What are the key components and recommendations for primary health care?

Primary Health Care: Core Components and Implementation Framework

High-quality primary care must be built on Barbara Starfield's foundational "4 Cs"—comprehensive whole-person care, first-contact accessibility, continuous longitudinal relationships, and coordinated care—while integrating digital health infrastructure and addressing social determinants to improve population health outcomes. 1

Foundational Framework: The 4 Cs of Primary Care

Primary care functions are defined by four critical characteristics that distinguish it from specialty care and drive better health outcomes 1:

• Comprehensive care: Focus on whole-person health across all potential health situations, not disease-specific episodes 1
• First contact: Serve as the initial entry point for information-seeking and data collection when new health issues arise 1
• Continuous care: Maintain longitudinal relationships that track individuals' health trajectories as issues evolve over time, rather than episodic encounters 1
• Coordinated care: Integrate and curate comprehensive patient information across the healthcare system 1
• Contextual care: Incorporate social determinants of health and daily life information into care delivery 1

Five Strategic Objectives for Implementation

The National Academies of Sciences, Engineering, and Medicine established five core objectives that must be pursued simultaneously 1:

1. Pay for Primary Care Teams to Care for People

• Recognize that primary care receives only 5.4% of healthcare spending despite providing over half of outpatient visits—this funding inadequacy must be corrected 2
• Shift payment models to support relationship-based, continuous care rather than volume-based encounters 1
• Ensure adequate budgetary resources through coordinated primary care policy 1

2. Ensure Universal Access to High-Quality Primary Care

• All payers should require beneficiaries to declare a usual source of care, as having any usual source of care is associated with higher preventive service uptake, greater access to treatment including mental health services, and greater health system satisfaction 1, 3
• Create new health centers, rural health clinics, and Indian Health Service facilities in shortage areas to address geographic disparities 1
• Revise access standards for Medicaid beneficiaries with adequate state agency resources 1
• Primary care practices must assume ongoing relationships with uninsured patients they treat 1, 2
• Include community members in governance, design, and delivery while partnering with community-based organizations 1

3. Train Primary Care Teams Where People Live and Work

• Permanently support COVID-era rule revisions that expanded training flexibility 1
• Integrate community members into practice governance and delivery structures 1
• Develop competencies in collaborative goal-setting, cardiovascular risk assessment, functional impairment evaluation, immunization status review, and medication reconciliation 2
• Train clinicians to prioritize and sequence care when patients present with multiple competing issues 2
• Build skills in recognizing when acute presentations require specialist consultation versus primary care management 2

4. Design Information Technology That Serves Patients and Care Teams

Digital health certification standards must fundamentally shift from the Meaningful Use approach to support relationship-based, continuous, person-centered care 1:

• Develop next-generation certification standards that simplify user experience, ensure equitable access, and hold vendors accountable 1
• Adopt comprehensive aggregate patient data systems usable by any certified digital health tool for patients, families, clinicians, and care team members 1
• Automatically measure user experience (clicks, time spent, data transferred without manual review, efficiency, outcomes) rather than requiring clinicians to check boxes 1
• Integrate social determinants of health and wearable/home monitoring data automatically into existing systems 1
• Support whole-person information applicable to any health situation, not disease-specific data silos 1

5. Ensure Implementation Through Governance and Accountability

• Establish a Secretary's Council on Primary Care within HHS to coordinate policy, ensure adequate budgetary resources, report to Congress and the public, and receive guidance from a Primary Care Advisory Committee 1
• Form an Office of Primary Care Research at NIH and prioritize funding at AHRQ 1
• Assemble and disseminate a "High-quality primary care implementation scorecard" through professional societies, consumer groups, and philanthropies to improve accountability 1

Evidence of Primary Care's Impact on Health Outcomes

Primary care demonstrably improves population health and reduces health inequities 4:

• Primary care prevents illness and death regardless of whether characterized by supply of primary care physicians, relationship with a source of care, or receipt of key primary care features 4
• Primary care is associated with more equitable health distribution in populations, both cross-nationally and within nations 4
• Having a usual source of care at the primary level increases preventive service uptake and treatment access, including mental health services 3
• 75% of respondents globally report having a usual source of care, with 40% accessing it in the public sector at primary level 3

Critical Pitfalls to Avoid

Do not perpetuate the Meaningful Use approach that focused on adoption metrics rather than functional support for primary care's core characteristics 1. The digital health infrastructure must serve continuous relationships, not episodic documentation.

Do not ignore social determinants of health—poverty, food insecurity, lack of transportation profoundly affect outcomes and must be systematically addressed through team-based approaches that identify community resources and connect patients 2.

Do not assume specialty care can substitute for primary care—the evidence clearly shows primary care's unique contribution to health outcomes and equity that specialty care does not replicate 4.

Do not delay establishing usual sources of care—the relationship itself drives better outcomes independent of specific interventions 3, 4.