HHS asks for ideas, Commonwealth Fund responds


Money, payments, working with public health and social services are among the suggestions.

More money, changing payment methods, and integrating public health and human services would strengthen primary care in the United States.

The Commonwealth Fund, a health care research and advocacy organization, offered those who three strategies sent to the Office of the Assistant Secretary for Health (OASH) of the United States Department of Health and Human Services (HHS). This summer, OASH asked for suggestions on the HHS Initiative to Strengthen Primary Health Care, which “aims to establish a federal foundation for the provision of primary health care for all that promotes improved health outcomes and advanced health equity.”

“The first task is to develop an initial HHS plan for strengthening primary health care that will outline specific actions that HHS agencies and offices can take to achieve the goals, within the framework of legislation and the environment current funding levels,” the HHS request reads. He did not have a specific timeline for a plan, but asked for a realistic timeline for implementation, ranging from less than two years to the next six to ten years.

There are at least three things to do, said Commonwealth Fund authors Corinne Lewis, Program Manager for Delivery System Reform; Celli Horstman, Senior Research Associate for Delivery System Reform; and Christina Ramsay, program officer for federal and state health policy.

According to the Commonwealth Fund:

“Increase financial investment in primary care.”

Primary care physicians (PCPs) are paid less than specialists, and the United States spent 4.7% of total health care spending on primary care in 2019. This is down from 6.5% estimated in 2002 and below the average of 14% in other high-level countries. -income countries.

To address this, the federal Centers for Medicare and Medicaid Services (CMS) should review its process for establishing physician fee schedules, using independent data collection procedures.

“Move to hybrid or capitalized payment approaches.”

Paying for health care through fee-for-service encourages doctors to order more tests and procedures that may be unnecessary or of little value, and to see as many patients as possible. HHS could engage multiple agencies, including CMS and the federal Center for Medicare and Medicaid Innovation (CMI), to create hybrid payments.

“Support the integration of primary care with behavioral health, social services and public health.”

PCPs with patients who have behavioral health needs are hampered by lack of funding, understaffing, and unclear billing practices. Adding behavioral health will require new models of care and personnel, so CMS and HHS should support these efforts financially and by promoting a diverse workforce.

For the integration of social services, the CMI could add measures for the drivers of health, also known as the social determinants of health, to primary care delivery models to collect data that guides investments to serve at-risk communities.

PCPs were a trusted source of information for patients during the COVID-19 pandemic, so HHS could promote collaboration between PCPs and public health departments for providers to contribute to routine public health activities. .

“Evidence-Based Strategies for Strengthening Primary Care in the US” was published August 5 on the Commonwealth Fund Blog.


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