Primary Care Investment Resources and Links

Legislating Primary Care Investment

As of December 2022, at least twenty diverse states, from Rhode Island to Utah, have taken steps to measure and, in some cases, increase primary care spending as a proportion of overall medical spending. To see how they did it, the links below access specific bills that illustrate how these states approach the varied issues associated with primary care measurement and investment.  (To explore more state primary care investment legislative initiatives, see PCC's searchable web tool.)

Establishing a multi-stakeholder body

Colorado HB 19-1233 (2019)

"(2) THE COMMISSIONER SHALL INVITE REPRESENTATIVES FROM THE FOLLOWING TO PARTICIPATE IN THE PRIMARY CARE PAYMENT REFORM COLLABORATIVE:

(a) HEALTH CARE PROVIDERS, INCLUDING PRIMARY CARE PROVIDERS;

(b) HEALTH CARE CONSUMERS;

(c) EMPLOYERS THAT PURCHASE HEALTH INSURANCE FOR EMPLOYEES AND EMPLOYERS THAT OFFER SELF-INSURED HEALTH BENEFIT PLANS;

(d) HEALTH INSURERS, INCLUDING ENTITIES THAT CONTRACT WITH THE DEPARTMENT OF HEALTH CARE POLICY AND FINANCING AS MANAGED CARE ENTITIES;

(e) THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID SERVICES;

(f) THE PRIMARY CARE OFFICE IN THE DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT CREATED PURSUANT TO SECTION 25-1.5-403;

(g) THE EXECUTIVE DIRECTOR OF THE DEPARTMENT OF HEALTH CARE

POLICY AND FINANCING; AND

(h) EXPERTS IN HEALTH INSURANCE ACTUARIAL ANALYSIS."

Defining the Duties of a Multi-Stakeholder Body

Oregon SB 934 (2017)

(2)(a) The Oregon Health Authority shall convene a primary care payment reform collaborative to advise and assist in the implementation of a Primary Care Transformation Initiative to:

(A) Use value-based payment methods that are not paid on a per claim basis to:

(i) Increase the investment in primary care;

(ii) Align primary care reimbursement by all purchasers of care; and

(iii) Continue to improve reimbursement methods, including by investing in the social determinants of health;

(B) Increase investment in primary care without increasing costs to consumers or increasing the total cost of health care;

(C) Provide technical assistance to clinics and payers in implementing the initiative;

(D) Aggregate the data from and align the metrics used in the initiative with the work of the Health Plan Quality Metrics Committee established in ORS 413.017;

(E) Facilitate the integration of primary care behavioral and physical health care; and

(F) Ensure that the goals of the initiative are met by December 31, 2027.

Annual or Biannual Reporting of Primary Care Spend

Washington State S.5589 (2022)

Beginning August 1, 2023, the board shall annually submit reports to the governor and relevant committees of the legislature. To the extent possible, the reports must:

(a) Include annual primary care expenditures for the most recent year for which data is available by insurance carrier, by market or payer, in total and as a percentage of total health care expenditure;

(b) Break down annual primary care expenditures by relevant characteristics such as whether expenditures were for physical or behavioral health, by type of provider and by payment mechanism; and

(c) If necessary, identify any barriers to the reporting requirements and propose recommendations for how to overcome them.

Establish Spending Targets

Delaware’s SB 116 2021

(c) The Office of Value-Based Health Care Delivery shall do all of the following:

(1) Establish affordability standards for health insurance premiums based on recommendations from the Primary Care Reform Collaborative.

(2) Establish targets for carrier investment in primary care to support a robust system of primary care by January 1, 2025.

(3) Collect data and reports regarding carrier investments in health care to monitor and evaluate all of the following:

a. The calculation of the amount of primary care spending in this State, including data from the Delaware Health Care Claims Database, under Subchapter II of Chapter 103 of Title 16.

b. Carrier compliance with reimbursement rates for primary care required under § 3342B and § 3556A of this title and § 5203 of Title 29.

c. Health-care spending data collected and reported through the State benchmarking process.

(4) Annually evaluate primary care spending, with consideration of overall total health-care spending.

(5) Make recommendations to the Insurance Commissioner and the Primary Reform Collaborative about establishing appropriate reimbursement rates for primary care.

(6) Develop and annually evaluate affordability standards, through an open and transparent process, in collaboration with the Primary Care Reform Collaborative.

(d) The Insurance Commissioner shall adopt policies and procedures to implement this section.

Enforcement of Spending Targets

Oregon SB 934 (2017)

"743.010. (1) In addition to all other powers of the Director of the Department of Consumer and Business Services with respect thereto, the director may issue rules with respect to policy forms and health benefit plan forms described in ORS 742.005 (6)(a) and (b):....(d) Establishing requirements for carriers offering health benefit plans that spend less than 12 percent of total medical expenditures on payments for primary care to submit with each rate filing a plan to increase spending on payments for primary care as a percentage of total medical expenditures by at least one percent each plan year.

Primary Care Spending: Essential Resources

Messaging Primary Care Investment

PCC Publications on State Investment

Primary Care Spending's Impact: Review The Evidence

 

PC Investment & Measurement: What's Right for Your State?

PCC Webinars on State Primary Care Investment:

Measuring Primary Care Spend: Key  Resources

Primary Care Investment Initiatives: Understand the Context

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