Standardizing the Measurement of Commercial Health Plan Primary Care Spending

Focus Area:
Primary Care Transformation
Primary Care Investment

Primary care is often acknowledged as the foundation of any high-performing health care delivery system. But how much of our health dollars go to supporting it?

To address this question, the authors of this report—Michael Bailit, Mark Friedberg, and Margaret Houy—present a methodology to define and estimate spending on primary care, relative to other medical expenses. The study design first focused on developing consensus on a specific definition of primary care (including provider types and service billing codes) and then established the feasibility of applying this measure using data from a set of commercial insurers.

Primary care spending is a simple and easily understood measure of how oriented a delivery system or geographic community is to primary care, prevention, and population health. Given the proliferation of enhanced payment initiatives, there seems to be growing consensus in favor of increased spending for primary care and the idea that primary care is a necessary, fundamental step toward a better-performing health system.  And we want to increase policy focus on it.

This report shows the importance of precisely defining primary care spending—and provides additional questions for future research. With further development and validation, these measures of primary care spending could serve as the basis for national benchmarks and public policies that seek to orient health systems more strongly toward primary care.