High-quality primary care is the foundation of the health care system. It provides continuous, person-centered, relationship-based care that considers the needs and preferences of individuals, families, and communities. Without access to high-quality primary care, minor health problems can spiral into chronic disease, chronic disease management becomes difficult and uncoordinated, visits to emergency departments increase, preventive care lags, and health care spending soars to unsustainable levels.

Unequal access to primary care remains a concern, and the COVID-19 pandemic amplified pervasive economic, mental health, and social health disparities that ubiquitous, high-quality primary care might have reduced. Primary care is the only health care component where an increased supply is associated with better population health and more equitable outcomes. For this reason, primary care is a common good, which makes the strength and quality of the country's primary care services a public concern.

Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care puts forth an evidence-based plan with actionable objectives and recommendations for implementing high-quality primary care in the United States. The implementation plan of this report balances national needs for scalable solutions while allowing for adaptations to meet local needs.

Contents

• The National Academies of SCIENCES • ENGINEERING • MEDICINE
• COMMITTEE ON IMPLEMENTING HIGH-QUALITY PRIMARY CARE
• Reviewers
• Preface
• Acknowledgments
• Acronyms and Abbreviations
• Abstract
• Summary
  • THE STUDY CONTEXT AND CHARGE
  • WHAT IS HIGH-QUALITY PRIMARY CARE?
  • IMPLEMENTATION PLAN
• 1. A New Vision for Primary Care
  • PROJECT ORIGIN AND STATEMENT OF TASK
  • STUDY APPROACH
  • STUDY CONTEXT
  • ORGANIZATION OF THE REPORT
  • REFERENCES
• 2. Defining High-Quality Primary Care Today
  • AN UPDATED DEFINITION OF PRIMARY CARE
  • FACILITATORS OF HIGH-QUALITY PRIMARY CARE
  • REFERENCES
• 3. Primary Care in the United States: A Brief History and Current Trends
  • Primary Care Specialties
  • CURRENT PRIMARY CARE PRACTICE TYPES
  • ACCESS TO PRIMARY CARE
  • PRIMARY CARE USAGE TRENDS
  • FINDINGS AND CONCLUSIONS
  • REFERENCES
• 4. Person-Centered, Family-Centered, and Community-Oriented Primary Care
  • LISTENING TO INDIVIDUAL, FAMILY, AND COMMUNITY VOICES
  • ACHIEVING PERSON-CENTERED CARE
  • HEALTH EQUITY AND THE ROLE OF PRIMARY CARE
  • SHIFTING PRIMARY CARE TO BE MORE COMMUNITY-ORIENTED
  • FINDINGS AND CONCLUSIONS
  • REFERENCES
• 5. Integrated Primary Care Delivery
  • THE GOALS OF INTEGRATED CARE DELIVERY
  • IMPLEMENTATION FACILITATORS: HOW TO INTEGRATE PRIMARY CARE DELIVERY
  • FINDINGS AND CONCLUSIONS
  • REFERENCES
• 6. Designing Interprofessional Teams and Preparing the Future Primary Care Workforce
  • DESIGNING THE INTERPROFESSIONAL PRIMARY CARE TEAM
  • MEMBERS OF THE PRIMARY CARE TEAM
  • EDUCATING AND TRAINING THE INTERPROFESSIONAL PRIMARY CARE TEAM
  • DIVERSITY AND EQUITY IN THE PRIMARY CARE WORKFORCE
  • FUNDING TO SUPPORT THE TRAINING OF THE PRIMARY CARE WORKFORCE
  • FINDINGS AND CONCLUSIONS
  • REFERENCES
• 7. Digital Health and Primary Care
  • THE GROWTH OF DIGITAL HEALTH
  • DESIGNING DIGITAL HEALTH FOR PRIMARY CARE: WHAT DOES SUCCESS LOOK LIKE?
  • NEEDED FUNCTIONS OF PRIMARY CARE DIGITAL HEALTH SYSTEMS TO ACHIEVE VISION OF SUCCESS
  • HEALTH DISPARITIES AND DIGITAL HEALTH
  • DIGITAL HEALTH IMPLEMENTATION NEEDS
  • DIGITAL HEALTH RESEARCH NEEDS
  • FINDINGS AND CONCLUSIONS
  • REFERENCES
• 8. Primary Care Measures and Use: Powerful, Simple, Accountable
  • QUALITY, MEASURES, AND ACCOUNTABILITY IN PRIMARY CARE
  • THE BENEFITS OF AN IMPROVED MEASUREMENT ECOSYSTEM
  • GUIDANCE FOR SELECTING PRIMARY CARE MEASURES
  • IMPLEMENTATION NEEDS
  • FINDINGS AND CONCLUSIONS
  • REFERENCES
• 9. Payment to Support High-Quality Primary Care
  • WHY MONEY MATTERS
  • HISTORY OF PRIMARY CARE PAYMENT
  • PRIMARY CARE PAYMENT TODAY
  • REFORMING PAYMENT TO PRIMARY CARE
  • PAYMENT AS A FACILITATOR OF HIGH-QUALITY PRIMARY CARE
  • TECHNICAL CONSIDERATIONS
  • GOALS AND MEASURES OF SUCCESS FOR PRIMARY CARE PAYMENT
  • FINDINGS AND CONCLUSIONS
  • REFERENCES
• 10. Enhancing Research in Primary Care
  • THE 1996 INSTITUTE OF MEDICINE REPORT
  • THE STATUS OF RESEARCH SUPPORT IN PRIMARY CARE
  • NEEDED RESEARCH IN PRIMARY CARE
  • FINDINGS AND CONCLUSIONS
  • REFERENCES
• 11. The Committee's Approach to an Implementation Strategy
  • AN IMPLEMENTATION FRAMEWORK
  • AN ACCOUNTABILITY FRAMEWORK
  • A PUBLIC POLICY–MAKING FRAMEWORK
  • REFERENCES
• 12. A Plan for Implementing High-Quality Primary Care
  • OBJECTIVE ONE:. PAY FOR PRIMARY CARE TEAMS TO CARE FOR PEOPLE, NOT DOCTORS TO DELIVER SERVICES
  • OBJECTIVE TWO:. ENSURE THAT HIGH-QUALITY PRIMARY CARE IS AVAILABLE TO EVERY INDIVIDUAL AND FAMILY IN EVERY COMMUNITY
  • OBJECTIVE THREE:. TRAIN PRIMARY CARE TEAMS WHERE PEOPLE LIVE AND WORK
  • OBJECTIVE FOUR:. DESIGN INFORMATION TECHNOLOGY THAT SERVES THE PATIENT, FAMILY, AND INTERPROFESSIONAL CARE TEAM
  • OBJECTIVE FIVE:. ENSURE THAT HIGH-QUALITY PRIMARY CARE IS IMPLEMENTED IN THE UNITED STATES
  • REFERENCES
• Appendix A. Committee Member, Fellow, and Staff Biographies
• Appendix B. Primary Care: America's Health in a New Era Report Recommendations
• Appendix C. Committee's Calculations to Determine the Impact of the Decreased Density of Primary Care Physicians Between 2005 and 2015
• Appendix D. Three System-Level Tables of Actors and Actions
• Appendix E. The Health of Primary Care: A U.S. Scorecard

Suggested citation:

National Academies of Sciences, Engineering, and Medicine. 2021. Implementing high-quality primary care: Rebuilding the foundation of health care. Washington, DC: The National Academies Press. https://doi.org/10.17226/25983.

Digital Object Identifier: https://doi.org/10.17226/25983

Library of Congress Control Number: 2021937669

Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

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