Abstract

High-quality primary care is the foundation of a high-functioning health care system and is critical for achieving health care’s quadruple aim (enhancing patient experience, improving population health, reducing costs, and improving the health care team experience). High-quality primary care provides comprehensive person-centered, relationship-based care that considers the needs and preferences of individuals, families, and communities. Primary care is unique in health care in that it is designed for everyone to use throughout their lives—from healthy children to older adults with multiple comorbidities and people with disabilities. People in countries and health systems with high-quality primary care enjoy better health outcomes and more health equity.

In 1996, the Institute of Medicine released Primary Care: America’s Health in a New Era. The report made comprehensive recommendations to improve primary care, most of which were never implemented. As a result, the current Committee on Implementing High-Quality Primary Care was charged to build on the recommendations of the 1996 report and to develop an implementation plan for high-quality primary care in the United States.

The committee’s implementation plan targets primary care stakeholders, balancing national needs for scalable solutions while allowing for local fit. The implementation plan includes five objectives to make high-quality primary care available for everyone in the United States.

1. Pay for primary care teams to care for people, not doctors to deliver services.

2. Ensure that high-quality primary care is available to every individual and family in every community.
3. Train primary care teams where people live and work.
4. Design information technology that serves the patient, family, and interprofessional care team.
5. Ensure that high-quality primary care is implemented in the United States.

The committee’s implementation plan—comprising recommended actions under each implementation objective—builds on a three-element implementation strategy:

1. An implementation framework, with three levels of change that accounts for the complexity of the U.S. health care system and its public- and private-sector actors.
2. An accountability framework that establishes a structure and process for assessing the adequacy and completeness of implementation activities.
3. A public policy framework that prioritizes developing government policy to implement high-quality primary care, consistent with its status as a common good.

The committee’s implementation plan calls for appropriately scaled actions by public- and private-sector actors at the macro, meso, and micro system levels and recommends accountability structures to ensure the work gets done. The value of primary care is beyond dispute, with extensive research identifying policies and practices that facilitate high-quality primary care. The actions within this plan will promote and effectively scale those policies and practices. (See the Summary or the report for a full description and discussion of each recommended action.)

The nation deserves nothing less than high-quality primary care for all, but creating such a system requires leadership, accountability, and a clear path forward to accomplish this work. The committee hopes the work captured in this report realizes this vision sooner rather than later.