By Taylor Hughes
At its simplest, primary care is delivered for basic or everyday healthcare needs. You may have visited a primary care provider at a doctor’s office the last time you had an ear infection or for an annual checkup or needed a vaccination. Having a usual source of primary care is vital for things like the prevention of illness and the management of chronic diseases. On a national level, primary care visits comprise 35% of total healthcare visits, but only 5% of healthcare spending is allocated towards supporting primary care. New Jersey has some of the country’s lowest investments in primary care as a percentage of all healthcare spending.
In addition to a lack of financial resources, there is a shortage of providers working in this space. More medical school students are choosing to specialize rather than practice as a generalist. Some reasons for this trend are that generalists are paid much less and hold less prestige than their counterparts while managing a challenging and diverse workload. A New Jersey Health Care Quality Institute report provides insight and recommendations for implementing “Advanced Primary Care” statewide and how alternative payment models can improve primary care administration.
Advanced Primary Care (APC) is a patient-centered, sweeping approach to administering primary care. The basis of APC is that a team of providers, including primary care providers, behavioral health providers, pharmacists, and others, work together to provide a patient with comprehensive care over time. It also includes meeting patients where they are, whether arranging an in-person visit, a phone call, or a digital visit. Providing this team-based care requires investing in the current primary care infrastructure and reassessing how primary care is paid for in New Jersey.
Fee-for-service (FFS) is the most common payment method for health care in New Jersey, where services are individually billed. A National Academies of Sciences, Engineering, and Medicine (NASEM) report, Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care, recommends a payment model combining FFS with capitation payments, which could provide more significant investment into primary care and better incentivize providers to deliver care beyond individual billable services. The New Jersey Health Care Quality Institute also recommends increasing FFS primary care rates because they are systematically lower than rates for other services. Expanding data collection efforts, perhaps through New Jersey’s Healthcare Affordability, Responsibility and Transparency (HART) Benchmark Program, could help guide further fiscal and policy decisions.
Finally, the New Jersey Health Care Quality Institute recommends that the state “take an active role in developing and encouraging Advanced Primary Care in New Jersey.” The development of APC could be introduced incrementally, following the above changes in payment delivery, and it would require working with multiple stakeholders, including payors (public and private insurance) and providers. Primary Care Physicians are interested in moving towards an Advanced Primary Care delivery model, and other stakeholders in New Jersey are prepared to assist, but more support is needed.
Taylor Hughes is a graduate student pursuing a Master of Public Policy degree at the Edward J. Bloustein School of Planning and Public Policy. She serves as a research assistant with the New Jersey State Policy Lab.