Building Toward a Healthier New York: Investing in Primary Care

Primary care is the bedrock of our nation’s health care system, and foundational to our pursuit of better health. Despite strong evidence that access to primary care reduces emergency department use, improves health outcomes, reduces disparities, and lowers long-term health care costs, America’s investment in primary care continues to lag behind peer countries. In the U.S., between 5% and 7% of total health care spending goes to primary care—less than half the share spent by other developed nations (~14%)—and a proportion that may be declining over time.

The structure and financial incentives of the U.S. health care delivery system are likely contributors to its lower primary care expenditures. Pervasive fee-for-service (FFS) payment models incentivize the delivery of higher-cost procedural and specialty care services while undervaluing preventive care.

Federal and state policymakers have recognized the need for payment rebalancing, establishing programs and policies that redirect more of America’s health care dollars toward primary care to improve long-term health outcomes and reduce costs. States have promoted value-based payment (VBP) adoption through models such as Patient Centered Medical Homes (PCMHs) or Accountable Care Organizations (ACOs), which strengthen integrated care teams, enhance coordination, expand workforce capacity, and improve access. Further, at the federal level, the U.S. Centers for Medicare and Medicaid Services (CMS) has advanced efforts to scale VBP models through the State Rural Health Transformation (RHT) Program, directing funding to states with continued commitment to regional primary care VBP capacity. In parallel, nearly 20 states have established policies to explicitly define, measure, and/or increase primary care spending as a proportion of overall health care expenditures—an approach New York is presently considering. In 2022, only 4.1% of New York’s health care spending went to primary care, a proportion that has likely remained even or declined over the past decade.

As American health care costs continue to rise and states confront reductions in federal support for programs such as Medicaid, the imperative to realize the health-improving and cost-saving potential of primary care has never been greater. This brief seeks to provide policymakers and other stakeholders with information on primary care’s impact on improving health and reducing costs; state strategies to strengthen primary care investments; and New York’s history of primary care investment, as it considers new opportunities for reform.

Key Takeaways:

• Access to and use of primary care improves health outcomes and helps individuals avoid care delivered in more expensive settings, yet continues to be under-resourced nationally.
• States are actively pursuing policy strategies to bolster primary care infrastructure, with nearly 20 states now having established requirements to measure and/or increase primary care investments.
• New York State’s primary care infrastructure continues to lag behind that of many other states, fueling calls for the establishment of a primary care investment target.

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