Introduction
Over the past several years, a growing number of states have adopted or are actively considering primary care spending targets. These targets are typically associated with familiar aspirations: better access to care, better health outcomes, better management of chronic disease, lower avoidable emergency department utilization, lower avoidable hospital utilization, greater health equity, and better long‑term value from healthcare spending. They are intended to produce a stronger and more effective primary care system.
States that have already set a primary care spending target now face a major task, translating that target into a detailed set of staffing requirements and developing a realistic plan to build that workforce over the next several years. Key Lever 4 (Workforce Development) addresses that question by describing the essential ingredients of an aspirational workforce plan that details the additional primary care capacity the state aspires to and how that capacity will be built in light of the current shortage of primary care clinicians.
The materials reviewed in this report suggest that in many states this translation work is still at an early stage. Much of their currently visible work focuses on maintenance‑level staffing, describing the staffing needed to preserve today’s level of service as populations grow and age. But an aspirational‑level staffing plan needs to specify the additional primary care capacity required to achieve better access, stronger care teams, reduced avoidable hospital and emergency department use, and improved outcomes. That is a more complex process that depends heavily on earlier work on Goals and Objectives (Key Lever 1) and a well-conceived Needs Assessment (Key Lever 2).
The purpose of this report is to clarify how Key Lever 4 fits into the Nine Key Lever framework and to outline the basic elements of an aspirational primary care workforce plan. The goal is to suggest what a strong workforce plan should contain and make it easier for stakeholders to assess a state’s progress toward a complete and realistic workforce development plan, one of the keys to a successful and cost‑effective primary care funding strategy.