Measuring Non-Claims-Based Primary Care Spending

Focus Area:
Primary Care Transformation
Primary Care Investment


The Centers for Medicare and Medicaid Services, states, and private payers are investing in the primary care infrastructure to improve health care quality and outcomes and to strengthen health care system performance. Research demonstrates that greater relative investment in primary care compared to specialty care leads to better patient outcomes, lower costs, and improved patient experience of care. States’ actions to encourage primary care investment include measuring primary care spending as a percentage of total health care expenditures and establishing expectations or requirements to increase primary care spending. Yet there is little uniformity in defining primary care spend, particularly non-fee-for-service spending. This brief proposes a standard definition and measurement methodology that will allow policymakers to quantify total investment in primary care and enable comparisons of spending across states and within a state by region, payer, and health care system.

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