To Beat COVID-19, Address Primary Care Payment

In an article published in Medpage Today, VSSL Director Joshua Liao wrote about the need to address primary care payment as part of our nationwide response to the ongoing COVID-19 pandemic.

In the article, Dr. Liao first outlined the key role that primary care plays in "all phases of our pandemic response", a reality that underscores the need to ensure that our COVID-19 response includes preserved, if not expanded, primary care capacity.

Ongoing patient care. As Dr. Liao notes, "patients with suspected or test-positive disease but who are not ill enough to require hospitalization are managed in primary care settings. Via in-person or telemedicine interactions, primary care clinicians around the country are working to triage cases, answer questions, assuage fears, and manage symptoms for these patients and their families."

Ongoing release valve for hospitals. Dr. Liao highlights that "in the short-term, primary care also provides a vital release valve for hospitals" by accepting patients discharged from hospital floors and ICUs. He notes: "the responsibility for these patients is passed to primary care practices, whose clinicians must ensure safe transitions (e.g., reviewing medications that were changed or added during hospitalization) and continued recovery from illness."

Future "front line" in the battle against COVID-19. "In the longer term, the COVID-19 battlefront may shift almost entirely to primary care. Vaccines against the virus would be delivered in primary care settings, as currently occurs for flu, pneumococcus, and other infections. Primary care clinicians will play key roles in managing COVID-19 cases through testing, triage, symptom management, and follow-up support. Each of these functions will only become more important if there is a resurgence in viral transmission over the next several years, as some experts anticipate."

However, Dr. Liao highlights a key problem:

"We have been facing a primary care crisis long before the novel coronavirus emerged, one rooted partially in how we pay for primary care. There is widespread underinvestment in primary care across the country – in some instances, it receives less than 5% of healthcare spending, compared with other types of care. In many areas, access to primary care is also limited and falling due in part to clinician burnout and workforce shortages. The result is at least two-fold: failure to realize the potential health benefits of primary care, which include better outcomes and most cost-efficient care; and greater risk of patients receiving duplicative or unnecessary care as a result of uncoordinated, fragmented care.

Dr. Liao highlights two strategies to "address primary care's pre-existing problems on a timeline that meets the pandemic's challenges." Learn more and read the full article here.

**As. Dr Liao notes in the article ("Over the last year, I have worked with colleagues in the Value & Systems Science Lab on this very issue"), a team of VSSL members has been working on developing a framework to can guide discussions among stakeholders committed to reforming primary care payment and improving primary care delivery. Click here to learn more.**