A group of independent philanthropies, including NYHealth, called on the U.S. Department of Health and Human Services to release its Action Plan for Primary Health Care. In addition to any new federal initiatives called for in the Action Plan, its release would give structure, coherence, and acceleration to numerous other public and private sector initiatives already underway to systematically strengthen primary health care.

September 8, 2023
The Honorable Xavier Becerra
Secretary, U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201

Dear Secretary Becerra:

We are a group of independent philanthropies committed to promoting a high-performing U.S. health system, built on a strong foundation of accessible, equitable, high-quality, and comprehensive primary care. We are writing to encourage the release of the U.S. Department of Health and Human Services (HHS) Action Plan for Primary Health Care. Release of the Action Plan would send a clear signal that the Administration believes primary care is a priority area and one in need of federal policy action, help identify key strategies and priorities for re-building the foundation of primary health care, and serve to coordinate and build momentum for public and private initiatives.

As the 2021 National Academy of Sciences, Engineering and Medicine (NASEM) Report “Implementing High-Quality Primary Care” notes, primary care is an essential health service associated with improved life expectancy and health equity. Evidence is clear that improving the capacity and quality of primary health care so that it can improve the health and wellbeing of whole persons and whole populations is essential to successfully addressing the nation’s most pressing health crises and the Administration’s health priorities including:

  • Ending the decline in life expectancy in the U.S.;
  • Reducing the cost of health care for patients and families;
  • Advancing health equity;
  • Addressing a burgeoning mental health crisis;
  • Responding to the opioid epidemic; and
  • Developing a reliable system for identifying and mitigating the next health-related emergencies, including pandemics.

Primary care is the most fair, efficient, and accessible way for all people – regardless of race, ethnicity, or income – to enter the health care system and obtain the services they need. Decades of evidence link primary care’s defining elements – continuity, coordination, comprehensiveness, and whole-person care – to improved health equity, as recently summarized by The California Health Care Foundation.

Yet the state of primary care is fragile and weakening. The recent National Primary Care Scorecard from the Milbank Memorial Fund found the portion of U.S. healthcare spending going to primary care is just five to 12 cents on the dollar and has declined in the last ten years. Moreover, the reliance on fee-for-service fails to reimburse, or inadequately reimburses, physicians for services that contribute to high-quality, comprehensive, and personalized care. Fewer people can identify a usual source for their care, and the gap between communities with adequate and inadequate supplies of primary care clinicians is widening. Research supported by the Commonwealth Fund has found that, compared to other high-income countries, U.S. patients are among the least likely to have a usual source of care or a longstanding relationship with a primary care provider. This trend is only likely to worsen as providers leave the workforce in historic numbers due to burnout and more physicians reaching retirement age, particularly in communities with historically few primary care clinicians like rural areas.

The NASEM Report was clear that federal policy leadership across all agencies of HHS will be essential to address the gap between primary health care’s status and its potential. We are pleased that HHS leadership has signaled the important aims of the Action Plan, which are aligned with the NASEM Report’s recommendations and would be a major step in making clear the Administration’s commitment to rebuilding the U.S. primary health care system through a coordinated, cross-agency effort.

With federal leadership – and in partnership with the private sector and state government – this rebuilding of the primary care infrastructure can be realized. The Action Plan could serve to chart the course to meaningfully strengthen primary health care. Multiple stakeholders across the country have reviewed, provided feedback, and articulated enthusiastic support for the Action Plan. Upon release, to ensure successful implementation of the Action Plan, and as the NASEM Report recommended, HHS could create a Secretary’s Council on Primary Care to execute the initiatives of the plan and ensure coordination across HHS agencies to re-build primary health care in the U.S.

In addition to any new federal initiatives called for in the Action Plan, release of it will give structure, coherence, and acceleration to numerous other public and private sector initiatives already underway to systematically strengthen primary health care, including:

  • The newly funded NASEM Standing Committee on Primary Care, authorized by statute to advise the Action Plan.
  • The recently announced “Making Care Primary” Model from the Center for Medicare and Medicaid Innovation which will shift primary care payments from fee-for-service to capitated payments and transform primary care delivery in 8 states.
  • Proposed federal rules modifying the Medicare Physician Fee Schedule, awarding of Graduate Medical Education slots, and Medicaid provider access standards.
  • The 20 states that have passed legislation to measure and/or increase primary care investments across all payers, as supported by the New York Health Foundation and California Health Care Foundation, among other private funders.
  • Section 1115 Medicaid waivers granted to Oregon and Massachusetts which authorize primary care payment reforms.
  • Upcoming Congressional reauthorization of the Community Health Center, Teaching Health Centers and National Health Service Corp programs.
  • The recent guidance on financing whole person, whole population health detailed in the NAM Report “Valuing America’s Health.”

We hope these activities are clear signals that there is pent-up demand for action to strengthen primary health care, many ready partners, and an urgent need for coordinated federal leadership. Releasing the Action Plan will build momentum and signal the Administration’s commitment to addressing its stated priorities.

Thank you for your public service and your attention to our request.


Mark E. Miller, Executive Vice President of Health Care, Arnold Ventures
Sandra R. Hernández, President and Chief Executive Officer. The California Health Care Foundation
Joseph R. Betancourt, President, The Commonwealth Fund
Wayne Jonas, President, Healing Works Foundation
Christopher F. Koller, President, The Milbank Memorial Fund
David Sandman, President and Chief Executive Officer, New York Health Foundation

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