Advanced Primary Care at a Turning Point: What’s Changing, What Matters and What’s Next

Primary care is the foundation of a high-performing healthcare system, but workforce shortages, access challenges and rising costs are putting that foundation under increasing strain.

That reality framed a keynote discussion at NCQA’s Health Innovation Summit featuring Asaf Bitton, MD, MPH, Executive Director of Ariadne Labs; Anna Flattau, MD, Chair of Family and Community Medicine at Thomas Jefferson University; Kyu Rhee, MD, MPP, President and CEO of the National Association of Community Health Centers (NACHC); and Daniel Stein, Founder and President of Embold Health.

Key Takeaways From This Session

Community Health Centers Demonstrate Primary Care’s Value and Vulnerability

Community health centers represent one of the strongest examples of primary care’s ability to improve access and advance health equity at scale. Today, they serve 52 million people, or one in seven Americans, at more than 17,000 locations nationwide while accounting for only about 1% of healthcare spending.

But this success exists alongside mounting financial pressure. Because they serve patients regardless of ability to pay, coverage and funding reductions could leave them caring for more uninsured patients with fewer resources.

Balancing ‘Big Q’ and ‘Little Q’ Quality

Panelists emphasized that quality measurement should support, not overshadow, the core elements of primary care.

Flattau distinguished between “big Q” quality, which includes access, continuity, comprehensiveness and trust, and “little Q” quality, such as screening rates and chronic disease control. “If we engage in the big Q quality,” she said, “the little Q quality will come afterward.”

The panel argued that strengthening these foundational dimensions of care creates the conditions for sustainable improvement across individual quality measures.

Create a Simple, Portable Measure Set

A recurring theme was the need to simplify measurement. Rhee called for a small, consistent set of primary-care-sensitive measures that could be used across Medicaid, Medicare, commercial and employer-sponsored coverage.

“I’d love a top 10 list of measures that we all consistently agree are improving our nation’s health,” he said. Blood pressure control, diabetes control and colorectal cancer screening were cited as examples of measures that could remain consistent regardless of a patient’s coverage type.

A more aligned approach could reduce administrative burden and help organizations focus more resources on improvement rather than reporting.

Access Is a Quality Issue

For patients, quality begins with access. Can they get an appointment? Can they see a clinician who knows them? Can they get the care they need when they need it?

Stein noted that employers increasingly recognize primary care’s value, but access remains a major obstacle. “We keep hearing from employees, ‘It’s a six-month wait,’ or, ‘I’m not taking new patients,'” he said.

These challenges are fueling interest in virtual-first, AI-enabled and employer-based primary care models. While innovation may help expand capacity, panelists stressed that it should strengthen, not replace, continuous, relationship-based care.

Set Concrete Targets for Primary-Care Investment

The panel translated primary care’s challenges into three measurable goals:

• Increase primary care spending from 5% to 10% of healthcare expenditures.
• Expand access to a usual source of care from 10% to 20%.
• Increase the share of physicians entering primary care from 20% to 40%.

Panelists also encouraged quality leaders to connect quality improvement efforts to financial outcomes. Stein advised attendees to “make that CFO your friend,” arguing that understanding how organizations evaluate ROI makes it easier to demonstrate the value of primary care investments.

Looking Ahead

The panel concluded with a simple but powerful message: primary care is not separate from quality. It is foundational to it.

As healthcare organizations work to improve outcomes, advance equity and control costs, success will depend on stronger investment in primary care, simpler measurement and better alignment across the healthcare ecosystem.

As Bitton reminded attendees, “You can’t have a quality strategy without primary care.”

Learn More

We will post more insights from the Health Innovation Summit on our blog, so stay tuned.