Primary care is the backbone of the healthcare system. Primary care providers (PCPs) are usually a patient’s most influential and most important point of contact for their healthcare needs, from delivering preventive care and recommending screenings to treating illness and addressing chronic health challenges. PCPs are a vital part of driving better patient health outcomes and lowering overall healthcare costs.

Over the last several years however, primary care has undergone a crisis. Namely, there’s a nationwide shortage of primary care providers, with more providers leaving the field than entering it. According to the American Association of Medical Colleges (AAMC), more than 40% of active physicians will be 65 or older within the next 10 years, and by 2034 it’s estimated that the national PCP deficit will be somewhere between 17,800 and 48,000.

Also consider these national statistics, shared by the Rhode Island Office of the Health Insurance Commissioner (OHIC) from their December 2023 report titled Primary Care in Rhode Island:

• Less than 9% of third-year internal medicine residents indicated an interest in primary care, according to a career plan study conducted between 2019 and 2021.
• Only 20% of all physicians who completed their residency were still practicing primary care two years later, according to studies conducted between 2012 and 2020.
• Physician burnout is a contributing factor, exacerbated by the COVID-19 pandemic. By the end of 2021:
  • Nearly 63% of all physicians reported symptoms of burnout.
  • 71% of PCPs reported their burnout or mental exhaustion was at an all-time high.
  • 25% of PCPs said they planned to leave their primary care practice over the next several years.

According to that same OHIC report, Rhode Island ranks fourth-best in the U.S. in terms of active PCPs per 100,000 residents, at 301. The report also shows that in 2021, more Rhode Islanders reported having a regular source for healthcare compared to other states – it was reported that 10% of adults and 24% of children don’t have a PCP, compared to 17% of adults and 27% of children nationally.

Enhancing primary care by supporting a transition to VBC

There is certainly room for improvement across Rhode Island’s primary care landscape, and BCBSRI has made significant investments over the last decade to bolster and support it. These investments are intended to benefit providers as well as our members/your patients. Since 2013, we’ve invested roughly $450 million in primary care practices across the state – above and beyond standard member claims reimbursements to PCPs – to support practices’ transitions to value-based care (VBC) models.

Those investments have included funding quality improvements, providing data and analytical support, and adding support staff such as nurse care managers and pharmacists, which have helped to create a more patient-centered primary care approach. Today, more than 70% of BCBSRI members are seen by a primary care practice that is participating in a VBC agreement with us. 

All the enhancements mentioned above benefit both PCPs and their practices, enabling them to:

• Build multi-disciplinary care teams – including specialists like behavioral health clinicians, nurses, and pharmacists – to enhance efficiency and effectiveness of patient care and create a more personalized and satisfying patient experience
• Thrive professionally and financially through more predictable cash flow
• Improve job satisfaction through a team-based care model
• Lessen administrative responsibilities and burden through enhanced administrative support and training, potentially decreasing the amount of burnout experienced
• Enhance overall efficiency as they make the transition from fee-for-service models to VBC payment models

We’ve also implemented additional financial rewards and incentives over the last several years through our Physician Quality Improvement Plan (PQIP) to recognize practices for improved quality of care and patient health outcomes. This has provided further additional incentive for practices to utilize the VBC model of care.

Through these combined efforts, BCBSRI is working with medical leaders as well as leaders throughout our larger community to address the current primary care workforce challenges, as the industry collectively prepares for the next generation of primary care professionals in Rhode Island. We’re committed to continue working to address and improve the primary care landscape in our state, both by looking internally to find new and innovative ways to support primary care and also by collaborating with you, our providers, on ways to ensure that the state’s primary care practices can thrive and be here for future generations of Rhode Islanders.

An invitation to share your thoughts with us

Our Health Care Community Exchange Council (HCEC) is just one of our many external provider committees that encourage participating providers to share their expertise and collaborate to improve the health and well-being of Rhode Islanders. You’re invited to participate – this group meets regularly and discusses issues such as what we’ve covered in this column on primary care, and we’re always seeking new PCP members to join us. If you’re interested, please contact me at Farah.Shafi@bcbsri.org.