Massachusetts SD 3480: Primary Care Task Force Statutory Deliverable #3: Establish a Primary Care Spending Target

Bill Text

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Statutory Deliverable #3:
Establish a Primary Care Spending Target

Introduction
Despite evidence that access to high-quality primary care is associated with increased health
outcomes and lower health care costs, only five to seven cents of every health dollar is spent on
primary care in the United States.1 In 2021, the U.S. spent 4.7% of its total health care spending in
primary care, compared to an average of 14% in other high-income nations, many who rank higher
in health outcomes than the US.2 In Massachusetts, primary care spending as a percentage of all
commercial health care spending was 6.7% in 2023, and is declining.3
To address this underinvestment, many states have passed legislation to increase the proportion of
total health care spending directed to primary care. In 2024, California’s Office of Health Care
Affordability set a goal of increasing primary care spending to 15% of total medical expenditures by
2034.4 In 2017, Oregon set a primary care expenditure target of at least 12% for all payers to be
reached by 2023. Though this benchmark is not enforceable, the Oregon Health authority can
require carriers that do not reach the target to submit a plan to increase spending on payment for
primary care as a percentage a percentage of total health expenditures by at least one percent
each plan year.5 In 2024, Rhode Island set a new primary care spending target of 10%, effective
2025.6
Primary Care Task Force Deliberation: Statutory Deliverable #3
At the Massachusetts Primary Care Access, Delivery, and Payment Task Force (PCTF) meeting on
June 17, 2025, Christopher Koller, President of the Milbank Memorial Fund, gave a guest
presentation, Increasing Primary Care Spending Rates in Massachusetts: Lessons from Other
States, and provided insights on how best set a target for increasing spending in primary care. This
presentation provided the PCTF with a guiding framework, design questions, and a set of principles
for establishing a primary care spending target here in Massachusetts.
At the PCTF meeting on July 22, 2025, task force members reflected on available state data
regarding primary care spending from the Center for Health Information Analysis (CHIA) Primary
Care Dashboard and reviewed legislative proposals calling for a spending target in Massachusetts.
Drawing on their experience and expertise in the Massachusetts primary care landscape, they
provided their feedback on the primary care spending target design questions shared by Mr. Koller.

1 Koller, C., Bianco, D., Greene, K., Hraber, M., Wilkniss, S. (2025). Implementing High-Quality Primary Care: A Policy Menu for States.
The National Academy for State Health Policy and Milbank Memorial Fund.
2 Gumas, E.D., Lewis, C., Horstman, C., Gunja, M.Z. (2024, March 28). Finger on the Pulse: The State of Primary Care in the U.S. and
Nine Other Countries. The Commonwealth Fund.
3 Center for Health Information Analysis (2025, June 5). Massachusetts Primary Care Dashboard.
https://www.chiamass.gov/massachusetts-primary-care-dashboard#June-2025
4 Department of Health Care Access and Information. (2024, October 22). California Sets Benchmarks for Primary Care Investment
to Promote High-Quality, Equitable Health Care. California Department of Health Care Access and Information News.
5 2022 Primary Care Spending in Oregon Report Executive Summary. Oregon Health Authority. October 2024.
6 Foubister V. Five States Leading Efforts to Increase Primary Care Spending. The Milbank Memorial Fund. March 12, 2025.

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HPC staff then developed a draft proposal incorporating this feedback and presented it to members
at the PCTF meeting on September 17, 2025 for further task force deliberation at the December 3,
2025 meeting.
Through this work, the PCTF has developed the following recommendations for establishing a
primary care spending target for private and public health care payers, pursuant to Chapter 343 of
the Acts of 2024.
Primary Care Task Force Recommendation: Statutory Deliverable #3
The PCTF recommends the Commonwealth of Massachusetts take bold action by setting an
aggregate primary care spending target with a timeline that reflects the urgency of the current crisis
in primary care. This recommendation is a necessary goal that is aligned with best practices put
forth by policy experts, recent primary care reform legislation passed in other states, and pending
legislation in Massachusetts. If achieved, Massachusetts will be a national leader among states in
rebalancing its health care system to one that prioritizes sustainable primary care, supports and
strengthens the primary care workforce, and delivers more accessible, efficient, effective, and
equitable care to patients.
• Primary Care Spending Target: The Legislature should establish an aggregate primary care
spending target for the Commonwealth that is equivalent to either (1) doubling the share of
health care spending on primary care as a percentage of total health care spending or (2)
15%,