Rhode Island and Massachusetts Step Up to Support Primary Care 

Two New England states are calling for more support for primary care. On May 12, the Rhode Island Cost Trends Steering Committee and the Office of the Health Insurance Commissioner (OHIC) hosted their annual public forum on health care affordability and quality. The forum highlighted the latest data on health care spending trends and care quality and compared statewide spending performance to the 2023 cost growth target. This year, the forum also highlighted the critical role that primary care can play in managing the state’s health care spending while improving health and wellness. On the same day, the Massachusetts Senate held a hearing for Senate Bill 867, which would establish a primary care spending target. 

Rhode Island Continues Efforts to Rebalance Health Spending 

Rhode Island was the first state to establish a goal for primary care investment as percentage of total health spending for commercial insurers in 2010; the primary care target is currently 10%. A recent article in Health Affairs demonstrates how the affordability standards in Rhode Island, which include primary care investment, have saved money for residents and employers in the state. The study builds on prior research showing the affordability standards slowed spending growth for the commercially insured. Just last month, OHIC issued new regulations requiring that commercial insurers increase funding for primary care and reduce prior authorization requirements by 20%. In addition, Governor McKee has announced several measures to sustain primary care such as OHIC review of primary care rates to ensure that they are competitive.  

During the forum, Milbank Memorial Fund Program Officer Rachel Block moderated a panel with Rhode Island primary care leaders. Like the nation, Rhode Island faces a growing crisis in primary care access due to a shrinking primary care workforce, growing administrative burdens for practices, and inconsistent reimbursement policies for primary care practice supports like team-based care. “Commissioner King made it very clear – a stronger primary care system is necessary to help the state achieve sustainable health care costs,” Block said.  

Massachusetts Senate Considers Primary Care Target   

Meanwhile, the Massachusetts Senate Health Care Financing Committee held a hearing on a bill would require that state insurers and health providers nearly double the percentage of health care spending going toward primary care over the next four years to 12%, while not exceeding the cost growth benchmark established by the Massachusetts Health Policy Commission. This legislation would make the state’s new primary care task force a permanent board tasked with defining primary care services for the purposes of the target, establishing primary care spending reporting requirements, developing an all-payer primary care payment model, and more.  

Milbank Memorial Fund President Christopher Koller gave testimony at the hearing, drawing on his experience as the Health Insurance Commissioner of Rhode Island and the Fund’s work supporting state health care affordability efforts. “Recognizing the unbalanced, specialty care–focused health care delivery system in the United States, over 20 states have set primary care spending targets for commercial insurance,” Koller said. “Now some of those states are considering Medicaid spending on primary care, making existing targets binding, and establishing more formal oversight.”