Standardizing the Measurement of Commercial Health Plan Primary Care Spending

Published in: Milbank Memorial Fund website, July 2017

Posted on RAND.org on September 15, 2017

by Michael Bailit, Mark W. Friedberg, Margaret Houy

Read More

Access further information on this document at www.milbank.org

This article was published outside of RAND. The full text of the article can be found at the link above.

Primary care is often acknowledged as the foundation of any high-performing health care delivery system. But how much of our health dollars go to supporting it? To address this question, the authors of this report — Michael Bailit, Mark Friedberg, and Margaret Houy — present a methodology to define and estimate spending on primary care, relative to other medical expenses. The study design first focused on developing consensus on a specific definition of primary care (including provider types and service billing codes) and then established the feasibility of applying this measure using data from a set of commercial insurers. Primary care spending is a simple and easily understood measure of how oriented a delivery system or geographic community is to primary care, prevention, and population health. Given the proliferation of enhanced payment initiatives, there seems to be growing consensus in favor of increased spending for primary care and the idea that primary care is a necessary, fundamental step toward a better-performing health system. And we want to increase policy focus on it. This report shows the importance of precisely defining primary care spending—and provides additional questions for future research. With further development and validation, these measures of primary care spending could serve as the basis for national benchmarks and public policies that seek to orient health systems more strongly toward primary care.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/principles.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.