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Primary care is critical for population health, health equity, and the overall efficiency of the health care system.1 It also has been consistently associated with improved life expectancy and reduced health care disparities. The four defining features of high-functioning primary care are:
- accessibility
- comprehensive care for most patient problems
- continuity of care over time
- coordination of care with the broader health care delivery system.2
Though extensive research has demonstrated the value to patients and the wider community when primary care practitioners (PCPs) deliver care defined by these key elements, they are often lacking in the United States.3 Compared to other high-income countries, U.S. patients are less likely to have a usual source of care, after-hours access to primary care, or a longstanding relationship with a provider of comprehensive primary care.4 One reason is Medicare’s physician fee schedule, which does not adequately incentivize primary care practices to provide accessible, comprehensive, continuous, or coordinated care.5 For example, fee schedule payments do not support the additional costs of providing care outside regular business hours, which can limit accessibility for people with caregiving responsibilities, multiple jobs, or jobs with irregular hours.6 PCPs are also providing less comprehensive care, increasingly referring patients to specialists for in-depth management after documenting their concerns.7