In the last several years, PCDC and its partners have built a solid advocacy foundation that helps to keep the urgency and importance of primary care investment in front of policymakers.

It wasn't always that way. PCDC was founded at a time when the critical lack of access to primary care was barely a blip on the political radar. There was little recognition of the importance of capital investment in primary care; fairer payments for primary care physicians; coordination of care through health information technology; or the widespread shortage of primary care providers.

But as more people lost healthcare coverage and skyrocketing healthcare costs threatened the financial stability of families, states, and the entire country, policymakers turned to primary care as a means to reign in costs and improve health. As they turned to primary care for a solution, what they found were decades of underinvestment, leaving the primary care system ill equipped to deliver the quality, affordable care that was needed.

In New York, a fragmented patchwork of healthcare resources, duplication of services, oversupply of hospitals, and undersupply of community-based care had become an unacceptable and expensive burden on the State. More than five million New Yorkers lack access to primary care in their community, creating dependence on costly emergency rooms and inpatient care. In fact, New York ranks among the worst in the nation for hospitalizations and readmissions. In 2006, a special Commission (the Berger Commission) recommended a number of hospital closures along with major expansion of primary care to right-size New York's healthcare system.

Recognizing the opportunity to promote primary care , PCDC co-founded the New York State Primary Care Coalition to push lawmakers to invest in primary care capital projects, increase Medicaid reimbursements, and enact other policies that would create quality primary care throughout New York. PCDC and the Coalition issued influential reports, presented testimony, garnered positive media attention, and met with key policymakers to demonstrate the critical lack of primary care in New York, and make specific recommendations for strengthening the sector.

From 2007-2009, amid the worst fiscal years on record, it seemed that any legislative spending for new initiatives was impossible. But armed with strong evidence that spending on primary care saved money across the board, and backed by a growing coalition of primary care advocates, New York State's leadership made bold investments that are putting our primary care sector on a new course. "When it came to crunch time- to go to the Legislature and to get this done- we knew that PCDC stood with us as a strong advocate," said New York State Health Commissioner Richard F. Daines, M.D.

PCDC and our partners worked to support the State on these primary care investments:

• $100 million invested in primary care infrastructure (HEAL 6)
• $160 million for electronic health record adoption, including its application in Patient Centered Medical Home (PCMH) implementation (HEAL 5 and 10)
• More than $400 million in increased Medicaid primary care payments and enhancements for hospital clinics, community health centers, and small-practice providers.
• $70 million for doctors and clinics that meet PCMH standards

Our efforts are far from over. New York and indeed most of the country still face enormous primary care shortages. The pressure to expand primary care, not only to increase capacity, but to cultivate a strong primary care workforce, will only grow as healthcare reform expands health insurance coverage. More people with insurance will place more demand on the healthcare system. Without a robust primary care sector to serve a growing number of patients, we will fall into the same traps that have brought us the costly and ineffective healthcare system we are just beginning to reform.