Shifting the Focus: 3 Strategies to Prioritize Primary Care Investment as a Key Policy Need
November 20, 2023

By John Molera, Senior Policy Analyst

From waste to escalating costs, there are plenty of systemic health care issues crossing the desks of legislators, but one that doesn’t often get the attention it deserves is underinvestment in primary care. By improving funding for this foundational element, the health care system could potentially avert several downstream effects and cascading health expenditures. 

But how can we rally stakeholders to prioritize minimum primary care spend among the many issues on their minds? Here are 3 strategies, gleaned from an expert panel at Aledade’s third National Policy Collaborative, that could help advance the cause.

  1.  Involving primary care practitioners in advocacy.

Primary care plays an outsized role in supporting public health, but the interests of the primary care community are often overshadowed by specialists and hospital systems. 

Christopher Koller, President of the Milbank Memorial Fund and Former Rhode Island Health Insurance Commissioner, discussed his experience as a regulator: “When I ran a Medicaid health plan, I wanted to support primary care, but you guys were at the bottom of the chain. I had to negotiate with emergency room docs, hospitals, and primary care kind of got … crumbs.”

While all players are crucial, it is important that policymakers in state governments understand the role of primary care as the basis to a healthy society. And there is no better way to drive home that point than through the voice of primary care practitioners themselves.

Aledade’s state policy committees empower independent and community-based clinicians to use their collective voice, stories and data to advance primary care legislation in their region. This approach has led to proposed legislation to target rural primary workforce needs, access to COVID-19 vaccines and participation in a collaborative to increase alternative payment model adoption.

  1. Convening allies across the industry. 

To build a robust base for advocacy, the expert panel suggested supporting legislation that a broad array of stakeholders with a variety of constituents (e.g., local associations, payers, academic partners, and other anchor organizations) can rally around. 

Ankit Sanghavi, Executive Director of the Texas Health Institute, spoke about the role of the Texas Health Institute as a convener – building a network of engagement and educating stakeholders about the importance of long-term investment. It was critical to demonstrate to legislative officials that advocates spoke with a wide range of constituents to build trust and credibility. This work has borne fruit for the Texas Health Institute, which helped progress several relevant pieces of legislation in the last session.

Dr. Sumana Reddy, a California primary care physician and advocate, also discussed how multi-stakeholder groups are critical for sharing information. Describing her role in California’s Office of Health Care Affordability Advisory Committee, Dr. Reddy explained that there is a “necessity for collaboration across organizations” and that “the advisory committee has allowed decision-makers to hear many different perspectives and demonstrate just how supportive regular people are in understanding the effectiveness of primary care.”

For the last two years, Aledade has brought a range of stakeholders together with our ACO member physicians to strategize ways to advance legislation in various states, through meetings with physicians and legislators as well as highlighting success stories of states that have made progress in primary care investment. 

  1. Highlighting the value of longitudinal primary care. 

It’s easy to get bogged down in the details of health policy, but legislators often respond more readily to messaging with broader strokes, such as highlighting the social and community value of primary care. The collaborative’s panel discussion focused on the importance of primary care in establishing a regular point of care for patients, and helping patients take control of their health. 

“There is the reality that people are enamored in specialization, but I would not accept this as inevitable,” Koller said.

“What people want is a relationship, particularly over time, particularly one connected to the community. When we don’t do good primary care, we do a lot more transactional based care. Strong advocacy from the primary care community reinforces the social value of primary care and the social value of that relationship.”

Christopher Koller, President of the Milbank Memorial Fund and Former Rhode Island Health Insurance Commissioner

Dr. Reddy agreed: “Primary care can help patients navigate through complicated health issues in a cost-effective way that builds a relationship of trust.” Instead of one and done treatments, primary care should be about “wrapping your arms around your patient and your community.” When a patient is connected to a practice that focuses on building patient relationships, that patient becomes more likely to return and ultimately see the value of that coordination. 

Moving forward
Aledade’s Policy Team is continuing to work with our stakeholder partners on these efforts to strengthen primary care policy, both nationally and at the state level. For more information, visit our Policy Page or reach out to