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Report shows range in primary care spending across public, private health insurance plans

Feb. 6, 2019

SALEM, Ore. -- A joint report from the Oregon Health Authority and Department of Consumer and Business Services shows that in 2017 Oregon’s public and private health insurance plans’ spending on primary care averaged from 10.6 to 16.5 percent of their medical expenditures. Coordinated care organizations (CCOs) spent the highest percentage of their medical spending on primary care.

Senate Bill 934, passed in 2017, requires health insurance carriers and CCOs to allocate at least 12 percent of their health care expenditures to primary care by 2023. Research indicates that availability of primary care providers is associated with improved health outcomes including reduced mortality rates, reduced rates of low birth weight and preventable hospitalizations, and increased self-rated health status.

"Primary care serves as the front line of Oregon’s health care system," said Dana Hargunani, OHA’s chief medical officer. "The report helps us better understand the investments that are being directed to primary care services and shows that CCOs are currently leading the way in this area."

Findings from the report include:

  • Coordinated Care Organizations spent the highest percentage (16.5 percent) of their medical spending on primary care.
  • Large commercial carriers spent an average of 13.4 percent of their medical spending on primary care.
  • PEBB and OEBB spent an average of 12.2 percent of their medical spending on primary care.
  • Medicare Advantage plans spent an average 10.6 percent of their medical spending on primary care.
  • Commercial plans, CCOs, Medicare Advantage plans, and PEBB and OEBB plans spent $1.5 billion on primary care out of $11 billion in total spending.

The report also includes information about the percent of primary care spending that was not fee-for-service based, which includes: incentive payments, payments for programs recognized as providing good clinical care, and payments to help providers adopt health information technology such as electronic medical records.

The report’s methodology of primary care spending has been updated to more accurately reflect primary care spending and cannot be compared to previous versions of the report.

The full report is available on the OHA website.​

 Media contact

Allyson Hagen

OHA External Relations

503-449-6457
allyson.hagen@dhsoha.state.or.us

Brad Hilliard

DCBS

503-798-6376
brad.hilliard@oregon.gov

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