As a woman of color, primary care provider (PCP), and president of a medical practice in New York City, the most diverse city in the world, I know we cannot fully address health care inequities without increasing access to primary care.
Policymakers have recognized the importance of primary care and illness prevention to improve health outcomes and reduce overall health care costs. Yet while efforts to address health disparities have progressed, federal and local funding for providers in underserved communities still goes mostly to those who work in or for hospitals.
We understand the crucial role hospitals play in serving people of color. However, we must expand support for independent primary care offices. Otherwise, we risk prolonging health care inequities by limiting access to health care services that keep people in underserved communities out of the hospital.
Primary care and independent medical practices are essential to improve health outcomes and reduce health disparities.
Policymakers recognize that primary care services offered in doctor offices improve the health and well-being of the American public. PCPs do this by:
- Early diagnosis and disease prevention: Doctors, nurses, and others can help detect health conditions before they become severe and require hospitalization. They also advise patients on dietary changes and other information to keep these conditions from worsening. For example, PCPs screen patients for the beginning stages of chronic illnesses like depression, diabetes, and heart disease, allowing people to work with their providers to make lifestyle changes that improve their health and reduce unnecessary hospitalization.
- Building long-term relationships between community providers, patients, and their families: Trust is essential to providing ongoing, preventive care instead of just treating illnesses. The doctors, nurse practitioners, behavioral health specialists, and other health care providers at these offices build lasting relationships with patients. This is especially important to help reduce the stigma that surrounds mental and behavioral health services.
- Managing chronic diseases: Primary care and independent doctor offices employ health care professionals like nurses, dietitians, and others who help people with chronic conditions manage their diseases and stay healthier longer. For example, dietitians help patients with diabetes to change their diets and help keep their blood sugar levels on track. Nurses who specialize in care management coordinate treatment plans with other health care professionals and are a patient’s primary contact.
These activities are recognized and encouraged by policymakers when they develop programs that support medical practices. For example, Patient-Centered Medical Homes (PCMH) and Accountable Care Organizations (ACOs) reward practices that use team-based care to keep patients out of the hospital and encourage patients to use primary and specialty care practices to reduce hospital costs.
Our nation’s focus on health care equity demands that these services be available in underserved communities. People of color are more likely than other Americans to have multiple chronic conditions like diabetes and heart disease. This suggests they are not always getting the doctor-led preventive services and care management they need. Addressing health disparities in underserved communities requires improving access to affordable, preventive care delivered by trusted medical professionals who understand their patients’ medical and social care needs and the communities where they live.
A commitment to New York’s diverse population
I run a practice called AdvantageCare Physicians of New York (ACPNY). ACPNY focuses on providing primary care in underserved areas that is equal to the care available to Americans in areas with more resources. We operate more than 30 offices, serving nearly 500,000 people in New York City and Long Island. More than half of our offices are in either federally designated Medically Underserved Areas (MUAs) or Health Professional Shortage Areas (HPSAs). While many people associate these names with rural areas, there are many MUAs within our city. For example, in 2019, we opened an office in the East New York section of Brooklyn, long considered a “medical desert,” where we see about 30,000 patients every year.
The first step to making health care more available and accessible is to create trust between the doctors, nurses, and other professionals who provide health care services and the people they treat. Research shows that patients prefer having a doctor of their race or ethnicity and are more satisfied with their care when these preferences are met. Studies also show that patients are more satisfied with their treatment and show more beneficial health behaviors, fewer symptoms, and higher quality of life when they trust their health care provider.
ACPNY employs more than 400 providers who speak at least one language other than English. Sixty-six percent of ACPNY employees identify as Black, Hispanic/Latino, Asian, Native Hawaiian/Pacific Islander, or American Indian/Native Alaskan. In short, the offices look like the communities they serve. This connection has benefited these communities, as shown in these impressive health care statistics from our patients:
- Between January 2021 and September 2023, more than two-thirds of ACPNY primary care patients completed an annual wellness visit and wellness exam.
- In 2023, more than 99% of ACPNY patients were screened for depression and anxiety.
- Breast cancer screenings were completed for 79% of patients who met screening criteria.
- Cervical cancer screenings were completed for 74% of patients who met screening criteria.
- 73% of adults with diabetes have well-controlled diabetes based on HbA1c measures.
- 82% of adult patients with diabetes received annual kidney health evaluations.
Community-based doctor offices were crucial during the COVID-19 pandemic by helping to reduce some of the health care disparities that grew during that time. Twenty of our offices remained open during the height of the pandemic. We partnered with New York City and state governments to promote and provide vaccines when they first became available. This proved critically important, given that a recent study found PCPs were the most trusted source of information on COVID-19 vaccines in minority, urban populations.
Recommendations to achieve health equity goals and improve access to care for underserved population
Primary care delivered in outpatient, community settings prevents unnecessary hospitalizations, improves the health and well-being of the people who receive it, and reduces health care disparities. Policymakers should consider new ways to support doctor practices operating in underserved areas. Here are some recommendations for consideration:
- Medical practices in underserved areas should receive federal funding like hospitals and Federally Qualified Health Centers (FQHCs). We agree that FQHCs are vital to address the needs of people without insurance or Medicaid. Doctor offices provide many of the same services offered in FQHCs and complement their role by reducing disparities for underserved populations. Approximately 25% of our patients have Medicaid coverage. Others are lower-income workers and New York City essential workers like police officers and teachers. In addition to hospitals and FQHCs, federal grants should also help fund independent medical practices to help maintain access to quality, affordable health care in low-income, underserved communities. This can be achieved by creating a new grant funding opportunity through the Health Resources and Services Administration, eligible to non-FQHC doctor offices and targeted to those operating within MUAs or HPSAs.
- Medical practices in underserved areas should be eligible for state funding. State funding should be available to independent medical practices with PCMH-accredited organizations that serve at least 20% of Medicaid beneficiaries and operate in at least five MUAs and HPSAs. Targeted funding could be offered through a rate add-on or state grant program for qualifying independent doctor groups that demonstrate a commitment to high-quality primary care services to communities of color.
- Doctor offices should be included in policy and program development. Policymakers should include independent doctor offices when researching, developing, and planning new models and programs that address health equity to better reach underserved communities and the people these programs are created to help. Hospitals and other health care systems are critical to address the needs of underserved populations. However, equity-focused programs should aim to keep underserved individuals out of the hospital. That requires the leadership of doctors, nurses, and other providers to create models built on primary care, prevention, and care management.
Efforts to expand access to health care, improve health equity, and reduce health disparities in underserved communities are hindered by the lack of federal and state financial support for independent medical practices. Policymakers should address this missed opportunity to help keep underserved people healthy.
Dr. Navarra Rodriguez, M.D., Chief Medical Officer and President of AdvantageCare Physicians (ACPNY).