State Primary Care Investment Initiatives

Requires the Office of Value-Based Health Care Delivery to establish mandatory minimums for payment innovations, including alternative payment models, and evaluate annually whether primary care spending is increasing in compliance with the established mandatory minimums for payment innovations.

This Act expands the membership of the Primary Care Reform Collaborative and creates an Office of Value-Based Health Care Delivery in the Department of Insurance to reduce health care costs by increasing the availability of high quality, cost-efficient health insurance products that have stable, predictable, and affordable rates. The Office of Value-Based Health Care Delivery will work with the Primary Care Reform Collaborative and the State benchmarking process.

Tasks Insurance Commissioner with 1) forming a collaborative (the Colorado Primary Care Payment Reform Collaborative) to advise on increasing primary care spend 2) issue rules to set affordability standards, including PC spend targets

Establishes an Office of Health Care Strategy Office to develop an annual health care cost growth benchmark and primary care spending target. Develops and adopts health care quality benchmarks. Develops strategies, in consultation with stakeholders, to meet such benchmarks and targets developed. Enhances the transparency of provider entities. Monitors the development of accountable care organizations and  patient-centered medical homes in the state. Monitors the adoption of alternative payment methodologies in the state. Legislation enacted as a provision of 2022 state budget legislation.

Hawaii requires Medicaid Managed Care Organizations to report on and increase the percentage of medical expenditures devoted to primary care.

Defines primary care and details how primary care spending report will transpire in Maine moving forward. 

Requiring the Maryland Health Care Commission to provide a report, beginning December 1, 2024, and each year thereafter, to the Governor and the General Assembly containing an analysis of primary care investment, ways to improve the quality of and access to primary care services, and any findings and recommendations; requiring the Commission to establish a workgroup to develop the report to include an interpretation of the results of the required analysis and to make recommendations; etc.

Establishes a Center for Health Information and Analysis (CHIA) charged with a range of duties, incuding analyzing health costs and utilization in the Massachusetts. On September 20, 2022, CHIA subsequently released the first report on primary care and behavioral health spending in Massachusetts.

This broad health equity bill includes provisions requiring the Massachusetts Health Policy Commission to establish targets for primary care and behavioral health spending targets and provide analyses of progress toward those targets.

For the 3-year period ending with calendar year 2024, the aggregate primary care expenditure target for each of the 3 years shall be equal to a 30 per cent increase above aggregate primary care baseline expenditures, and the primary care expenditure target for each of the 3 years shall be equal to a 30 per cent increase above primary care baseline expenditures.

This omnibus appropriations legislation would require a report on primary care spending and establish a Health Care Affordability Board that may consider establishing quality and primary care spending standards.

This omnibus appropriations legislation would require the Commissioner of Health to provide a one-time report on primary care spending and establish a Health Care Affordability Commission with broader responsibility to establish broader health spending and outcome targets for the state.

Elements of this bill were incorporated in the final budget bill,SF 2995.

establishing the Health Care Affordability Board and Health Care Affordability Advisory Council; requiring monitoring of and recommendations related to health care market trends; establishing the health care spending growth target program; requiring reports; providing for civil penalties; requiring certain transfers of funds;

This legislation establishes a Primary Care Investment Council, charged with measuring primary care spending in Nebraska recommend an appropriate level of primary care investment across public and private payers, and recommend steps to attain that target. The Council is futher instructed to issue a report to the Governor and Legislative Council on an annual basis, starting in 2023 and continuing through 2028.

This legislation included a provision requiring an annual report on trends and drivers in spending in the health insurance market.  Subsequent reports have included information on primary care spend as a portion of overall spend.

Provisions of the 2021-2022 state appropriations legislation establish a requirement that Medicaid Managed Care Organizations report the percentage of total medical expenditures devoted to primary care.  Requires the State Department of Pension and Benefits to report on primary care spending for state-run health plans, such as the state employees' plan.

Establishes a primary care council, charged with analyzing primary care spend as a proportion of health care spending yearly, making recommendations for policy to recommend policies, regulations and legislation to increase access to primary care, improving the quality of primary care services and lowering the cost of primary care delivery while reducing overall health care costs;  Council must present a 5 year plan to the Secretary

Charges the North Carolina Primary Care Payment Reform Task Force with developing a definition of primary care that is applicable to the NC Medicaid program and commercial insurance, measuring how much insurance plans spend on primary care, determining the quality of the primary care delivery system in North Carolina, studying the primary care payment landscape in states that implement a minimum primary care spend, and collecting data to inform a primary care investment target for insurance plans.

SB 563 affirmed requirements for reporting of the percentage of health care expenses by each contracted entity on primary care services and that no later than the fourth year of a contract with the Medicaid program must devote at least 11% to primary care.

Requires most large health plans, Public Employees' Benefit Board and the Oregon Educators Benefit Board to report on the percentage of total medical expenditures devoted to primary care.

Requires the state's Medicaid Coordinated Care Organizations (CCOs), state-run educators' and public employees' plans and state-regulated health insurance carriers to annually report the percentage of total medical expenditures planned to be spent on primary care, the percentage of spending on primary care that will be made using APMs, and the types of APMs used. Requires CCOs, no later than January 1, 2023 to spend at least 12 percent of total medical expenditures on primary care. Requires the Oregon Health Authority (OHA) to take into account anticipated primary care spending and use of alternative payment methodologies (APMs) when determining CCO global budgets. Requires CCOs, state educators' and public employees health plans, and insurance carriers, no later than January 1, 2023, to reimburse a certain percentage of all primary care costs through APMs.  This percentage will be established by Oregon Health Authority and Department of Consumer and Business Services (DCBS).

Authorizes Insurance Commissioner to set minimum PC spending target for state-regulated insurers; engage in practice transformation activities, as part of promoting Affordability Standards

Requires the Health Data Committee to annually issue a report on primary care spending within the state of Utah. 

This legislation directed.the Green Mountain Care Board and Department of Vermont Health Access to identify which health care providers and services constitute primary care, determine the percentage of health care spending currently allocated to primary care by certain public and private payers and by Vermont’s health care system overall, and report the percentages and related information to the General Assembly.

This bill proposes to require health insurers, the State Employees’ Health Benefit Plan, and the health plans offered to school employees to increase the percentage of total health care spending they allocate to primary care to at least 15 percent and would require the next all-payer model agreement with the federal government to include a provision requiring annual increases in primary care spending in Medicare.

This multi-issue bill includes provisions to increase primary care payments and spending. It requires that Medicaid matches 100% of the amount that Medicare pays its providers and that state and large health insurers increase their annual spending on primary care until the total reaches at least 12% of overall health care spending.

This bill required the state Department of Health and Human Resources to contract with the Virginia Center for Health Innovation for actions necessary to facilitate and continue the work of the Virginia Task Force on Primary Care. The purpose of the task force is to enhance the financing, quality and delivery of primary care in the Commonwealth.

$110,000 of the general fund—state appropriation for fiscal  year 2020 is provided solely for the office of financial management to determine annual primary care medical expenditures in Washington, by insurance carrier, in total and as a percentage of total medical expenditure. Where feasible, this determination must also be broken  down by relevant characteristics such as whether expenditures were B4 for in-patient or out-patient care, physical or mental health, by type of provider, and by payment mechanism

Establishes a Primary Care Support Program within the Department of Health and Human Resources, that would, among other duties, conduct and make available upon request an annual primary care report which shall consist of total West Virginia Medicaid primary care expenditures as a percentage of total West Virginia Medicaid expenditures.

Primary care spending would be subject to measurement, analysis and annual reporting under this broader legislation establishing health care spending growth benchmarks for the state.

Establishes the primary care reform commission to review, examine, and make findings on the level of primary care spending by all payers in the context of all health care spending in the state and publish an annual report on the findings, and also make recommendations to increase and strengthen spending on primary care in the state and improve primary care infrastructure, taking care to avoid increasing costs to patients or the total cost of health care.

Establishes the primary care reform commission to review, examine and make findings on the level of primary care spending by all payers in the context of all health care spending in the state and publish an annual report on the findings, and also make recommendations to increase and strengthen spending on primary care in the state and improve primary care infrastructure, taking care to avoid increasing costs to patients or the total cost of health care.

Establishes the Primary Care Investment Task Force which will take a detailed and objective look at where Pennsylvania stands when it comes to primary care investments compared to other states. Building off their findings, the task force will also identify what can be done to bolster investment in primary care.