Primary care providers are critical for ensuring better coordinated care and better health outcomes for all Americans. To meet the health needs of Americans, the Obama Administration has made the recruitment, training and retention of primary care professionals a top priority. 

Expanding the Primary Health Care Workforce

Together, the Affordable Care Act, the American Recovery and Reinvestment Act of 2009 (Recovery Act), and ongoing federal investments in the health care workforce have led to significant progress in training new primary care providers – including physicians, nurse practitioners and physician assistants – and encouraging primary care providers to practice in underserved areas, including:

• Nearly Tripling the National Health Service Corps in Three Years:  By 2011, more than 10,000 doctors, nurses and other health care providers were caring for Americans in communities nationwide, thanks to investments over the past three years in the National Health Service Corps (NHSC) through the Affordable Care Act, the Recovery Act and annual appropriations. The NHSC has awarded nearly $900 million in scholarships and loan repayment to health care professionals to help expand the country’s primary care workforce and meet the health care needs of communities across the country. In 2008, approximately 3.7 million patients were provided service by 3,600 National Health Service Corps providers.  In 2011, with field strength of more than 10,000 clinicians, the NHSC provided health care services to about 10.5 million patients.
• Training New Primary Care Providers: The Affordable Care Act invests in the training of new primary care providers, including providing nearly $230 million to increase the number of medical residents, nurse practitioners and physician assistants trained in primary care.  With these investments, by 2015, more than 1,700 new primary care providers will have been trained and enter primary care practice. The President’s Fiscal Year 2013 budget includes $677 million, an increase of $49 million over FY 2012, within the Health Resources and Services Administration to expand the capacity and improve the training and distribution of primary care, dental, and pediatric health providers. The Budget will support the placement of more than 1,500 new primary care providers in underserved areas and begin investments that expand the capacity of institutions to train 2,800 additional primary care providers over five years.
• Training Physicians in Community-Based Settings: The Affordable Care Act created the Teaching Health Center Program to help move primary care training into community-based settings. The five-year investment in this program is expected to supportthe community-based training of over 600 new primary care physician residents by 2015. 
• Supporting Mental Health Training: Mental health issues rank in the top five chronic illnesses in the United States. In Fiscal Year 2012, the Affordable Care Act will invest $10 million to support training to help close the gap in access to mental and behavioral health care services by increasing the number of adequately prepared mental and behavioral health providers.
• Expanding Residency Slots for Primary Care: To encourage more medical residents to pursue careers in primary care, the Affordable Care Act redistributes unused residency positions and directs those slots for the training of primary care physicians. In distributing the residency slots, priority for awarding residents is given to hospitals that have rural training tracks, train residents in geriatrics, use the additional slots to create or expand a primary care program, demonstrate focus in training residents to pursue careers in primary care, or are located in a primary care health professional shortage area.
• Expanding Training of Advanced Practice Nurses: The Affordable Care Act allows up to five hospitals to receive $50 million each year, for fiscal years 2012 to 2015, to train advanced practice nurses, including nurses in community-based settings through the Centers for Medicare and Medicaid Services. 

Modernizing Primary Care Training and Practice

Implementation of the Affordable Care Act provisions is strengthening the primary care training infrastructure, creating new primary care clinical training opportunities, and supporting primary care practice. These efforts include:

• Encouraging Physician Training in the Community: The Affordable Care Act provides incentives for hospitals to train primary care physicians in the community by providing flexibility in Medicare residency training requirements. Prior to the law, hospitals had to bear the cost of education in non-hospital sites, often by paying both the resident’s and teaching physician’s salary. This requirement discouraged training in community settings, which encourages primary care practice. The Affordable Care Act changed this policy and requires hospitals to only pay the resident salaries.
• Encouraging Health Homes:  Under the Affordable Care Act, States are incentivized to create Medicaid “health homes” for individuals with chronic health conditions. Health homes encourage the use of primary care providers to provide integrated care to help patients better manage their health. States that create health homes will receive enhanced federal matching funds for care coordination services for the first eight quarters a health home state plan amendment is in effect.

Modernizing Payment and Improving Financial Incentives for Coordinated Care

• Creating Primary Care Payment Incentives:  The Affordable Care Act authorizes a ten percent Medicare payment bonus from 2011 to 2015 for physicians who specialize in family medicine, internal medicine, geriatric medicine, or pediatric medicine, nurse practitioners, clinical nurse specialists, or physician assistants for whom primary care services account for at least 60 percent of their Medicare allowed charges. The Affordable Care Act also increases primary care physician payment rates in the Medicaid program to match Medicare payment levels in 2013 and 2014. 
• Realigning financial incentives in Accountable Care Organizations (ACOs):Under old payment systems, care coordination – the hallmark of effective primary care – wasn’t rewarded financially. Medicare’s shared savings program changes that model by rewarding physicians and other primary care practitioners for high-quality care and preventing the need for care in the first place. Already, 27 ACOs have joined the program and over 150 more potential ACOs have submitted an application. CMS has also created two demonstration programs to supplement the shared savings program: the Pioneer ACO initiative for 32 large and experienced health systems ready to move into accountable care quickly; and the Advanced Payment ACO, for smaller practices that need help with startup costs. Together, these initiatives are improving primary care for 1.1 million people with Medicare.
• Innovation Center: The Center for Medicare & Medicaid Innovation has launched 16 initiatives involving over 50,000 health care providers that will touch the lives of Medicare and Medicaid beneficiaries in all 50 States. Many of those are explicitly designed to promote primary care.
  • Comprehensive Primary Care Initiative Demonstration: A public-private partnership to enhance access to primary care services by establishing medical homes supported by multiple payers. Funding of up to $322 million is available to support 75 practices in 5-7 States starting this year.
  • Federal Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration: This initiative makes almost $50 million available to support 500 FQHCs in 44 States with care coordination payments that will allow the Centers to become medical homes, the hub of a patient’s primary care needs. This initiative started in 2011.
  • Multi-payer Advanced Primary Care Practice Demonstration: This initiative, launched in 2011, is a State-led, multi-payer collaboration to help primary care practices transform into medical homes. It makes $283 million available in 8 States.
  • Independence at Home: This initiative supports home-based care for patients with multiple chronic conditions that would benefit from primary care coordination. It provides up to $15 million to support up to 50 practices and will launch later this year.