The Changing Landscape Of Primary Care: Effects Of The ACA And Other Efforts Over The Past Decade

Abstract

Providing high-quality primary care is key to improving health care in the United States. The Affordable Care Act sharpened the emerging focus on primary care as a critical lever to use in improving health care delivery, lowering costs, and improving the quality of care. We describe primary care delivery system reform models that were developed and tested over the past decade by the Center for Medicare and Medicaid Innovation-which was created by the Affordable Care Act-and reflect on key lessons and remaining challenges. Considerable progress has been made in understanding how to implement and support different approaches to improving primary care delivery in that decade, though evaluations showed little progress in spending or quality outcomes. This may be because none of the models was able to test substantial increases in primary care payment or strong incentives for other providers to coordinate with primary care to reduce costs and improve quality.

Keywords: Affordable Care Act; Center for Medicare and Medicaid Innovation; Federally qualified health centers; Health policy; Medicaid services; Medicare; Organization of care; Patient-centered medical homes; Payment; Quality of care; primary care.