What You Should Know
– Harvard Medical School’s Center for Primary Care has released a comprehensive “Primary Care Investment Guide,” providing the first evidence-based roadmap for deploying capital into team-based care models.
– The report identifies six critical “Advanced Primary Care” (APC) services—including behavioral health integration and e-consults—that demonstrate measurable ROI through reduced hospitalizations and improved equity.
– With the U.S. spending only 4.6% of its healthcare dollar on primary care despite a shortage affecting 98 million people, the guide argues that aligning payment models with these specific structural capabilities is the only path to sustainable health outcomes.
Harvard’s Center for Primary Care Investment Guide: Evidence-Based Ideas for Decisionmakers
For decades, the U.S. healthcare system has operated on a paradox: it spends more than any other nation, yet underfunds its most critical layer. Primary care receives just 4.6 cents of every healthcare dollar, a starvation wage that has led to a workforce crisis where nearly 98 million Americans live in shortage areas.
The Harvard Medical School Center for Primary Care, in collaboration with the Primary Care Collaborative (PCC), released a definitive answer to this crisis. The Primary Care Investment Guide (PCIG) is not just a policy paper; it is an operational manual for allocating capital where it actually generates health.
“Investing in advanced primary care works and is required to strengthen primary care so we can improve the nation’s health,” said Amie A. Pollack, Director of Research at the Harvard Center for Primary Care. “When more investment supports the frontline team… clinicians experience less burnout and more joy in practice.”
Top 6 Investments for Health Systems According to Harvard Medical School
The core of the report is a rigorous analysis of six “Advanced Primary Care” (APC) services. These are not theoretical concepts; they are the specific, investable workflows that transform a practice from a reactive clinic into a proactive health hub.
1. Behavioral Health Integration (BHI) The report identifies BHI as a top priority for reducing emergency department (ED) visits. By embedding psychologists or care managers directly into the primary care workflow—using models like Collaborative Care (CoCM) or Primary Care Behavioral Health (PCBH)—practices can address the “whole person” immediately.
- The Tech Angle: To overcome psychiatrist shortages, high-performing systems are leveraging tele-behavioral health and AI-enabled therapy tools to extend capacity.
- ROI: Studies showed ROI as high as 6199% in specific safety-net settings by reducing downstream utilization.
2. Integrated Clinical Pharmacy This goes beyond dispensing pills. The guide advocates for embedding pharmacists to manage complex chronic diseases like diabetes and hypertension.
- Impact: 12 of 14 studies reviewed showed positive financial returns, with significant reductions in hospitalizations when pharmacists managed medication titration and prior authorizations.
3. Data-Driven Population Health Moving from “patient care” to “panel management” requires robust data infrastructure. Successful models utilize centralized analytics teams to risk-stratify patients and deploy remote monitoring tools.
- The Finding: 73% of diabetes population health interventions analyzed reported cost savings.
4. Social Determinants of Health (SDOH) The guide emphasizes that medical care accounts for only a fraction of health outcomes. Effective APC models use Community Health Workers (CHWs) and screening tools to connect patients with housing and food resources.
- Innovation: Hybrid models pairing internal navigators with external community-based organizations (CBOs) are proving most effective at resolving non-clinical barriers.
5. E-Consults Technology that connects primary care physicians (PCPs) with specialists asynchronously is a game-changer for access.
- Efficiency: E-consults reduce decision times and avoid unnecessary referrals, keeping care within the lower-cost primary care setting.
- Financials: All eight studies reviewed on e-consults demonstrated cost savings, largely by averting face-to-face specialist visits.
6. Care Management For the highest-risk patients, proactive care management is essential. The report highlights that ROI is highest when targeting patients at immediate risk of hospitalization.
The Interoperability and Payment Gap
While the clinical case is clear, the report highlights a massive “technological and financial firewall” preventing scale.
The “Black Box” of Funding Payers interviewed for the report expressed frustration that they cannot verify if their increased primary care payments actually reach the frontline clinicians. Funds often get absorbed by health system bureaucracy.
- Recommendation: The guide calls for enforceable mechanisms to ensure “dollars reach the full primary care team,” coupled with transparent tracking of primary care spend.
The Tech Burden For APC to work, data must flow freely. The report notes that interoperability remains a major barrier, with clinicians struggling to access timely data across fragmented systems.
- The Fix: Payers and providers must establish “near real-time data-sharing partnerships” to support population health and outreach.
Why This Matters Now
The timing of this guide is critical. Five states—California, Colorado, Delaware, Oregon, and Rhode Island—have already legislated higher primary care spending targets. As 2026 approaches, the market is signaling that the era of fee-for-service, reactive medicine is ending. The winners will be the organizations that use this guide to build the infrastructure—human and digital—required for the value-based future.
“Every decision-maker who wants to shift our health care system to health and away from more expensive services will benefit from this guide,” said Ann Greiner, President and CEO of the Primary Care Collaborative.
