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Modeling shows doubling primary-care share will require big primary-care growth or offsets elsewhere
Summary
A UCSF modeling presentation showed that moving primary care from roughly 7% to 15% of total health spending in a decade requires either higher overall spending or sizable offsets in hospital and specialty growth; under strict total-spending caps, primary-care spending would need double-digit annual growth.
Kevin Grumbach, a physician and researcher at the University of California, San Francisco, told the Washington Health Care Authority Cost Board that states can aim to substantially raise the share of health spending that goes to primary care, but doing so requires explicit trade-offs.
"We think we're probably about 7% now of total spending on primary care, and the goal is to get it to 15% across plans in California by 2034," Grumbach said, describing California's Office of Health Care Affordability goals as a laboratory for the modeling. He and his team ran scenarios under three different overall growth limits. Under a strict 3.5% annual cap on total spending, achieving a much larger primary-care share would require primary-care spending to grow at roughly double-digit annual rates while hospital and specialty spending growth would have to slow to provide offsets.
Board members pressed the modeling's practical implications. Eileen Cody asked whether stronger primary care could reduce hospitalizations and thereby create offsets; Grumbach said empirical results on return-on-investment vary across studies. He emphasized that implementation choices matter: state rules or payment designs need to ensure additional primary-care dollars reach frontline practices rather than being absorbed as profit or retained at system-level corporate entities. "It's not gonna work if the plan says 'we just met Kevin's trajectory' and the money never gets to frontline practices," he said.
Grumbach outlined policy approaches states use to direct funds to clinical capacity, including pooled funds, tiered capitation that pays more for advanced primary care capabilities, and upfront investments tied to time-limited performance requirements. He warned that under tight spending caps the rebalancing would require measurable offsets elsewhere in the system, and that states must design accountability and auditing to ensure funds support workforce and care-integration goals.
The board took Grumbach's modeling as a way to set numeric plausibility bounds, while reserving questions about how to operationalize payment flow, site-neutral policies and accountability mechanisms for future meetings.
