Providing high quality primary care is key to improving health care in the United States. One decade ago, the Affordable Care Act (ACA) was passed, transforming the nation’s health care coverage, delivery, and payment. In particular, the ACA sharpened the emerging focus on primary care as a critical lever to improve health care delivery, lower costs, and improve the quality of care. In the March issue of Health Affairs, which is devoted to examining the effects and legacy of the ACA, Mathematica’s experts discuss “The Changing Landscape of Primary Care: Effects of the ACA and Other Efforts over the Past Decade.” To support this retrospective, the authors drew on their collective experience as evaluators of the Comprehensive Primary Care and Comprehensive Primary Care Plus initiatives; their decades of experience conducting research on primary care; and, for two of the authors, their direct clinical experience delivering primary care.
The article describes primary care delivery system reform models that the Center for Medicare & Medicaid Innovation—which was created by the ACA—developed and tested during its first decade and reflects on key lessons and remaining challenges. Although we have made considerable progress in understanding how to implement and support different approaches to improving primary care delivery in that decade, evaluations showed little progress in spending or quality outcomes. This might be because none of the models fundamentally changed primary care payment or offered strong incentives for other providers in the health system to coordinate with primary care to reduce costs and improve quality.
“As the ACA enters its second decade, it’s an ideal time to reflect on the models tested to date, their effects, and lessons learned,” said Deborah Peikes, senior fellow and lead author. “The first generation of models has produced many insights about how to support primary care practices to improve care delivery. The next generation of models should test bolder changes in payments to primary care with accompanying incentives for specialists and hospitals to improve patient outcomes.”
