2016

Working Towards the Triple Aim: Improving Access to Primary Care

In the national debate on health care reform there is one change almost everyone agrees will help improve our health care system: increasing access to primary care. Consistent primary care - general medical care from a family medicine physician, internist or pediatrician – is vital to maintaining patients’ overall health and preventing chronic disease. For patients with chronic conditions, primary care is crucial to preventing complications. 

A key aspect of primary care is the Patient-Centered Medical Home (PCMH), a model for delivering comprehensive primary care that’s accessible and tailored to meet individual patients’ needs. PCMHs are practices that commit to providing comprehensive, coordinated care from a physician-led team that involves patients in decision-making. Evidence consistently shows the PCMH model reduces health care costs and unnecessary use of services. In fact, 21 out of 23 studies on the topic between 2014 and 2015 found PCMHs led to cost reductions in one or more measures, according to a review by the Patient-Centered Primary Care Collaborative.

Since primary care is many patients’ main point of access to the health care system, and PCMHs focus on coordinated, continuous care, increasing access to primary care can lead to better health, better care and lower costs: the “triple aim” of health care.

Here’s how:

Better Health: Access to primary care has been proven to help patients live longer, healthier lives. In fact, U.S. adults who have a primary care physician have 19 percent lower odds of dying than those who see only a specialist. That’s because primary care providers who provide continuous, coordinated care in a PCMH setting are able to stay on top of their patients’ health and prevent complications.

Better Care: Primary care providers focus on the patient as a whole and form long-term relationships with their patients. This allows them to focus on prevention and providing patient-focused, appropriate, care, ultimately creating a better care experience. Research has found an increase of one primary care doctor per 10,000 people could decrease costly and unnecessary care.

Lower Costs: Practicing prevention and coordinated care allows primary care providers to avoid costly unnecessary treatments and prevent expensive hospitalization for complications. This means a major savings for patients and the health care system as a whole. In fact, one study found the U.S. would save $67 billion each year if everybody used a primary care provider as their usual source of care. Individuals who have a primary care physician have 33 percent lower health care costs, the same study found.

Many primary care practices are already implementing measures to improve patient access to their care. Telehealth can save patients time, money and distance traveled- making it easier for them to access their primary care physician. Open-access scheduling, a model that lets patients schedule same-day appointments, makes accessing primary care more convenient. Some practices even have 24/7 access policies, giving patients every opportunity to access care. The more opportunities we provide for patients to access primary care, the closer we will be to achieving the triple aim. Payers can support these practices through programs that encourage quality primary care, like Anthem's Enhanced Personal Care Program, which supplies primary care physicians with tools, resources and support to provide patient-centered, coordinated care.

Although the U.S. spent more than $2.9 trillion on health care in 2013, just four to seven percent of that total was dedicated to primary care. We must invest more in primary care to improve our health and our health care system.