Milbank Memorial Fund’s 2025 Primary Care Scorecard Reveals Primary Care Underinvestment, Access Challenges Persist
Primary Care Collaborative
Nonprofit multi-stakeholder membership organization dedicated to primary care as the foundation of the health system
On Tuesday, February 18, the Milbank Memorial Fund — in partnership with the Physicians Foundation and the AAFP Robert Graham Center — released its 2025 Primary Care Scorecard, which provides a snapshot of the state of primary care across the nation.
The latest report found primary care now accounts for about 4.6 percent of all health care spending and only 3.4 percent of spending in Medicare as the United States faces persistent underinvestment in primary care.
PCC’s Ann C. Greiner recently sat down with Milbank Memorial Fund President Chris Koller to discuss these latest findings and what the report means for policymakers at the federal and state levels.
Koller noted the U.S. health care system’s funding model for health care is broken, skewing heavily toward specialty and institutional care rather than preventive, ongoing care that leads to better outcomes.
Greiner added that the problem isn’t just payment amount, but also payment delivery. She championed hybrid payment models, which blend fee-for-service with per-patient payments, allowing for more flexible and effective care. Koller agreed, explaining that this approach supports team-based care and reduces reliance on in-person visits as the only source of revenue. He then acknowledged the PCC’s role in advancing these models through policy and legislative efforts.
The discussion next turned to how a dwindling primary care workforce is hampering access to high-quality, whole person primary care. Greiner and Koller highlighted the decline in primary care participation across all clinicians, including physicians, nurse practitioners and physician associates. Koller attributed this due to lower pay and higher workload. The result is worsening access to care, particularly for those who need ongoing management of chronic conditions.
Greiner and Koller also explored policy solutions. They highlighted promising efforts at both federal and state levels, including changes to Medicare’s physician fee schedule and legislative efforts including the Senate Finance Committee’s work and the bipartisan Pay for PCP’s Act, both of which call for implementing some form of hybrid payments. Koller stressed that policy change is essential to bolstering primary care and cannot be left to market forces alone.
Finally, Koller urged listeners to engage with the issue through policy advocacy and utilizing resources like Milbank’s interactive dashboard to push for state-level improvements. Greiner agreed, emphasizing that strengthening primary care is critical for reducing costs and improving health outcomes.