Did you know?
Primary care is the one field of medicine that has been shown to improve overall health outcomes and decrease care disparities, and in turn reduce healthcare costs. It is often the first or only point of contact for patients with a healthcare need. However, primary care in the US is in crisis: the primary care system continues to experience demand that outpaces supply, resulting in wait times to see providers that are long and growing. Moreover, as Millbank Memorial Fund has noted, as healthcare mergers and acquisitions can emphasize short-term returns on investment, primary care gets turned “into an inventory of goods [rather] than an essential part of health care infrastructure.” Even as states attempt to address a dwindling supply of primary care physicians, they are not necessarily creating a healthcare system that is whole-person centered, integrated, accessible, and equitable, which the National Academy of Sciences, Engineering, and Medicine (NASEM) has defined as a high-quality primary care system.
Here is the latest
Building on NASEM’s observation that there is a chronic lack of support for the implementation of high-quality primary care in the Unites States, the Robert Graham Center’s seminal report, The Health of US Primary Care: 2024 Scorecard Report, identifies five reasons why primary care is in crisis: (1) a slow-growing primary care workforce, (2) too few primary care resident physicians with community-based training, which is essential for a functional primary care system, (3) underinvestment in primary care reimbursement, (4) technology burdens for providers, and (5) a lack of research on novel care delivery and payment solutions.
Critical to effective primary care is a trusting provider-patient relationship. A trusting relationship can be difficult to build if, for example, patients are unable to find providers who share a common race, ethnicity, and language, which many communities struggle to offer, according to a recent report from the Robert Wood Johnson Foundation. When patients do not feel comfortable with a healthcare provider, health issues may go unaddressed, leading to poor health outcomes and exacerbating racial and ethnic health disparities that result in higher rates of illness and death.
Patients, policy makers and those who purchase health care, like employers, are seeking strategies that enhance investment in primary care and models that help patients find treatment for their ‘whole person’ and not just the presenting condition.
What does this mean for New Hampshire?
A high-quality primary care healthcare system requires ongoing public investments to prioritize and right-size primary care provision and to ensure a whole-person, integrated and accessible healthcare system that centers the patients and communities it serves.
A February 2024 IHPP report identified several similar concerns related to accessibility of primary care in New Hampshire, including that the demand for primary care will likely outpace provider availability due to a lack of new medical school graduates specializing in primary care, the aging population of existing primary care physicians, and lower reimbursement rates for primary care services. Moreover, different regions of the state rely on different types of healthcare provider entities; the northern, more rural regions of the state experience the greatest deficits with respect to accessible, professional, healthcare services. A focus group of New Hampshire residents, also conducted in early 2024, highlighted some of the quantitative aspects of these trends: participants reported that they struggled to find a primary care provider who accepts their insurance and is seeing new patients, and indicated that they delay seeking care in order to avoid unpredictable or high out-of-pocket costs.
New Hampshire has already taken some steps to improve and protect primary care provider supply by establishing independent practice authority for nurse practitioners. This step is important because it helps to expand the pool of available primary care providers and reflects a decade worth of data that indicates the number of primary care nurse practitioner graduates continues to surge while the number of primary care physician graduates is flat and relatively low.
However, nurse practitioners remain ineligible for the largest source of federal funding for graduate medical education. Researchers reflect that enhanced federal funding should be made available for the education of all primary care providers to make full use of the current primary care workforce pipeline. In the near term, New Hampshire can do more to increase the primary care clinician pipeline by financially supporting graduate education and training for nurse practitioners. New Hampshire could customize this financial support to meet its own specific needs by prioritizing community-based training in New Hampshire’s rural and underserved areas, which our own data show experience the greatest deficits in accessible, professional, healthcare services.
The Granite State can also incentivize primary care by creating policies such as requiring insurers to invest more in primary care providers as done in Rhode Island or requiring primary care practices that prioritize workforce development and training in other ways.
Finally, the state can support primary care by improving the accessibility of healthcare systems by making substantial investments in reliable transportation and state-wide investments in high-speed internet. These types of public investments in primary care enabling services help to ensure that a patient’s income or address are not barriers to accessing the healthcare system.
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Written by Deborah Fournier, JD & Alison Mehlman, JD
