How smart policy can strengthen primary care and improve health outcomes

Primary care physicians, lawmakers, and researchers explored the policy levers that can make the biggest difference in improving the foundation of U.S. public health

In the wake of recent and proposed federal budget cuts to Department of Health and Human Services agencies, health experts say now is not the time to pull back on foundational health care. Rather, it’s time for the U.S. to invest more in its primary care system.

Primary care professionals, health policy experts, and researchers came together at the Johns Hopkins University Bloomberg Center recently to discuss how payment frameworks and policy can strengthen primary care systems and improve health outcomes.

Why is primary care reform important right now?

Primary care is the backbone of health care in the U.S., according to Eliana Perrin, Bloomberg Distinguished Professor of primary care at Johns Hopkins University. It’s the least expensive and most efficient way of delivering care with the ultimate goal of preventing health issues before they arise.

And while the U.S. spends, on average, twice as much per person on health care as other large, wealthy countries, it invests less in primary care than peer nations.

“We have failed social policy, and we are seeing that,” Perrin said. Patients’ increasingly complex health needs are demanding more time, time that primary care doctors—already struggling with burnout—don’t have. The erosion of trust in doctors—demonstrated by prior authorization and patient skepticism of treatments like vaccines—only makes care more challenging, she added.

The U.S. has a lower life expectancy than other high-income nations, and the country’s death rates from chronic diseases of the liver, kidneys, and respiratory system, as well as diabetes, are rising. Meanwhile, in other similar countries, they’ve remained the same or even decreased.

The U.S. has historically underinvested in its primary care system, according to a 2024 report. As a result, experts said doctors and patients are both suffering. Primary care doctors are choosing other careers or transitioning to part-time care, trainees aren’t staying in the primary care field long term, and patients are seeing a decline in good primary care as a consequence, said Yalda Jabbarpour, family medicine physician and director of the American Academy of Family Physicians’ Robert Graham Center for Policy Studies.

“It goes back to the fact that we are just not financially and otherwise supporting primary care the way that we are supporting other specialties,” she said. “It’s this self-fulfilling cycle: We can’t support primary care; therefore, we don’t have a primary care system that’s meeting the needs of the patients; therefore, the patients are choosing to go to subspecialists instead of primary care, which means, again, we’re not supporting primary care.”

How can policy help improve the primary care system?

Experts agree that primary care physicians can still do more to collaborate across disciplines, leverage AI technology, and build stronger ties in the community to reduce burnout, build public trust, and improve quality of care. But they also acknowledge that there must be broader institutional reforms, too.

“If we don’t empower and encourage and raise up evidence-based leadership in health care policy, we regress,” said Emily Maxson, partner at Despierta, a Miami-based venture capital firm that invests in mission-driven health care and AI companies. “We cannot achieve health outcomes that we desire, we cannot achieve efficiency, with that type of regression.”

Part of strengthening public trust in primary care doctors also involves amplifying their voices, Maxson said.

“If we can empower them, give them the megaphones, and help patients regain that trust in these experts who have trained for a long time to serve them, we will be better served as a health care system,” she said.

More broadly, stronger policy can support a better primary care system and improve public health outcomes in a few ways.

Reforming the payment model. Primary care reform advocates often propose transitioning from the current system of fee-for-service care to a value-based model. This would pay doctors for the quality and outcomes of their treatments instead of reimbursing them based on the volume and extent of tests and services.

While Zirui Song, associate professor of health care policy and medicine at Harvard Medical School and primary care physician, supports the transition to value-based primary care with risk adjustment, he acknowledged it’s a complex and difficult process that lacks a basic playbook to help facilitate that transition.

“For the country to do this, across all the health systems and the community centers and the practices that are private practice, it’s a tall order,” he said. “We’re very far from that vision.”

An opportunity for payment reform within the current model, Maxson noted, is to address the reimbursement gap. There’s lower reimbursement for primary care than specialty care services, which contributes to the overall compensation disparity between primary care doctors and specialists.

Social determinants of health. Coupled with payment reform, other policies that address social determinants of health can support a better, more cost-efficient primary care system by taking a holistic approach to improving health outcomes, Maxson said. These policies may look at other factors in a patient’s life, such as access to housing and quality education, that are upstream influences of health.

Research. More data on the financial impacts of primary care can help inform more policy support for the field, Perrin said. There aren’t any models on the long-term impacts of pediatrics, for example, or how primary care can lower costs in other areas like social welfare, education, or employment. Funding research that helps connect those dots can support a healthier America, she said.

Bipartisan health care legislation to watch

Despite budget cuts to health and scientific agencies and institutions, some legislators are working across the aisle to propose solutions for a stronger health care system.

The Pay PCPs Act. In 2024, Sen. Sheldon Whitehouse, D-R.I., and Bill Cassidy, R-La., introduced the Pay PCPs Act, legislation to increase pay for primary care providers and improve patient care through hybrid payments linked to health outcomes.

The Preserving Patient Access to Accountable Care Act. Introduced by Whitehouse and Sen. John Barrasso, R-Wyo., in April 2025, this legislation focuses on improving care for seniors by using Medicare incentive payments to prioritize value-based models.

The Kids’ Access to Primary Care Act. Introduced by a bipartisan group of representatives in February 2025, this bill aims to expand primary care access for children and families by increasing Medicaid payment rates to at least the same rate as Medicare for primary care services. This would help broaden the provider network and help doctors sustain their practices.