Lawmakers weigh 'Primary Care for You' overhaul to double primary-care spending and change payments

BOSTON — The Joint Committee on Health Care Financing heard extended testimony in favor of a package of bills collectively called "Primary Care for You" (H.1370 / S.867) that would substantially increase investments in primary care, change payment methods from fee-for-service toward monthly prospective payments, and create accountability measures to ensure funds reach frontline practices.

Representative Haggerty, the lead House sponsor of H.1370, framed the legislation as a response to a state and national primary-care crisis: access is deteriorating, providers are leaving, and primary care receives a small share of the health-care dollar. "If we invest more in keeping people healthy, we can avoid much higher costs of treating them when they get sick," Haggerty told the committee.

Witnesses described a multi-part policy package. Key elements discussed included: a primary-care spending target (moving spending toward 12% of total health-care expenditures for plans subject to the rule); a requirement that payers or a stabilization fund make prospective monthly payments to practices that adopt specified “transformer” services (team-based care, integrated behavioral health, care management, population health and data-driven quality measures); protections and a commercial-rate floor for federally qualified health centers (FQHCs); and a primary-care stabilization fund to pool and distribute funds to frontline practices. Proponents said the stabilization fund solves a common implementation problem by consolidating resources and providing uniform payment rules for most patients, including employees of self-insured employers.

Experts testified on expected effects and implementation challenges. Dr. Kevin Grumbach (UCSF), who advised California’s primary-care policy work group, endorsed the stabilization fund as a legal and practical method to collect funds from diverse payers (including third-party administrators) and disburse uniform prospective payments to clinicians. Several clinicians — including Dr. Sarah Nossal (president‑elect, American Academy of Family Physicians), Dr. Catherine Atkinson (family physician in western Massachusetts), Dr. Renee Critchlow (Codman Square Health Center) and Dr. Jim Perrin (pediatrician) — described how prospective payments and team-based care would allow practices to hire care managers, integrate behavioral health, address social needs and reduce emergency-room visits and hospitalizations.

Insurers and plan representatives signaled conditional support. Sarah Caramita of the Massachusetts Association of Health Plans said plans were "directionally supportive" of increased primary-care investment but urged that any increase be within the cost-growth benchmark and be accompanied by offsets so total health-care spending did not rise unsustainably. A payer executive’s written testimony read into the record said stronger primary care aligns payer financial interests with improved population health and lower downstream costs.

Researchers and policy analysts presented modeled savings and timelines. Dr. Catherine McDaniel and a Friedman Health Consulting simulation showed that, with expected reductions in high-cost utilization, increased primary-care investment could pay for itself within about 49 months of implementation and generate an estimated $1.6 billion in savings over 10 years. Witnesses emphasized that early wins (for example, medication management and integrated pharmacy services) can appear within the first year, while broader population-health gains accrue over several years.

Younger clinicians and students testified about workforce incentives: students said low pay, heavy administrative burdens (EHR inboxes and unpaid "pajama time") and perceived lower prestige deter them from choosing primary care. Supporters asked the committee to combine the bills’ strongest elements — spending target, prospective payment for transformer services, FQHC parity, a stabilization fund and transparent reporting and enforcement — into a legislative package that could be enacted this session.