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HAI outlines four investment indicators for 2026 primary care snapshot, flags data tradeoffs
Summary
HAI proposed core investment indicators for the 2026 snapshot—primary care investment as share of total medical expense and per-member measures, year-over-year change, breakdown by claims vs non-claims, and cumulative change relative to other service categories—while noting limitations in geographic and non‑claims data.
HAI staff proposed three core investment indicators for the 2026 primary care snapshot and a fourth candidate indicator to show relative spending shifts, while highlighting data limitations and stratification tradeoffs.
"We propose primary care investment both as a percent of total medical expense and on a per member per year basis," Miranda Wartz, Senior Primary Care Specialist, told the workgroup. She listed two additional core measures: year‑over‑year change in primary care investment, and primary care investment broken out by claims and non‑claims payment categories.
HAI said the proposed indicators will rely primarily on OKA’s primary care investment and total medical expense (TME) data collection, which has completed its first round and is expected to report this year. HAI noted the OKA data will be available only in aggregate across payer types and will not be stratified by geography or demographics for the 2026 snapshot. By contrast, the Healthcare Payments Database (HPD) provides granular claims data that can be stratified by geography but currently lacks non‑claims data such as practice transformation payments.
Workgroup members pressed HAI on stratification choices. One participant asked whether the commercial market would be split between Kaiser and non‑Kaiser reporting; HAI said it will report by market categories initially and could consider payer‑level reporting later. Another participant recommended that HAI consider how HPD and OKA sources might be combined in future iterations to get both geographic granularity and non‑claims payment detail.
HAI also proposed a fourth investment indicator—cumulative change in primary care spending relative to higher‑intensity categories such as inpatient and specialty care—to show whether spending is being redistributed toward primary care. HAI showed an example visualization used in Utah and said similar graphics could be created for California using OKA data.
HAI will gather workgroup feedback through a post‑meeting survey and will develop technical specifications for any investment indicators selected for the 2026 snapshot.
