Considerations for Statewide Advanced Primary Care Programs

Focus Area:
Primary Care Transformation
Population Health Primary Care Investment Primary Care Spending Targets
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As part of the movement to improve population health through investments in primary care, more than 20 states are measuring the percentage of overall health care expenditures on primary care.1 The United States has over 10 years of experience with multipayer primary care models conducted in collaboration with the Center for Medicare and Medicaid Innovation (CMMI) that have helped to lay a foundation of advanced primary care. The energy around primary care investment targets, the impact of those investments, and lessons learned from CMMI’s multipayer advanced primary care programs now present an opportunity for reflection on the role of states in advancing primary care.

In this report, we share insights gained from our experience working with CMMI on innovative state-led primary care programs in Vermont and Maryland, presenting key elements of approaches to invest new primary care dollars. Acknowledging that individual states will follow many different paths, this discussion is meant to be categorical rather than prescriptive. We hope that lessons learned from these state-led journeys can inform and assist other states working with Medicare and Medicaid to move toward increasing their own investments in advanced primary care.


  1. State Primary Care Investment Hub. Primary Care Collaborative.

Haft H, Jones C. Considerations for Statewide Advanced Primary Care Programs. The Milbank Memorial Fund. March 2024.


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