Primary Care and Behavioral Health (PCBH) Spending

Overview

Primary care and behavioral health services play a critical role in improving health outcomes across the Commonwealth, advancing health equity and helping moderate overall health care costs. However, these services have historically been under-resourced, making it difficult for many Massachusetts residents to obtain timely and affordable access to this vital care.  

To provide insight into investments in these services, CHIA collects primary care and behavioral health spending data from health plans covering Massachusetts residents. This report focuses on spending for members enrolled in private commercial, MassHealth, and Medicare Advantage plans for calendar years (CY) 2023 and 2024.  

 

 

Report Materials (June 2026)
Report (PDF) Databook (Excel) Dataset (Excel) Technical Appendix

Primary care spending

Primary care continues to represent a modest share of total health care spending, with divergent trends across payer types.

  • In 2024, primary care accounted for 6.6% of commercial, 8.4% of MassHealth, and 4.2% of Medicare Advantage spending. 
  • The share declined for commercial members but increased for MassHealth and Medicare Advantage. 

Behavioral health spending

Behavioral health accounts for a substantially larger share of spending in MassHealth, with growth concentrated in that population.

  • In 2024, behavioral health represented 8.1% of commercial, 22.4% of MassHealth, and 2.3% of Medicare Advantage spending. 
  • Spending shares were stable for commercial and Medicare Advantage, but increased for MassHealth. 

Pediatric vs. adult spending patterns

Children receive a greater share of care through primary care and behavioral health compared to adults.

  • Pediatric members in commercial plans had a higher proportion of spending in both categories than adults. 

Primary care spending by service category

Non-claims and full-risk payments represented a substantial portion of Mass Health primary care spending as a result of the new Primary Care Sub-Capitation Program.

  • In 2024, non-claims accounted for 68.6% of MassHealth, 0.1% of private commercial, and 2.0% of Medicare Advantage primary care spending 

Additional Information

CHIA collects spending and diagnosis prevalence for mental health and substance use disorder services separately; combined spending on these service categories represents total behavioral health expenditure figures referenced in this report. Additional analyses include primary care and behavioral health spending metrics by age group, payer, and managing clinician group.  

Note: The primary care and behavioral health data presented in the May 2026 report cannot be compared with CHIA’s previous reporting due to differences across data collection periods.  

Previous Publications

Recommended Links

Primary and Behavioral Health Care Expenditures Data Submissions

Information for Massachusetts health care payers to submit detailed data to CHIA, including deadlines and user guides.

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Primary Care Dashboard

Explore primary care spending, utilization, and workforce data across Massachusetts payers, providers, and communities.

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Behavioral Health Care Dashboard

A comprehensive overview of the current state of behavioral health care in Massachusetts alongside metrics for comparison.

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