Data That Can Drive Primary Care Investment

Join a Primary Care Development Corporation webinar on using APCDs to inform primary care policy and investment September 29, 2026, at 2 pm ET.

Primary care is the foundation of a high-functioning health care system, yet the US chronically underinvests in it. Primary care accounts for roughly 35% of health care visits but receives only 5%-7% of total health care spending. For state policymakers working to address this imbalance, the first questions asked are also some of the most basic: How do we know how our health care dollars are being spent? And once a state sets a primary care investment target, how can we know whether that target is being met?

State All-Payer Claims Databases (APCDs) can help answer these questions. By bringing together claims (data submitted for payment) and encounter data ( records of services provided) across public and private payers, APCDs can give states a more comprehensive view of health care utilization, spending, prices, and enrollment. This information can help policymakers establish primary care spending benchmarks, monitor progress, inform payment reform, and identify workforce needs.

A new report from the Primary Care Development Corporation (PCDC), developed with input from the Primary Care Investment Network (PCIN), examines how states are using APCD and other data strategies to advance primary care investment. Drawing on state experiences and insights from PCIN members, including state policymakers working to strengthen primary care investment, the report identifies six policy recommendations for states seeking to make APCDs more effective tools for primary care investment.

The central lesson is straightforward: APCDs can serve as powerful tools for informing primary care investment policy when paired with clear policy objectives, stakeholder engagement, and sustained investment. At the same time, states should not delay primary care investment efforts while developing APCD infrastructure, as complementary data collection and reporting strategies can also provide a strong foundation for meaningful policy action.

APCDs work best when states know what they want to accomplish

The strongest state examples show that an APCD is most useful when its design is closely tied to how policymakers intend to use the data. Oregon, for example, uses its APDC to produce an annual primary care spending report and to track progress toward its 12% primary care spending target. Washington designed its APCD to support transparent public reporting and give consumers, providers, purchasers, and researchers access to actionable information on health care cost and quality, including through public-facing tools.

The report’s first three policy recommendations focus on ensuring that APCD infrastructure is designed to be useful for primary care policy.

First, prioritize transparency. APCDs should produce publicly available reports, dashboards, and summary datasets that allow policymakers, researchers, and consumers to understand health care spending patterns.

Second, invest in usability and accessibility. Data is only valuable if researchers, advocates, and decision makers can access and analyze it. States should reduce administrative, financial, and technical barriers and provide user-friendly tools and standardized research files. Despite having an operational database, Texas, for example, has historically faced implementation, access, and funding challenges that have limited its use.

Third, align APCD infrastructure with primary care spending targets and broader policy goals. If a state establishes a primary care investment benchmark, its data system should be explicitly designed to measure progress toward that benchmark and support evaluation or enforcement.

Claims don’t tell the whole story

There is an important catch: traditional claims data do not capture all primary care investment.

As payment models move beyond fee-for-service, health plans are increasingly using arrangements such as capitation, care coordination payments, pay-for-performance bonuses, and shared savings. Those payments may not show up in traditional claims data in a way that allows states to accurately measure primary care investment. As a result, relying exclusively on claims can understate the resources actually flowing to primary care practices.

The report’s fourth policy recommendation is to incorporate non-claims payment data into APCDs or develop complementary reporting systems. This will help develop a more complete picture of primary care investment. Colorado and Oregon offer examples of how states can move in this direction.

At the same time, policymakers should be realistic about the limitations of APCDs. The federal Employee Retirement Income Security Act (ERISA) framework prevents states from requiring private-sector self-insured employer plans to submit data to APCDs, creating a significant gap in coverage, although some employers voluntarily submit data. Some states’ APCD data can also be incomplete, delayed, or difficult to access.

These limitations make it especially important for policymakers to establish realistic expectations for what an APCD can accomplish and to invest in the people, technology, governance, and funding necessary to make the data useful.

Don’t let the perfect database become the enemy of primary care investment

The report’s fifth and arguably most important policy recommendation is also the simplest: states do not need to wait for a fully operational APCD before acting on primary care investment.

Nebraska, for example, has moved forward with primary care investment policy without an APCD, including establishing a Primary Care Investment Council that recommended defining primary care and setting a spending target.

For states that don’t have an APCD, the report recommends considering other approaches, including requiring health plans to report primary care spending and utilization directly. Policymakers should weigh resources, timelines, and limitations associated with building an APCD against the urgency of advancing primary care investment policy.

For states that do invest in APCDs, the work does not end once the database is up and running. The report’s sixth and final policy recommendation is to ensure sustainable funding and governance. Dedicated appropriations, payer assessments, and clear governance structures can help maintain data quality, timeliness, and analytic capacity over the long term.

Conclusion

Taken together, the report’s six recommendations offer a practical roadmap for state health policymakers: (1) prioritize transparency, (2) invest in usability and accessibility, (3) align with primary care investment policy goals, (4) incorporate non-claims payments, (5) recognize that APCDs are not strictly necessary to pursue primary care investment policy, and (6) ensure sustainable funding and governance.

The goal isn’t simply to build better databases. It’s to use better data to build better primary care policy. States should make the most of the data infrastructure they have, invest in improving it where needed, and keep moving forward on primary care investment rather than waiting for the data to be perfect.

The authors acknowledge the contributions of Julie Schiltz of the the Primary Care Development Corporation to this post.