Health Reform and the Future of Primary Care

The 2010 health reform act created the potential for substantial expansions in access to primary care services. Based on the acknowledgement that primary care is at the center of an affordable high performing health care system, several provisions in the health reform bill were intended to expand access to primary care. The Community Health Center (CHC) program is slated to double its capacity and add 20 million people to the 20 million patients it already serves by 2015. State reimbursement for primary care services under Medicaid will rise to Medicare rates in 2013. And reimbursement in primary care in general is slated to rise by 10%. There is an opportunity to fix the unfair relative value scale that currently handicaps primary care at the expense of specialty medicine. Health workforce initiatives are intended to expand the supply of primary care providers with more training and national health service corps scholarships. At the same time, substantial challenges confront this agenda. The pipeline of primary care providers is imperiled and may not be reconstructed quickly enough by the expansions of medical education and scholarships that were placed in the Health Reform package. Shortages of primary care providers are likely to continue and even worsen as access expands creating the potential to undermine primary care as some communities rely on an oversupply of specialty providers. If the reimbursement system is not substantially changed, it will imperil efforts to get more out of the system and moderate spending through proven primary care elements and principles like continuity, coordination, case management, and patient activation. Substantial efforts are needed to bring good intentions regarding primary care to fruition.