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HPC preview: primary care share down, wide price variation and high potentially avoidable ED use in 2023–24 analyses
Summary
HPC researchers previewed chart‑pack findings showing slower growth in primary care spending, sharp disparities in primary‑care access, large provider price variation (e.g., 2:1 in common procedures), and that ~40% of treat‑and‑release ED visits were classified as potentially avoidable in 2024.
Research Director David Hourback, joined by Executive Director David Seltz, presented selected exhibits from the HPC's 2025 healthcare cost trends chart packs and solicited commissioners' input for policy recommendations.
Key takeaways included: primary care per‑member spending grew more slowly (about 13% PMPY in the shown period) than behavioral health and other medical spending, causing primary care's share to fall; disparities in primary care access are stark (in the lowest‑income zip decile about 30% of adults had zero primary‑care visits in 2023 versus 20% in the highest‑income decile; for children the gap was roughly 11% vs 4%).
Hourback highlighted persistent price variation across providers: example exhibits showed about a twofold difference in average hospital prices for a low‑complexity vaginal delivery and $11,000–$22,000 variation for outpatient administration of the oncology drug pembrolizumab (Kitruda), with Medicare considerably lower than commercial prices for some services. The chart pack also created a site‑neutral index (25 services) showing substantial HOPD (hospital outpatient department) vs office price differentials for several private payers (ratios varied by insurer).
On utilization, HPC analysis shows 2.8 million ED visits in 2024, with about 70% discharged home and the remainder admitted, observed or transferred; the commission's algorithm classified about 40% of nonadmitted ED visits as potentially avoidable, the highest share observed in the HPC time series. Presenters noted that while overall ED visit counts remain below pre‑pandemic levels, boarding, wait times and lost hospital ED capacity (closures) are worsening system strain.
Commissioners discussed where policy levers might be applied and asked HPC staff to prioritize 'canary' indicators to track rapidly evolving federal and market changes. Hourback said the full report and chart packs will be released with policy recommendations, and staff welcome commissioner input on priority themes.
