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CHIA Publishes Report on Primary Care Spending

DATE : October 05, 2023

The Center for Health Information and Analysis (CHIA) today published its latest report on primary care expenditures in Massachusetts.

This report focuses on spending for primary care services for members enrolled in private commercial, Medicaid MCO/ACO-A, and Medicare Advantage plans for Calendar Year 2021. New to this year’s report, primary care expenditures are reported at the provider and payer level to enhance transparency and support data driven policymaking.

 

KEY FINDINGS:

  • In 2021, spending on primary care represented 6.9% of total spending for commercial members, 6.0% for Medicaid MCO/ACO-A members, and 4.2% for members enrolled in Medicare Advantage plans.

 

  • Commercial primary care per member per month (PMPM) spending was $41 in 2021. Medicare Advantage members had slightly higher primary care spending PMPM at $44, and MassHealth members enrolled in MCO/ACO-A plans had lower primary care spending PMPM at $31.

 

  • Across all insurance categories, a majority of primary care spending was comprised of office visits for general evaluation and management services.

 

Investments in primary care are known to meaningfully shape patient outcomes and are often associated with lower health care costs and higher quality care. To better understand the system-wide investments in these areas, CHIA launched a report series that examines spending on primary care services in Massachusetts. Comprehensive data on expenditures for these services in the Commonwealth has been limited to date. To address this gap, CHIA collects data on payments made by health plans to health care providers delivering these services in the Commonwealth.

This series is part of an effort by CHIA to offer policymakers and industry leaders valuable data that can be used to track system-wide investments in primary care across the Commonwealth.

Accompanying this report is a detailed databook and technical appendix. For more information, please visit https://www.chiamass.gov/pcbh.