Our team has spent the first half of this year at industry conferences and executive roundtables, and primary care has been at the center of nearly every conversation. There are many messages indicating that the system is broken and unsustainable as is.
One framing that kept surfacing alongside those messages is the need for healthcare at the right time, in the right place, and the right service. I heard versions of it from payer executives, system CMOs, and primary care leaders alike. It is not a new idea, but the gap between the aspiration and the infrastructure is still wide. Care demand is growing, and neither the workforce nor the infrastructure is keeping pace.
People in these rooms were not debating whether the framing is right. They were trying to figure out what it takes to deliver on it, and that looks different depending on where you apply it.
The conversations around primary care kept returning to the same set of priorities: improving clinical outcomes, technology implementation, bringing primary care to the home, and better plan and provider alignment. AAMC workforce projections show shortages in primary care, neurology, and psychiatry deepening through the next decade, and health systems are already trying to redesign delivery models around the fact that there will not be enough providers to sustain the current approach.
Delivering the right service in the right place means something specific when the workforce cannot scale to meet demand. It means the tools and workflows inside primary care have to do more, and they have to work in settings that extend beyond the clinic. That pressure is felt across the board, but it shows up most clearly in the clinical areas where primary care is being asked to do something it does not yet have the infrastructure to do consistently.
Behavioral and mental health is one of the clearest examples. It was raised often across these conversations as a key area that needs to be better solved for, especially in underserved communities. The tools and workflows that exist for managing chronic physical conditions have not been replicated for mental and behavioral health with the same rigor, and patients with unaddressed needs in these areas generate more downstream utilization, more emergency visits, and more complexity across every care team that touches them. Every health system leader in these rooms recognizes the problem, so the gap is coming down to infrastructure rather than awareness.
Cognitive health is a related but distinct challenge, and I’ve been struck by how often it comes up in conversations that were initially framed around other things. Someone is talking about medication adherence, or chronic disease management, or whether patients can realistically follow complex care plans, and the question of cognitive status is sitting underneath all of it. A patient's cognitive status affects their ability to participate in their own care. If a patient cannot manage a medication schedule, adhere to dietary changes, or follow through on a treatment plan, the clinical outcome suffers regardless of how well the care itself was designed.
The data backs up what these conversations suggest, with roughly 92% of expected mild cognitive impairment cases in the U.S. Medicare population going undiagnosed, and for dementia, estimates of undiagnosed cases consistently landing around or above 60%.
Medicare already requires a cognitive assessment as part of every Annual Wellness Visit, but the most recent nationally representative data, published in early 2025, found that while 80% of Medicare beneficiaries had received an AWV, only 31% underwent any kind of structured cognitive test. AWV uptake has climbed significantly over the past several years, but the rate of structured cognitive testing within those visits has stayed essentially flat. The mandate and the clinical rationale are there, but the infrastructure to execute on it consistently is lacking in many settings.
This is where the right time, right place, right service framing becomes very concrete. It means a structured cognitive assessment, not just a subjective memory question, delivered in primary care where the patient is already being seen, and early enough that the results can inform the care plan before it's built on incomplete information. For health systems operating under value-based arrangements, when cognitive conditions go undiagnosed they go uncoded, and that translates directly into missed risk adjustment and inaccurate population health profiles.
According to KFF, Medicare Advantage now covers 54% of eligible Medicare beneficiaries, approximately 34 million people, and there is a sentiment that the government is not likely to want to see a big imbalance with fee-for-service offerings grow much further. For health systems in value-based arrangements, this could mean anticipating a need to demonstrate outcomes with the resources they have, rather than counting on expanded budgets. This also means that the tools health systems adopt need to deliver the right clinical insight at the right point in the care journey, in the settings where patients and clinicians already are, rather than depending on net-new resources or settings.
Whether health systems can get the right clinical service to the right patient at the right time, in the setting where they are, is the question every health system is answering differently right now.
For cognitive health specifically, the gap between aspiration and execution is measurable. The assessment mandate exists through the AWV, but structured testing happens in fewer than a third of visits. The diagnostic tools exist, but the vast majority of MCI and dementia cases still go undetected.
These are infrastructure problems, not awareness problems, and they are eminently solvable ones. The systems that treat them as operational priorities now, rather than future initiatives, will be the ones that successfully deliver on the promise of right time, right place, right service, and better outcomes for the patients they serve.
Marc Lipton, Co-founder and CEO at Creyos
Marc co-founded Creyos to reimagine how cognitive function is measured, monitored, and understood. He also serves as Vice-Chair of the University Health Network (UHN) Foundation Board and Chair of its Investment Committee. Previously a partner at Torquest Partners, he holds an MBA from Rotman and is a Chartered Professional Accountant.