February 2020 – Onpoint is excited to have collaborated with Washington State’s Office of Financial Management (OFM) on the state’s first comprehensive analysis of annual primary care medical expenditures. The data source for this report, “Primary Care Expenditures,” was the Washington All-Payer Health Care Claims Database (WA-APCD), which is maintained by Onpoint and recently transitioned from OFM oversight to the Washington State Health Care Authority.
During the 2019-2021 biennial state budget process, Washington’s Legislature directed OFM to determine annual primary care medical expenditures as a percentage of total medical expenditures. Onpoint was asked to calculate the expenditures and produce the analyses to help inform OFM’s study. This study follows similar reports produced in Oregon and Rhode Island, with the shared goal of helping policymakers better understand the current level of investment placed in primary care so that they can better guide future healthcare investments.
The Washington State analysis found that primary care expenditures accounted for 4.4% to 5.6% of all medical expenditures overall in 2018, depending on whether a narrow or broad definition of primary care providers and procedures was used.
Figure 1. Summary of Medical Expenditures in Washington State, 2018
Individuals younger than 18 years of age were responsible for the highest percentage of primary care spending, ranging from 10.4% to 11.2% of total medical expenditures. Next highest: Working-age adults, ages 18-46 years, whose primary care expenditures accounted for 3.8% to 5.4% of total medical expenditures in the state. The population with the lowest primary care expenditures compared to total medical expenditures was adults, ages 65 years and older, ranging between 3.5% and 4.0%.
The results of this report provide Washington State with a baseline to use when monitoring future healthcare investments and initiatives and will serve as a launching pad to facilitate the state’s future research into understanding how it can best support the health of its population.
The “Primary Care Expenditures” report is based on data from the WA-APCD, a comprehensive source of claims that includes more than six million covered lives across more than 50 commercial, Medicaid, and Medicare payers. The report suggests several goals, including:
- Conducting a transparent process for determining which providers and services are considered primary care
- Developing a transparent and detailed methodology that can be replicated to measure trends and changes in primary care spending in future years
- Discussing differences between Washington’s methodology/results and other estimates and reports
- Identifying barriers to accurately estimating primary care expenditures
- Providing suggestions and guidance for future tracking of primary care spending and iterations of this type of report
For more details on the background, methodology, and results of Washington’s “Primary Care Expenditures” report, please access the full report here.