Greater Spending on Primary Care: A Key Element to Alternative Payment Models’ Success


Leslie Champlin
Senior Public Relations Strategist
(800) 274-2237, Ext. 5224 


WASHINGTON, DC — Alternative payment models alone cannot resolve the challenges facing the U.S. health care system. Instead, APMs should be seen as “kindling for ongoing primary care innovation” that includes increased overall spending on primary care.

Those are two of the conclusions by 150 U.S. and Canadian health policy and research experts who attended a symposium on advancing primary care through alternative payment models. The experts came together during a bi-national symposium to review and analyze U.S. and Canadian efforts to transform their health care systems away from fee-for-service and toward paying for quality and outcomes of care.

Their observations and recommendations are summarized in “Advancing Primary Care Through Alternative Payment Models: Lessons from the United States & Canada(,” by Andrew Bazemore, M.D., M.P.H., director of the Robert Graham Center. Published in the May/June issue of the Journal of the American Board of Family Medicine, the article summarizes key lessons and implications for health policy makers, payers and researchers.

“There was general consensus that altering payment models alone, absent incentives for innovation and continuous learning as well as increased proportional spending on primary care overall, wouldn’t correct health system deficiencies,” Bazemore wrote.

Although symposium attendees strongly support APM experimentation, they offered lessons that would help ensure development of successful payment models. Among them:

  • APMs are “falsely promoted as a panacea for health system problems” and instead should be “seen as kindling for ongoing primary care innovation.”
  • “Regardless of the APM chosen, overall spending on primary care must increase to achieve health system aims.”
  • Researchers should evaluate how APMs promote or inhibit health equity.
  • Health care practices and providers cannot bear all the cost of transformation; they will require prospective compensation, either as a capitated or a blended payment.

APMs hold promise for advancing primary care, but wider system changes are necessary to ensure their success, Bazemore wrote. “APMs alone would fail to capture the positive primary care effect on creating healthy populations, satisfied patients and lower costs,” Bazemore wrote. “…Ultimately, to improve health care and health outcomes in a sustainable way, it will be necessary to make primary care the center of the health care system, invest in it adequately, and organize and pay for it deliberately to align incentives, support teams, foster innovation, and provide ‘joy’ in practice.”


About the Robert Graham Center

The Robert Graham Center for Policy Studies in Family Medicine and Primary Care works to improve individual and population health by enhancing the delivery of primary care. The Center staff generates and analyzes evidence that brings a family medicine and primary care perspective to health policy deliberations at local, state, and national levels.

Founded in 1999, the Robert Graham Center is an independent research unit affiliated with the American Academy of Family Physicians (AAFP). The information and opinions contained in research from the Center do not necessarily reflect the views or policy of the AAFP.