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OKA workgroup previews 2023–24 primary care spending and APM adoption; absolute spending rose but share of total medical expense remains small
Summary
OKA staff told a workgroup that statewide primary care spending rose from $10.1 billion in 2023 to $11.3 billion in 2024, but primary care remained under 5% of total medical expense; staff also presented APM adoption baselines and noted data exclusions and methodological caveats.
Margaretta Brandt, assistant deputy director for health system performance at OKH, opened the OKA Investment and Payment Workgroup meeting and said staff would preview the 2023–24 primary care spending and alternative payment model (APM) adoption data ahead of a public report to be published in early fall 2026.
Debbie Lindis, healthcare delivery system group manager at OKH, said total statewide primary care spending increased from $10.1 billion in 2023 to $11.3 billion in 2024, a 12% rise. "Statewide primary care spending was 4.7% of total medical expense in 2023, increasing slightly to 4.8% in 2024," Lindis said, while noting that per-member primary care dollars increased in every market. She highlighted that medical managed care saw the largest year‑over‑year increase in absolute and percent terms.
The presentation separated absolute spending growth from share-of-spending measures. Lindis explained that differences between percent-of-total-medical-expense (TME) trends and per-member growth are driven in part by simultaneous increases in the TME denominator. She also described the payment mix for primary care: "capitation and full risk payments account for slightly over 71% of primary care spending in both 2023 and 2024," while fee-for-service accounted for roughly a quarter of primary care spending and non-claims payments made up a small share.
Staff cautioned that payer-level data shown in the workgroup slide deck were deidentified for the preview. Margaretta Brandt said two payers were excluded from reporting because OKA could not validate their submissions and that other payer-level exclusions reflect low-member-months or excluded payment categories.
During questions, workgroup members repeatedly requested payer-level enrollment context so that averages could be interpreted by market share. When asked whether Prop 56 payments were included in primary care reporting, Margaretta Brandt answered that "Prop 56 payments were excluded from the primary care alternative payment model reporting." Staff said the forthcoming public report and technical appendix would include enrollment detail and other methodological clarifications.
Hamdi Abdullahi, value-based payment group manager, reviewed APM adoption baselines and methodology. He said OKA measures APM adoption using the HCP-LAN/expanded non-claims payments framework and counts members in arrangements whose payments are linked to quality. Hamdi reported market-level baselines for 2024 (examples: roughly 79% of members in qualifying arrangements in commercial HMO/POS; about 26% in the commercial PO/EPO market) and noted variation across payers; several payers remained at zero adoption in some markets.
Why it matters: staff framed the data as baseline and context for assessing progress toward two approved benchmarks: an annual improvement benchmark of a 0.5–1 percentage point increase in primary care investment per payer per line of business, and a long-term statewide target of 15% of TME by 2034. The public report scheduled for early fall 2026 will identify payers and include the technical appendix requested by stakeholders.
The workgroup did not take formal votes but asked staff to include enrollment weighting, denominator definitions (what is included in TME), and other clarifications in the public report. Staff said they will continue one-on-one technical assistance with payers and accept corrected resubmissions ahead of future reporting.
