What if every American knew the date and time of their next primary care appointment?
getty
A few weeks ago, I was working a shift in the emergency department where I still practice. I met a man who had lived with depression for years. He had never had a primary care physician. He had never been screened. No one had ever offered treatment.
It happened to be a slow evening—the rare kind of shift that lets an emergency physician practice medicine the way we were trained to. So I sat down with him. We screened him properly, started treatment, and arranged follow-up before he left.
I haven’t stopped thinking about him—not because his story was unusual, but because it wasn’t.
Most of my week is spent on the other side of healthcare, leading one of the organizations that is supposed to make sure people like him never slip through the cracks. His story reminded me of something I don’t say often enough: the biggest improvements in healthcare are often the simplest ones. We mistake sophistication for progress.
American healthcare is drowning in objectives. We have quality measures, value-based payment models, strategic pillars, transformation initiatives, and endless dashboards. We have become extraordinarily good at measuring complexity while losing sight of something much simpler.
People who are sick need a relationship with someone who knows them.
That leads to a goal I wish every part of American healthcare—government, employers, insurers, hospitals, physician groups, and health systems—would embrace.
What if every American always knew the date of their next primary care appointment?
Not simply had access. Not was eligible. Actually knew the date—the way many of us know the date of our next dental cleaning or annual physical.
The point isn’t the appointment itself. The point is continuity. If you know the date of your next appointment, someone is expecting you. Someone owns your care. Someone will notice if you don’t show up. If you don’t know when you’ll next be seen, there’s a good chance no one owns the space between today and the next time you become sick enough to seek help.
What makes this idea different is not its simplicity but its accountability.
Nearly every quality measure in healthcare is verified by the institution being evaluated. We collect the data, calculate the score, and report our own performance. But this measure belongs to the patient. Either you know the date of your next appointment or you don’t. The source of truth doesn’t live in a spreadsheet, a quality department, or a regulatory filing. It lives with the person receiving care.
Healthcare spends billions measuring itself. This is one of the rare measures the patient gets to grade.
The gap that measure would expose is enormous.
More than 100 million Americans lack reliable access to primary care. Millions more are living with diabetes or high blood pressure they don’t even know they have. They aren’t outside the healthcare system as much as they’re disappearing inside it. My patient with depression wasn’t an exception. He represented an entire category of people hiding, as public health experts often say, in plain sight.
Undetected illness rarely stays small. It becomes more advanced, more expensive, and ultimately more tragic. Eventually it appears at two o’clock in the morning in front of a physician who has never met you before.
Now comes the uncomfortable part, because my own sector should be first in line to own this problem.
Health plans know exactly which of their members have gone too long without seeing a primary care clinician. We have every reason to act on that information. Yet very few organizations make it an explicit objective that every member who lacks an ongoing primary care relationship leaves that category with an appointment on the calendar.
Instead, we naturally concentrate on the people whose engagement is easiest to improve and whose quality measures are easiest to move. The people who are hardest to reach often remain the hardest to reach—not because we cannot find them, but because easier work is always sitting right in front of us.
I include myself in that criticism. Like many healthcare leaders, I’ve spent years pursuing ambitious transformations while overlooking a goal that is almost embarrassingly straightforward. If everyone we were responsible for knew the date of their next primary care appointment, we would almost certainly prevent more suffering than many of the sophisticated initiatives that consume far more of our attention.
The objections are predictable.
The first is that there simply aren’t enough primary care appointments.
That’s true—and becoming truer every year. Wait times continue to grow, and the United States faces a significant shortage of primary care physicians over the coming decade. But scarcity is an argument for making the line visible, not for pretending it doesn’t exist. You manage a scarce resource by knowing who is waiting, not by leaving people uncertain whether they’re in line at all.
The second objection is that expanding primary care will simply increase utilization and healthcare spending.
Some utilization may increase. But that misunderstands where the real costs of American healthcare come from. The expensive care isn’t the fifteen-minute office visit. It’s the stroke that could have been prevented, the amputation caused by uncontrolled diabetes, the heart failure hospitalization that followed years without treatment, or the cancer discovered only after symptoms could no longer be ignored.
You don’t save money by keeping people away from primary care. You simply postpone the bill, allow it to grow, and eventually pay it in an emergency department or an intensive care unit.
The third objection is that the people without appointments are the hardest to reach.
Exactly.
That isn’t the weakness in the proposal. It’s the reason for it.
A poorly designed initiative would simply schedule the easiest patients and widen existing disparities. A universal goal does the opposite. It makes the missing people visible. Today they disappear inside averages, attribution models, and performance reports. Once every American is expected to know the date of their next primary care appointment, the people who don’t become impossible to ignore.
You cannot solve a disparity you refuse to count.
And finally comes the deepest question: whose responsibility is this?
In American healthcare, the patient belongs to everyone and therefore to no one.
Health plans assume delivery systems own the relationship. Delivery systems assume insurers should coordinate it. Employers assume both are handling it. Government assumes the market will solve the problem. Everyone has a reasonable explanation for why someone else should go first.
That diffusion of responsibility is precisely how millions of Americans end up without a front door to healthcare.
This is not fundamentally a technology problem. It is not a data problem, either. The information already exists, scattered across organizations that rarely act as though they share responsibility for the same human being.
What we’re missing is something much simpler: the collective decision that a country where every American knows the date of their next primary care appointment is a country worth building.
Because if we cannot accomplish something that basic, no payment reform, quality framework, digital platform, or artificial intelligence tool will solve the deeper problem. They will simply help us measure our failure with greater precision.
Progress in healthcare isn’t always found in making the system more sophisticated.
Sometimes it begins by making one simple promise: that no one becomes invisible.
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