Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Primary Care topic
No spam. Unsubscribe anytime.
HPC study: primary care in Massachusetts is shrinking and aging; task force to recommend fixes
Summary
HPC staff presented a study finding declining primary care spending share, an aging primary care workforce, growing use of nurse practitioners and PAs, and worsening access (e.g., Boston wait times ~40 days). The commission and EOHHS will co‑chair a 25‑member primary care task force to pursue policy remedies.
The Health Policy Commission on the board's first public meeting of 2025 released a staff study showing that primary care in Massachusetts is contracting in share, aging in workforce composition and struggling with access problems that disproportionately affect lower‑income and minority communities.
Associate Director Sasha Albert, who led the research, summarized key findings: there were about 15,000 primary care providers in Massachusetts in 2022; primary care’s share of commercial medical spending fell from 8.4% in 2017 to 7.5% in 2022; advanced practice providers (nurse practitioners and physician assistants) are taking a larger share of visits; and a substantial share of residents report difficulty accessing care. The presentation also cited a 2023 survey showing 41% of residents reported trouble accessing care and CHIA data showing long wait times (the presentation said Boston had about a 40‑day wait for a new patient physical in 2022).
Why it matters: HPC staff emphasized that primary care supply matters for population health and cost control—systems oriented to primary care typically see fewer emergency department visits and hospitalizations and better outcomes—but Massachusetts is losing ground on several fronts.
Drivers identified by staff
Low relative reimbursement: Researchers showed that Medicare and commercial payment structures often reimburse procedure‑based specialties at higher rates than cognitive primary care visits, creating financial incentives that favor specialty work over primary care.
High administrative burden and poor job quality: Staff cited studies and surveys showing clinicians spend substantial time on documentation, prior authorizations, portal messaging and other non‑visit work—factors associated with burnout, reduced patient‑care hours and exits from practice.
Workforce pipeline and distribution: The report found fewer new physicians entering primary care compared with other states and an older age distribution among primary care physicians; clinician diversity (Black and Hispanic clinicians) remains below population shares, and community health centers face particular wage and retention pressures.
Recommendations and task force
HPC staff proposed three priority areas: reduce administrative burdens (align measures, simplify prior authorization and reporting requirements), strengthen the primary care pipeline (restore Medicaid funding for GME, expand loan repayment and residency programs for primary care clinicians including APRNs and PAs), and increase investments in primary care (consider capitation and spending targets; Massachusetts has examples in MassHealth primary care subcapitation).
The commission also announced a 25‑member primary care payment and delivery task force, co‑chaired by HPC and EOHHS, charged with studying access, delivery and financial sustainability and with making recommendations including a primary care spending target.
Commissioners discussed alternative payment models, consolidation of primary care into larger systems, housing/cost‑of‑living pressures on clinician recruitment, behavioral health integration and geographic disparities in provider supply. Staff said the full report is available on the HPC website and that the research will inform the new task force as it begins work.
Sources: presentation by Dr. Sasha Albert and Charlotte Burlingame at the Health Policy Commission meeting (Jan. 2025).
