Care Transformation Center Blog

A vision for primary care 2025

Tomi Ogundimu

In 1979, the Institute of Medicine defined primary care as "care that is accessible, comprehensive, coordinated, continuous, and accountable." If that sounds familiar, it’s probably because the goals of primary care have not fundamentally changed over the last 34 years—they've only expanded. 

Last year the Institute for Alternative Futures created four plausible scenarios illustrating what primary care will look like in the U.S. come 2025.

Primary Care 2025 describes four parallel health care worlds based on assumptions of technological advances, political decisions, and social and economic changes. Each scenario shares three hallmarks: 

  • Increased provider pressure to reduce costs
  • Requirements to improve management of patients with growing morbidity
  • Efforts to effectively incorporate information technology across the network

Let’s unpack the first of the four future scenarios, which illustrates how primary care in the U.S. could exist if we keep moving along today’s trajectory for care delivery.

Patient-Centered Medical Home 2.0

A broad—and often digital—care team

Faced with a shortage of primary care providers, 2025’s standard care team is broad and includes nurses, social workers, community health workers, and pharmacists. Each member of the team practices at the top of their license and manages patients both physically in the clinic and virtually through the internet and mobile devices. 

Care management is also automated whenever possible. The role of care navigators is fully digital, giving patients’ access to personal health avatars that focus on prevention and health coaching.

Health IT supports population health management

An estimated 40% of patients receive their primary care from integrated systems in 2025 (another 30% from semi-integrated systems), which operate as full population health managers under a global budget. These systems are supported by evolved EMR platforms and remote patient biomonitoring devices—an evolution of remote monitoring that capture patient’s vital signs on a number of bio-physical, mental, neurological, and environmental measures. Seamless connectivity between self-monitoring, management, and direct patient care enable EMRs to predict or preempt major diseases and unlock proactive primary management.  

Few left behind still struggle with declining payments

The remaining fee-for-service-based practices either cater to a closed panel of patients willing to pay additional fees for preferential access to providers, or exist as sub-scaled clinics located among populations with the least access to care. The solo and small group physicians exist among vulnerable populations, specifically in rural areas and poorer inner city neighborhoods. Still struggling with flat or declining payments from Medicare, Medicaid, and private payers, these physicians continue to use basic technology, including early EMR systems built to only meet meaningful use standards.

All in all, this first scenario is the most conservative projection of the future of primary care. It assumes the expansion of the patient-centered medical home and the evolution of health IT with the goals of cost reduction and improved patient outcomes. 

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