The Milbank Memorial Fund is an endowed operating foundation that publishes The Milbank Quarterly, commissions projects, and convenes state health policy decision makers on issues they identify as important to population health.
We focus on a number of topic areas identified by state health policy leaders as important to population health.
The Center for Evidence-based Policy at Oregon Health & Science University is a national leader in evidence-based decision making and policy design.
Keep up with news and updates from the Milbank Memorial Fund. Get the latest from thought leaders, including Christopher F. Koller, president of the Fund.
We publish The Milbank Quarterly, as well as reports, issues briefs, and case studies on topics important to population health.
News and Updates
October 31, 2018
Primary Care Spend
Representatives from state agencies in Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont met earlier this month to hear and discuss reports from multi-state workgroups related to Certificate of Need reform and hospital regulatory issues, improving the value of community benefits reports, data-sharing opportunites, and primary care investments.
The meeting was sponsored by the Milbank Memorial Fund, the National Academy for State Health Policy, and the New England States Consortium Systems Organization (NESCSO), a non-profit corporation organized by six New England Health and Human Services agencies and the University of Massachusetts Medical School that seeks to foster communication and collaboration between its members. Read about the recent Fund/NESCSO meeting.
Launched in 2017, the Primary Care Investments Workgroup included representatives from four of the NESCSO states—Connecticut, Massachusetts, Rhode Island, and Vermont. The group’s main goal was to explore opportunities for improving primary care by comparing each state’s strategies and activities. During meetings over the past year, the group engaged in discussions about each state’s approach to primary care investments, including the state’s policy environments and data capabilities, and potential opportunities for collaboration.
Using the 2017 Milbank Memorial Fund report, Standardizing the Measurement of Commercial Health Plan Primary Care Spending, as a starting point, the group compared each state’s definition of primary care to the report’s specifications and considered the measures used by Oregon for its primary care spending report.
“It is generally accepted and well documented that primary care is important for a high-performing health system. Despite this, relatively little money in the US is spent on primary care. You cannot improve what you do not measure, however, and up until now, we have had very limited information about exactly how little that is,” said Rachel Block, program officer at the Fund. “Using the Milbank report and data from Oregon gave the New England states a starting point to determine how much is spent on primary care as a percent of total medical spending in their states.”
The group identified several common building blocks for their primary care investment strategies:
Working from the common set of primary care spending measures, each state selected their key data elements and applied them to their own state data sets. A comparative look at primary care payments in four New England states is provided in the table below.
*CT Includes Care Coordination and Shared Savings Quality Payments Only
Richard Slusky, former director of payment reform in Vermont, who served as facilitator, summarized the lessons learned about measuring primary care investment from the meeting:
The primary care workgroup has tentatively identified three topics for its work in 2019:
Go to the Primary Care Spend Resource page to learn more about the workgroup’s findings.
The Milbank Memorial Fund is an endowed operating foundation that works to improve the health of populations by connecting leaders and decision makers with the best available evidence and experience.
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