Federal Investment in Primary Care Transformation: A Systematic Review and Qualitative Analysis

Area of Science:

• Health Services Research
• Primary Care Policy
• Healthcare Management

Background:

• Understanding federal investment impact on primary care is crucial for improving care delivery.
• Key stakeholders include practitioners, program developers, and policymakers.
• Primary care transformation aims to enhance patient outcomes and system efficiency.

Purpose of the Study:

• To evaluate outcomes of federal investment in primary care delivery transformation.
• Assessed impact on patient experience, costs, utilization, population health, and practice experience.
• Informed future primary care improvement strategies.

Main Methods:

• Systematic review of publicly available program evaluation reports and articles.
• Searched multiple databases (PubMed, Scopus, etc.) for studies from July 2011 to December 2024.
• Included independently evaluated federal programs initiated after January 2011 and completed by December 2021.

Main Results:

• 142 records from 5 federal programs (FQHC APC, MPAPC, CPC, CPC Plus, EvidenceNOW) were analyzed.
• Investments supported practice changes via payment, performance, data, and technical assistance.
• Associated with improved clinical care, patient engagement, modest utilization reductions, but increased expenditures.

Conclusions:

• Primary care investment improved practice experience and population health; patient experience and cost outcomes were mixed.
• Barriers included data access, payment system challenges, and long implementation times (≥2 years).
• Future efforts need to address practice barriers, align payment, and support local organizational improvement.