FHC Develops CHCF Report on Investment in Primary Care Detailing Strategy for California

The California Health Care Foundation recently engaged Freedman HealthCare to develop a technical report on primary care investment data collection, reporting, and enforcement mechanisms. CHCF seeks to inform California stakeholders about national strategies to measure primary care investment in conjunction with accountability tactics to increase the proportion of the health care dollar directed toward primary care. This work can also inform other states’ efforts to create more effective health care delivery systems. Below is a short synopsis of the report. To learn more about the CHCF Primary Care Matters initiative, visit www.chcf.org/primary-care-matters.   

The ultimate goal of any effort to increase investment in primary care is to create a more robust primary care system that better serves patients and achieves better and more equitable health outcomes for all. On average, America spends only about five cents of every health care dollar on primary care. Our peer high-income countries, such as Canada, Netherlands, Switzerland and the United Kingdom, boast longer life expectancy and lower rates of chronic disease — all with lower per capita health care spending (1). In the US, primary care spending has trended downward for several decades, with the COVID-19 pandemic creating additional financial strain on primary care providers. Recognizing the urgent need to strengthen primary care, more than one-third of US states and several of the nation’s largest public and private purchasers have prioritized shifting more of the health care dollar to primary care.  

Purchasers use three types of mechanisms and a range of specific tools, often in combination, to direct greater resources to primary care: Transparency (measuring and reporting), Contracting (shaping formal arguments), and Regulatory (statutes and regulations).

The work is complex and takes time, yet leading states show measurable progress over multi-year journeys. The report summarizes the lessons learned among the profiled states that should be considered during the planning phase for similar initiatives. These include:  

1. Establishing a shared vision. To bridge efforts already underway, convene stakeholders to create a shared vision for primary care. By acting collectively, stakeholders offer providers, payers, and patients clear, aligned expectations for what should be included in the primary care experience and how primary care should be funded.  
2. Conducting annual measurements and reporting across markets based on a common definition of primary care investment. After developing a common vision, multi-stakeholder workgroups add detail by arriving at a common definition of primary care investment that can be applied across market segments to support annual measurement and reporting. Initially, measuring and reporting on primary care investment builds trust, serves as a call to action, and establishes a baseline by which to measure progress. 
3. Set investment targets ad encourage (or require) all purchasers to commit through contractual requirements. An investment target provides a clear and transparent goal. It should reflect the true cost of achieving the vision for improved care delivery, including expenses. Options include an improvement target, such as increasing the share of total cost that is spent on primary care by one percentage point annually, or an absolute target, such as spending at least 10% of total costs on primary care. Targets can be set by purchasers and/or the state, and they can be voluntary or required and enforced through penalties.  

For a deeper look into the findings summarized above, take a look at the full CHCF Report.  

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CHCF’s Primary Care Matters Series: 

The California Health Care Foundation has begun the Primary Care Matters Initiative. Strong levels of primary care investment within health care systems have better and more equitable health outcomes, lower costs, and better care quality. The focus of resources back to patients and their relationships with primary care providers will build a healthier future for Californians. 

For more information or assistance with primary care investment, contact Mary Jo Condon at [email protected].