How the Affordable Care Act Will Strengthen the Nation's Primary Care Foundation



As the country turns toward implementation of the Patient Protection and Affordable Care Act, realizing the potential of reform will require significant transformation of the American system of health care delivery. To that end, the new law seeks to strengthen the nation’s primary care foundation through enhanced reimbursement rates for providers and the use of innovative delivery models such as patient-centered medical homes. Evidence suggests that these strategies can return substantial benefits to both patients and providers by increasing access to primary care services, reducing administrative hassles and burdens, and facilitating coordination across the continuum of care. If successfully implemented, the Affordable Care Act has the potential to realign incentives within the health system and create opportunities for providers to be rewarded for delivering high value, patient-centered primary care. Such a transformation could lead to better outcomes for patients, increase job satisfaction among physicians and encourage more sustainable levels of health spending for the nation.


Affordable Care Act health reform delivery system reform primary care patient-centered medical home 


  1. 1.
    Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457–502.PubMedCrossRefGoogle Scholar
  2. 2.
    Davis K, Schoen C, Stremikis K. Mirror, mirror on the wall: How the performance of the U.S. health care system compares internationally, 2010 update. New York: The Commonwealth Fund; 2010.Google Scholar
  3. 3.
    Abrams M, Nuzum R, Mika S, Lawlor G. Health reform and primary care: Implications for patients, providers, and payers. New York: The Commonwealth Fund; 2010.Google Scholar
  4. 4.
    Macinko J, Starfield B, Shi L. Quantifying the health benefits of primary care physician supply in the United States. Int J Health Serv. 2007;37(1):111–26.PubMedCrossRefGoogle Scholar
  5. 5.
    Shih A, Davis K, Schoenbaum S, Gauthier A, Nuzum R, McCarthy D. Organizing the US health care delivery system for high performance. New York: The Commonwealth Fund; 2008.Google Scholar
  6. 6.
    The Commonwealth Fund Commission on a High Performance Health System. Why not the best? Results from the National Scorecard on US health system performance, 2008. New York: The Commonwealth Fund; 2008.Google Scholar
  7. 7.
    Stremikis K, Schoen C, Fryer AK. A call for change: Commonwealth Fund 2011 survey of public views of the U.S. health system. New York: The Commonwealth Fund; 2011.Google Scholar
  8. 8.
    Davis K, Stremikis K. Family medicine: preparing for a high-performance health care system. J Am Board Fam Med. 2010;23(Suppl 1):S11–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Davis K, Guterman S, Collins SR, Stremikis K, Rustgi S, Nuzum R. Starting on the path to a high performance health system: Analysis of the payment and system reform provisions in the Patient Protection and Affordable Care Act of 2010. New York: The Commonwealth Fund; 2010.Google Scholar
  10. 10.
    Davis K. A new era in American health care: Realizing the potential of reform. New York: The Commonwealth Fund; 2010.Google Scholar
  11. 11.
    Davis PA, Hahn J, Hoffman GL, Morgan PC, Stone J, Tilson S. Medicare provisions in the Patient Protection and Affordable Care Act: Summary and timeline. Washington: Congressional Research Service; 2010.Google Scholar
  12. 12.
    Congressional Budget Office. Letter to the Honorable Nancy Pelosi. Washington: Congressional Budget Office; 2010.Google Scholar
  13. 13.
    Division of Governmental Affairs and Public Policy. An internist’s practical guide to understanding health system reform. Washington: American College of Physicians; 2010.Google Scholar
  14. 14.
    Zuckerman S, Williams AF, Stockley KE. Trends in Medicaid physician fees, 2003–2008. Health Aff (Millwood, Va). 2009;28(3):w510–9.CrossRefGoogle Scholar
  15. 15.
    Reid RJ, Coleman K, Johnson EA, et al. The group health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers. Health Aff (Millwood, Va). 2010;29(5):835–43.CrossRefGoogle Scholar
  16. 16.
    Gilfillan RJ, Tomcavage J, Rosenthal MB, et al. Value and the medical home: effects of transformed primary care. Am J Manag Care. 2010;16(8):607–14.PubMedGoogle Scholar
  17. 17.
    Grumbach K, Bodenheimer T, Grundy P. The outcomes of implementing patient-centered medical home interventions: A review of the evidence on quality, access and costs from recent prospective evaluation studies, August 2009. Washington: Patient-Centered Primary Care Collaborative; 2009.Google Scholar
  18. 18.
    Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, Part 2. JAMA. 2002;288(15):1909–14.PubMedCrossRefGoogle Scholar
  19. 19.
    Guterman S, Davis K, Stremikis K, Drake H. Innovation in Medicare and Medicaid will be central to health reform's success. Health Aff (Millwood, Va). 2010;29(6):1188–93.CrossRefGoogle Scholar
  20. 20.
    Commonwealth Fund Commission on a High Performance Health System. The path to a high performance U.S. health system: A 2020 vision and the policies to pave the way. New York: The Commonwealth Fund; 2009.Google Scholar
  21. 21.
    Guterman S, Schoenbaum SC, Davis K, et al. High performance accountable care: Building on success and learning from experience. New York: The Commonwealth Fund; 2011.Google Scholar
  22. 22.
    Rittenhouse DR, Shortell SM, Fisher ES. Primary care and accountable care–two essential elements of delivery-system reform. N Engl J Med. 2009;361(24):2301–3.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Karen Davis
    • 1
  • Melinda Abrams
    • 2
  • Kristof Stremikis
    • 1
  1. 1.The Commonwealth FundNew YorkUSA
  2. 2.Patient-Centered Coordinated Care,The Commonwealth FundNew YorkUSA

Personalised recommendations