May 2020 – Transforming how primary care is delivered and paid for is widely viewed as foundational to achieving the cost-reduction and quality-improvement objectives that are essential to a sustainable healthcare system. States and regions across the country are working to understand their current investment in primary care and to standardize the measurement of spending in order to assess trends over time and the impact of policy initiatives that seek to increase investment in primary care.

Onpoint recently completed a primary-care spending study for Washington State and is supporting clients that are leading similar initiatives in New England and California.

The current study of primary-care spending across New England is sponsored by the New England States Consortium System Organization (NESCSO) and involves health-policy leaders that represent all six New England states: Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, and Vermont. The New England study uses a distributed model in which each of the six states will provide primary-care expenditure and total healthcare expenditure data to determine the percent of healthcare expenditures invested in primary care. The study uses a uniform set of specifications based on a 2017 Milbank Memorial Fund report, “Standardizing the Measurement of Commercial Health Plan Primary Care Spending,” considerable efforts by the NESCSO Primary Care Investment Workgroup, and methodologies developed in other recent studies and finalized by Onpoint.

Our work with NESCSO also includes the development of proposed measures of association between the rate of expenditure in primary care and access to care, avoidable use, gaps in care, and other quality-of-care and outcome measures.

California’s primary-care spending study is sponsored by Covered California, the state’s health benefits exchange, and is being led by Onpoint’s client, Integrated Healthcare Association, a statewide health improvement collaborative. Researchers from RAND also are participating in the study, with consulting physicians providing methodology recommendations.

Onpoint concurrently leveraged the NESCSO and California development work to arrive at a consistent definition of primary-care spending using standard provider specialty/taxonomy codes and CPT/HCPCS procedure codes to support both studies. Both broad (provider-based) and narrow (provider and service-based) definitions of primary care spending will be applied. Onpoint will report the percentage of primary-care expenditures out of total healthcare expenditures tabulated by major payer type, age and gender, primary care specialties, and service types. Onpoint also will provide quality measures and examine the relationship between primary-care spending and quality outcomes as well as the relationship between primary-care spending and total cost of care.

Onpoint is excited to expand upon the work that our team completed for Washington State and the lessons learned from other similar studies as we work with clients across the country to understand the current investment being made in primary care and to inform future policy initiatives.

Figure 1. Summary of Medical Expenditures from Washington's Primary Care Expenditure Report