THE ISSUE
A high-functioning primary care system is critical to the overall health care system and is key to better health outcomes, lower costs, and more equitable access to care. Robust access to primary care services improves overall population health and may
reduce avoidable emergency department visits. The Medical Society is concerned about the sustainability of primary care practices in Massachusetts, especially as the COVID-19 pandemic has caused unprecedented challenges and disruptions across all
health care settings.
The Massachusetts Center for Health Information and Analysis (CHIA) in collaboration with Massachusetts Health Quality Partners (MHQP), has published Massachusetts’ first-ever dashboard of metrics to monitor the health status of the primary care system
in the Commonwealth. Spending on primary care as a percentage of total medical spending in 2020 was 7.3% for commercial patients, 6.5% for MassHealth MCO/ACO-A patients, and 4.6% for Medicare Advantage enrollees.
In a recent research brief published by CHIA, it was reported that Black and Hispanic residents report a higher likelihood of potential reliance on hospital emergency departments for health care than white residents, driven in part by the lack of a primary
care relationship.
OUR STANCE
The Medical Society supports a system of primary care that delivers equitable access to care for all, that incentivizes practice transformation toward a comprehensive model of care, that significantly increases the funding for primary care to allow for
and encourage such transformation, and that allocates resources in an intentionally antiracist and just fashion, accounting for the severity of illness and social determinants of the population. Investments in primary care can promote higher-quality
and lower-cost care across the health care system. The role of the primary care provider in coordinating care is key, especially for an increasingly aging population with high rates of chronic disease and for the pediatric population, where primary
care providers can address adverse childhood experiences and promote optimal health and development at crucial points in a child’s life.
Further, investing in an integrated and more highly coordinated primary care behavioral health system is also necessary to improve overall health and health outcomes. The Medical Society released a report, Integrating Mental Health and Substance Use Care
in Your Practice: Models, Challenges, and Recommendations, which provides an overview of the current state of the mental health crisis in Massachusetts, describes real-world models of integrated care, delineates barriers to behavioral
health and substance use integration, and offers recommendations for a future of integrated primary care/mental health and substance use care in the Commonwealth. These recommendations are consistent with and complement the Commonwealth’s Roadmap
for Behavioral Health Reform.
OUR ADVOCACY
Valuing primary care physicians through increased investment, support, and stabilization is the direction our health system must embrace, while also ensuring any policies to promote increased investment in primary care initiatives are fairly allocated
and do not harm other medical practices that are struggling to remain afloat. Many practices are dealing with significant backlogs in care caused by the necessary deferral of care during the early phases of the pandemic, encountering workforce challenges
brought on by workforce shortages and historic increases in costs of labor, and facing overall expense growth resulting from inflation and new demands on the pandemic-related practice of medicine. The details of any such proposal are critical regarding
how money should be invested and, perhaps most importantly, how the investments are to be evaluated.
In the 2023–24 legislative session, the MMS supports An Act relative to primary care for you (S.750), filed by Senator Cindy Friedman. This legislation would double primary care investment in Massachusetts and switch the predominant payment model
for primary care in Massachusetts from fee-for-service to monthly prospective payment. In doing so, we can decrease health inequities and begin dismantling systemic racism in health care.
