Building Momentum to Measure Primary Care Spending

How much of our health care dollars actually go toward supporting primary care, which is consistently acknowledged to be key to improving population health?  Some states are working toward an answer.

“At the Fund, we are working to increase policy focus on primary care spending,” said Rachel Block, Fund program officer. “It’s a good measure of how oriented a health system is to primary care, prevention, and population health. It’s also a good measure of whether we’re moving in the right direction in terms of payment reform. We need primary care spending measures to determine if the various alternate payment mechanisms being implemented are, in fact, providing more support for primary care.”

Here are five ways in which efforts to measure primary care spending are taking shape:

• Earlier this month, Oregon released its third annual report on primary care spending, the result of legislation passed in 2015 requiring payers to report their annual primary care spending. Overall, primary care spending rates in Oregon stayed the same compared to the prior year. But the report notes that more spending was allocated by Medicaid and commercial plans to non-claims-based payments—in other words, supplemental payments made to primary care providers specifically to invest in care management infrastructure.
• The Fund has worked on developing methodologies to measure primary care spending and ways to use these measures as goals for health system performance. In 2017, the Fund published a report demonstrating that measuring primary care spending by commercial insurers is feasible and studying ways to do it.
• The Fund is supporting new research to apply primary care measures to a large Medicare database. “We are expanding our support of primary care spend,” said Block. “This new analysis will tell us about the current financial commitment made to primary care by one of the largest payers in the US and provide a baseline to measure future primary care investments.”
• The Fund is collaborating with other national organizations interested in primary care spending. The American Board of Family Medicine, with assistance from the Robert Graham Center, convened researchers in Washington in December 2017 to compare and align US and international efforts in this area. The Patient-Centered Primary Care Collaborative‘s fall 2018 annual conference will focus in part on primary care spending and how such investment leads to better health outcomes for patients and higher value care for the health system by facilitating team-based, coordinated care.
• Several states are developing legislation similar to Oregon’s, while others are producing or using their own data to measure primary care spending. State measurement efforts provide other pathways to learn about primary care spending patterns. “The Fund helps to advance policy innovation by connecting states to one another, the better to learn from one another,” said Block. “As we move from experimentation to standardization, we’d like to see more policymakers and researchers using common measures.”