A recent industry report highlights underinvestment, workforce strain and payment barriers despite strong evidence linking primary care to lower costs and better outcomes.
Primary care is increasingly being described as the “missing strategy” in addressing chronic disease, but persistent underinvestment, workforce shortages and payment structures that favor procedures over prevention continue to limit its reach, according to a new national report.
The Milbank Memorial Fund and The Physicians Foundation recently released The Health of US Primary Care report, along with an updated Primary Care Scorecard data dashboard examining access, workforce, financing, training and research. The findings highlight growing strain in primary care delivery at a time when chronic disease rates are rising, including among younger adults.
In an interview with Repertoire Magazine, Morgan F. McDonald, MD, National Director of Population Health at the Milbank Memorial Fund, said access to primary care continues to erode.
“Access to primary care is declining – our primary care scorecard shows one-third of adults lack access to a regular source of care, and most of us know the frustration of not being able to be seen when you need to be by someone who knows you. This is because primary care has had only 5% of our health care dollars, which means we have less of it than we need. Evidence shows what primary care can do for health outcomes and costs – and policymakers and others are starting to respond with policies to strengthen primary care,” McDonald said.
The report’s framing of primary care as a “missing strategy” underscores a longstanding imbalance in U.S. health spending, she said, where prevention and coordination are often undervalued compared with procedural care.
Asked what message she would distill for health care leaders, Dr. McDonald emphasized payment reform.
“Shifting more health care dollars to primary care to support comprehensive, coordinated preventive care and chronic disease management will lead to better health and lower costs,” she said.
The report also points to a concerning rise in chronic disease among younger adults, driven by behavioral, environmental and access-related factors.
“There are many factors contributing to the increase, including lack of access to healthy food and exercise, increases in screen time, and environmental exposure – and primary care helps families navigate these challenges. Our report shows that kids with a primary care provider receive more preventive services in childhood from eye exams to obesity prevention, helping to set children on the path to a healthy adulthood,” Dr. McDonald said.
As more patients develop multiple chronic conditions earlier in life, she warned of long-term consequences for both outcomes and spending.
“We should be concerned – and that’s another reason that we need strong primary care. We know regular care will help prevent chronic disease and, if young people do develop conditions like diabetes, primary care teams can help ensure those conditions are managed well to prevent use of expensive ED and hospital services,” she said.
Despite extensive evidence showing that consistent primary care reduces hospitalizations, emergency department visits and overall costs, Dr. McDonald said the U.S. payment system remains a major barrier.
“In U.S. health care, we mostly use fee-for-service payment that pays more for procedures and volume than prevention, coordination, and the thinking it takes to prescribe or stop prescribing a treatment or medication. Changing the current reimbursement structure, which financially benefits many other health care stakeholders, is like stopping a train and requires political will that has not been present until now,” she said.
The economic case, however, is clear, she added.
“Having a usual source of primary care was associated with having nearly 54% lower total health care expenditures for adults with chronic disease, and nearly 40% lower health care expenditures for children with chronic disease, compared to those who did not have a usual source of primary care,” Dr. McDonald said.
She noted that Medicare policy changes may help accelerate broader reform.
“As one of the largest payers for health care, Medicare typically sets the bar for payment reform and other insurers follow. Expanding some of the initial changes Medicare has made – such as the addition of Advanced Primary Care Management (APCM) codes in the 2025 Medicare Physicians Fee Schedule and adjustments to the pricing of Evaluation and Management codes in the 2026 fee schedule – should increase the portion of Medicare spending on primary care,” she said.
Workforce shortages and access barriers remain significant obstacles to continuity of care, Dr. McDonald said, particularly as fewer medical residents choose primary care specialties.
“In many parts of the country, it is difficult to get an appointment with a primary care clinician. Fewer residents are going into primary care given the higher workload and lower reimbursement relative to other specialties. Moreover, the high costs of care are driving more people to avoid routine care,” she said.
Still, she pointed to emerging models that could strengthen delivery systems, including federal payment innovations and state-level reforms.
“There are promising ways to pay appropriately for the work of primary care. Medicare has made some initial steps, such as introducing the Advanced Primary Care Management Codes that pay for team management and the additional work of coordinating care. This needs additional testing and funding for broader implementation,” Dr. McDonald said.
“There are also state examples such as Tennessee’s Patient Centered Medical Home model, supported by the state’s Health Care Innovation Initiative, which serves approximately 40% of the Tennessee Medicaid population. Providers are eligible for a yearly payment based on performance, including outcomes, quality, and efficiency,” she added.
Key takeaways
- Primary care remains underfunded
Only about 5% of U.S. healthcare spending goes toward primary care, despite evidence linking it to better outcomes and lower costs. - Access to care is declining
One-third of U.S. adults do not have a regular source of care, while workforce shortages continue to limit appointment availability. - Chronic disease is rising among younger adults
Experts cite factors including poor nutrition access, increased screen time and environmental exposures. - Current payment models favor procedures over prevention
Fee-for-service reimbursement often undervalues preventive care, coordination and chronic disease management. - Primary care reduces healthcare costs
Adults with chronic disease who have a regular primary care provider experience nearly 54% lower healthcare expenditures compared to those without one.
A Healthy Future
Looking ahead five years, Dr. McDonald said success would be defined by structural and workforce gains that make primary care more accessible and sustainable. The United States would be:
- Paying primary care more and differently, so that primary care teams can provide patient-centered, whole-person care in a sustainable way
- Enabling more people to have regular access to a primary care clinician
- Expanding and supporting the current and future primary care workforce.