Primary Care Investment

Higher investment in primary care is associated with lower costs, higher patient satisfaction, fewer hospitalizations and emergency department visits, and lower mortality. Despite current high levels of healthcare spending in the United States, the proportion spent on primary care is insufficient. A shift in resources to support greater access to comprehensive, coordinated primary care is imperative to achieving a stronger, higher-performing healthcare system.

Underinvestment in primary care gives rise to patient access and workforce issues. A significant financial incentive for physicians and other clinicians to choose other areas of specialty undermines primary care.

PCC's State Primary Care Investment Workgroup

PCC convenes Executive Members and state leaders from across the country (outside its membership) to discuss current trends in state legislation and regulations related to primary care investment. This workgroup meets quarterly in video calls that offer participants the opportunity to share best practices on how to successfully measure primary care spend and strategies to secure increased investment without growing overall health care expenditures. The workgroup shares updates across states, serves as a forum for peer exchange, and provides visibility to the increasing momentum of state-level actions to measure and improve investment in primary care.


  • Rachel Block, Milbank Memorial Fund
  • Larry McNeely, Primary Care Collaborative

To join the committee, contact Larry McNeely, Director of Policy.

What are states doing?

Several states are at the forefront of the effort to prioritize advanced primary care through better measurement and increased investment. 

A quick look at state activities

States that have reported (or committed to report) primary care spending

  • The 6 New England states (reporting together): Vermont, Maine, Massachusetts, Connecticut, Rhode Island, New Hampshire
  • Colorado
  • Delaware
  • Maryland
  • Nebraska
  • Oregon
  • Utah
  • Washington
  • California (Medicaid Managed Care only)
  • Hawaii (Medicaid Managed Care only)
  • New Jersey (Medicaid and state health plans only
  • West Virginia (Medicaid)

States that have set primary care investment targets

  • Colorado: 1 percentage point increases in 2022 and 2023
  • Connecticut: 10% by 2025
  • Delaware: 9-11% by 2025 (provisional target) 
  • Oregon: 12% by 2023
  • Rhode Island: 10.6% by 2014
  • Washington: 12% in 2022; new targets to be established

State legislation pending or in the works

  • Legislation pending that implements primary care spending targets: Massachusetts
  • Bills pending on affordability standards: California
  • Legislation reporting primary care spending: New York – awaiting the Governor’s signature
  • Legislation to report primary care spending in Medicaid Managed Care: Oklahoma – awaiting the Governor’s signature


Maps provided by the Milbank Memorial Fund

Key Resources

State Reports on Primary Care Spending:

Primary Care Spending: High Stakes, Low Investment

In its annual evidence-based report for 2020, the PCC took its broadest look to date at primary care spending over time, in all 50 states and nationally. The report reveals some alarming trends.

Investing in Primary Care: A State-Level Analysis

PCC's annual evidence-based report for 2019, which examined states’ primary care spending patterns, including spending across payer types, and considered the implications of these results for select patient outcomes.


Primary Care Investment Consensus Recommendations

Primary Care Spending Fact Sheet 

Primary Care Investment Logic Model DRAFT

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