients. The program emphasizes key attributes of patient-focused care: Chronic disease management, patient engagement, team-based care and 24/7 access to care, prevention and wellness.

Blue Cross and Blue Shield companies have made significant investments in primary care in communities across the country to support a shift from the fee-for-service model—which rewards the volume of medical services provided—to one that pays medical professionals for quality care and success in treating patients. With more than 700 patient-focused care programs nationwide, Blue Cross and Blue Shield companies saved an estimated $1 billion in 2013 by improving quality outcomes, minimizing avoidable emergency room visits and hospital admissions and reducing infections contracted during hospital stays.

See how Blue Cross Blue Shield companies are partnering with doctors to improve primary care and patient health:

CaliforniaMarylandNew JerseyMichigan