July | August 2017




Primary Care Important to Promoting Better Health

By Debra Miller, CSG Director of Health Policy
Health outcomes in the United States—as measured by indicators such as infant mortality, life expectancy, or incidence of diseases like diabetes, heart disease and others—are disappointingly poor compared to other wealthy nations.
Primary care—accessible, appropriate and affordable—is one strategy for improvement. But the success of primary care improvements face several challenges, which could affect the future of health care.
The Institute for Alternative Futures, a group of scholars that helps organizations monitor trends, explore future possibilities and create the futures they prefer, offers four futuristic scenarios of primary care in 2025 in a recent report.  Dr. William Rowley, one of the authors of the report, will discuss the scenarios with the CSG Health Policy Task Force May 18 during The Council of State Governments’ National Leadership Conference in La Quinta, Calif.
In Scenario 1, “Many Needs, Many Models,” policymakers will promote health prevention and self-management. The patient-centered health home is expanded with sophisticated electronic medical record systems and health information technology to improve the cost and quality of primary care.
Scenario 2, “Lost Decade, Lost Health” paints a bleaker picture. Economic difficulties will prompt cuts in health care spending and reduce provider reimbursements. Dissatisfied providers will leave the workforce, leading to even more workforce shortages and decreased access.
“Primary Care that Works for All” is the theme of Scenario 3. The patient-centered health home is transformed into a community-centered health home, effectively promoting improved population health. Advanced technologies permit the identification and remediation of “hot spots” of ill health.
The last scenario, “I Am My Own Medical Home,” portends individuals taking over a great deal of primary care by using personal technologies to monitor health and social networks for referrals to specialists.
Idaho Rep. John Rusche, a doctor and former health care administrator, told CSG he believes self-care, a key component of the last future scenario, is important and that personal technologies like cell phones and email can remind people to do things. 
“But 2025 is just 13 years away and the health literacy levels of much of the population are not that great for them to be their own primary care providers,” he said.
“A lot of primary care is to integrate physical factors, social environment and behavioral conditions, so I don’t see primary care being replaced by self-care,” said Rusche. “There is still a lot more art and a lot less science.”
Rusche said he sees three big issues ahead for primary care: labor force shortages, integrating practice, and compensation and payment. He pointed out that while some new medical schools have been added to train more physicians, it remains to be seen how many new primary care physicians will be produced.
Expanding scope of practice—what particular licensed health care professionals are allowed to do—will continue to be an issue, said Rusche.
Janet Haebler, associate director of state government affairs for the American Nurses Association, agreed. The association believes that nurses can play a key role in meeting the need for primary care.
“ANA supports the removal of barriers and discriminatory practices that interfere with full participation by advanced practice registered nurse in the health care delivery system,” Haebler said.
She said that nurses’ education—which emphasizes health promotion and disease prevention--makes them particularly well suited for the role of primary care providers.
Haebler agreed that payment and compensation issues are central to promoting primary care. For instance, a Medicare bonus payment for primary care reimbursement rates is available to some categories of nurse practitioners, but not to all.

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