Opinion: We Need to Balance Innovation with Equity in the Rush to Reimagine Primary Care

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Improving access to high-quality primary care is one of the best things we can do to improve health in America. Primary care improves nearly every measure of health and is the only form of health care where greater supply results in better health for more people. In fact, according to the U.S. Department of Health and Human Services, access to primary care is so important it is classified as a social determinant of health, that is, a nonmedical factor that influences how healthy people are during their lifetime.

Silicon Valley is recognizing the value of primary care. Fueled by advancing technology and innovative models, providers and startups are racing to build the next health care unicorn. In the last year, Amazon has rolled out a primary care service called One Medical that offers virtual visits for $9 a month, and primary care innovators Oak Street and ChenMed have grown significantly. 

The consolidation and corporatization of primary care is delivering the greater access and lower costs consumers are demanding. Yet long-term, this approach may be harming, not improving, health equity.

Defining high-quality care

High-quality primary care is accessible, affordable and equitable. Independent primary care practices that are not affiliated with major health systems or corporations exemplify these values. They are often deeply rooted in their communities, have long-term relationships with patients and deliver care in underserved areas. They provide individual, family-focused and community-oriented care for preventing, curing or alleviating common illnesses and disabilities, and promoting health

High-quality primary care also saves money. For every dollar invested in primary care, $13 is saved in downstream total costs

Sadly, fewer physicians are independently embedded in their communities. The share of physicians working in hospitals as direct employees or contractors nearly doubled between 2012 and 2022, increasing from 5.6 percent to 9.6 percent. This threatens long-term health outcomes, especially for marginalized populations. Without consistent, preventive care delivered through independent, community-based providers, acute and chronic illnesses can flourish, driving up costs and increasing pressure on individuals, hospitals and specialty care organizations. 

Disparities in access to high-quality primary care disproportionately affect marginalized populations. One study found that Black Americans are 67 percent more likely to live in a zip code where there are no, or very few, primary care physicians. Another study indicated language and immigration status can be a significant barrier to care. Meanwhile, the federal government projects rural areas across the U.S. will be short over 20,000 primary care physicians by 2025.

The limitations of tech-driven innovation

While corporations and health systems are improving access to care with tech innovations, they are not addressing the equity problem or providing the continuity of care needed to improve patient health and satisfaction cost-effectively.

For instance, using a tech platform, you may be able to see someone for an asthma flare-up within a few minutes for a virtual appointment, solving an immediate need. But you won’t gain more insights or care to further reduce the risk of flare-ups from happening in the first place. The provider you see will also likely be unable to link your event with other asthma flare-ups across the community, which could inform an emerging public health crisis. They will also likely be unable to handle any follow ups or more severe developments, instead referring you to a different doctor or a local hospital if your health does not improve.

Innovating a more equitable primary care future

History shows us that the introduction of technology-enabled health care does improve access to care for some people, but it does not solve all inequities. Though virtual care options were a boon during the pandemic and continue to help some populations, they have also deepened the digital divide for those who cannot easily access this new technology.

While innovation in primary care is necessary, we must not favor short-term profit and acute care access over long-term, equitable health outcomes. Only when we embrace care that equally serves all populations and remains free from a profit-driven focus will patients and their families truly benefit, allowing the entire health care system to function more effectively and efficiently.

Shruti Kothari is the director of industry initiatives at Blue Shield of California and is the founder of Women of Community, an organization increasing representation of women of color in health care leadership. 

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