New Payment Models for Advanced Primary Care: Data Collection Needs to Catch Up with Policy

Evidence suggests strong primary care is foundational to health system transformation. It can help people lead long, healthy lives and improve health equity. Yet, primary care spending in the United States is a very small component of total health care costs, and absent direct policy interventions, this spending is not likely to increase.

One approach to better supporting primary care that has gained traction is the implementation of advanced primary care models, which offer team-based, holistic care. These models are supported by various types of alternatives to fee-for-service (FFS) payments, which aim to constrain total costs of care while improving patients’ outcomes and experience. Yet, relatively little attention has been given to setting standards for the data collection and analysis needed to track whether and how these payment models actually support primary care.

The 2021 National Academies of Science, Engineering, and Medicine report on Implementing High-Quality Primary Care calls for spreading the use of payment models that support high-quality primary care by paying for enhanced primary care functions. The Milbank Memorial Fund has also supported research on and implementation of new primary care payment models, as well as state primary care spending targets, as ways to increase investment in primary care. In their 2022 legislative sessions, four states have adopted policies to measure, publicly report, and increase primary care spending, and more states are poised to adopt similar programs.

But the success of these initiatives is hindered by our lack of insight into current spending on primary care. We have limited data available to monitor how much health plans spend on primary care in total, even less information on their non-claims (or non-FFS) payments for primary care, and essentially no information about how dollars flow through these new payment models or through larger health systems. As a result, we cannot keep track of dollars spent on specific primary care transformation activities, or even how much in total is allocated to the non-claims or non-FFS component. States with all payer claims databases (APCDs) generally do not collect this information, and when they do, it is not collected in a way that is standardized across states.

A recent survey accounting for almost three-quarters of the national health care market found that 60% of payments are now being made through enhanced FFS or alternate payment models. It is increasingly important that we implement consistent data collection and reporting for these payments. There are important ways that states can use non-claims payment data with or without a primary care spending target:

• Alignment. Detailed information about non-claims payments can help establish consistency and alignment across payers in support of advanced primary care in states and regions that have adopted standards for these models.
• Accountability. States can use this data to determine whether payers are meeting a target for alternative payment models generally and primary care non-claims payments specifically. If payments are being increased or reallocated, we need to know by how much and where the dollars are going to support primary care improvements.
• Research and evaluation. Given the variety of new payment models, information on the full amount and types of payments is needed to evaluate the models’ impact on outcomes and costs.

We have some models for non-claims payment data collection and reporting that can be adopted or adapted on a more widespread basis.

• A Milbank Memorial Fund report assessed the landscape and defined a framework for data collection on the wide range of non-claims payments that are part of these advanced primary care payment models, including a standard template to facilitate this data collection.
• Oregon, Colorado and Maine have adopted standards for non-claims reporting through their APCDs.
• Rhode Island’s health insurance commissioner has a separate data collection process for this information.

Slow but certain progress can be achieved as more states adopt primary care investment targets and reporting requirements, and then converge by developing standard methods for data reporting. But the movement toward accountable alternative payment models for primary care can be further accelerated if national and federal efforts are aligned around common goals, terms, and methods. The National Association of Health Data Organizations has been working on standards for non-claims data submission to state APCDs. But given the crucial nexus between data needs and new primary care payment models, the faster pathway for consistent adoption would be national data standards and reporting requirements established by the Centers for Medicare and Medicaid Services.

The United States needs to measure primary care spending with a common yard stick to improve how we invest in primary care. It is time to establish specific national standards for non-claims payment data collection and reporting for alternative payment models used by health plans and systems.