New England States Work to Standardize Measures of Primary Care Investment
The New England States Consortium Systems Organization (NESCSO) is seeking to standardize measurements of primary care spending across six states. One goal is to build on early evidence that an increased percentage of total payments invested in primary care is associated with improved quality, utilization and cost outcomes.
While the work was informed by earlier efforts to define primary care providers and services, it is the first time a standardized definition has been applied across six states.
A recent report commissioned by NESCSO, with support from the Milbank Memorial Fund, found that spending on primary care in six New England States represents an average of 5.5 percent of overall healthcare spending. The analysis was based primarily on data from the all-payer claims databases of Connecticut, Rhode Island, Massachusetts, New Hampshire, Vermont, and Maine. It included claims data for 7.2 million commercial, Medicare, and Medicaid members.
While some non-claims data, such as capitated payments, was collected directly from payers, the report authors pointed to the need for policymakers to consider requirements for payers to report on non-claims data, particularly as value-based models of care become more common.
“The development of a standardized way to measure investment could serve as the basis for a regional benchmark, as well as public policies that aim to reorient health systems toward primary care,” said Milbank Memorial Fund program officer Rachel Block, in a statement.
In 2017, NESCO, a nonprofit corporation organized and directed by the six New England states’ health and human services agencies and the University of Massachusetts Medical School, formed a Primary Care Investment Workgroup, which includes representatives from all six New England states. The Workgroup’s main goal has been to advance a “Vision for Patient Centered Primary Care” by exploring opportunities for sharing state strategies and activities. During meetings over the past three years, the group has engaged in discussions regarding each state’s approach to primary care payments, policy environments, data capabilities, and potential opportunities for collaboration.
In 2019, the Workgroup proposed to use “standardized” data to produce a “The New England States’ All-Payer Report on Primary Care Payments” focused on how states incentivize and measure primary care payments as a percentage of total healthcare expenditures. The purpose of the report is to use standardized data to identify the percentage of all-payer primary care spending relative to overall healthcare spending in each state and to provide a framework to evaluate whether the states’ investments in primary care reflect the importance and value of primary care in each state.
The Workgroup chose this focus with the intention of building on early evidence that an increased percentage of total payments invested in primary care is associated with improved quality, utilization, and cost outcomes. The Workgroup envisioned establishing a baseline of comparable information and benchmarks as an important tool to help guide their states’ policies on primary care payments and to monitor the impact of those policies over time.
In 2020, NESCSO agreed to finance the Workgroup’s proposal by engaging Onpoint Health Data to provide the analytic services needed to support this project. The Milbank Memorial Fund provided supplemental funding in support of this project
The approach to produce this report was to use a distributed model in which all states could use a single, standardized methodology to report comparable summary results from their respective all-payer claims databases (APCDs) and other non-claims data sources.
The all-payer combined primary care payments as a percentage of total medical payments was 5.5 percent using a narrower definition and 8.2 percent using a broader definition, results that fell within the range of other published studies on the percentage of primary care payments
One finding of the study is that primary care payments as a percentage of total medical payments were lower for the older Medicare population than for the younger Commercial and Medicaid populations, but actual per member per month (PMPM) payments going to primary care were higher for the Medicare Advantage and Medicare Fee-for-Service (FFS) populations. Although understanding the relationship between the percent of primary care payments and the PMPM payments associated with primary care is beyond the scope of the report, achieving a better understanding of this relationship and the association of these investments with better outcomes is a topic worthy of further study, the authors noted.
Based on the findings, NESCSO recommended that states address specific policy and technical issues to improve data collection processes in order to ensure that the data is useful in evaluating the potential impact of increasing primary care payments as a means to improve quality and reduce costs.
