A Growing Number of States Have Policies to Increase Primary Care

June 5, 2019

Program:  Multi-Payer Primary Care Transformation

A first step toward increasing primary care investment is measuring and reporting on existing primary care spending. Over the last five to 10 years, two states, Rhode Island and Oregon, have pioneered legal and regulatory policies to measure and spur primary care investment, and other states have developed reports on public and private primary care spending. In 2019, several states introduced legislation on this topic, and Colorado and Vermont now have new laws to advance these policies.

Colorado: Many payers in Colorado, including Medicaid, have been committed to investing in primary care for several years, but until the new law passed there was not a standardized way to measure how much money was spent or how it was targeted. To address this gap, the Colorado Academy of Family Physicians (CAFP) developed a legislative proposal and mobilized support from other health care groups to formalize the process of measuring and increasing primary care investment.

The Colorado legislation is similar to Rhode Island’s law. The Commissioner of Insurance is authorized to establish health care affordability standards, including primary care investment targets, for commercial insurance. Medicaid and state employee plans are also required to adopt their own targets. The law also allocates state and private funds to publish the state’s progress on statewide and payer-specific primary care spending measures.

Vermont: Vermont’s new law also calls for the development and reporting of measures for primary care spending. Under the law, the Green Mountain Care Board, which manages many health care regulatory functions for the state, and the Department of Vermont Health Access, which administers Medicaid, will define what providers and services constitute primary care, and how to collect data on claims and non-claims payment for primary care. (Examples of non-claims payments include supplemental care management fees and reimbursement for purchase of electronic health records). The Green Mountain Care Board is required to complete a report by January 2020 that includes overall rates and spending rates by major payer categories, including large employers, Medicaid, and state employees.

The states with pending legislation include California, Missouri, Maine, Hawaii, and Delaware.

“States continue to lead the nation by bringing attention to the importance of primary care investment and adopting policies to build a stronger primary care foundation for the health system,” said Milbank Memorial Fund Program Officer Rachel Block. “Colorado and Vermont have joined Rhode Island and Oregon in bolstering primary care for their residents, which should help lower health care spending.”