State governments continue to explore different approaches to increasing the percentage of overall healthcare spending that goes to primary care, while also trying to decrease overall spending. The Oregon Health Policy Board (OHPB), the policy-making oversight body for the Oregon Health Authority, is launching a Primary Care Strategy Committee to lead a coordinated effort to stabilize, strengthen, and align Oregon's primary care system.

OHPB notes that both in Oregon and across the country, primary care is in crisis, as fewer primary care providers are entering the workforce and many are leaving; providers face burdensome administrative requirements; and investment in primary care has declined. The primary care crisis is limiting access to care for patients, the policy board said. 

The committee will promote solutions for a strong primary care system focusing on payment and affordability, workforce, and the delivery system. The public committee will hold meetings open to the public and will offer time for public comment.


As a white paper from the Oregon Primary Care Payment Reform Collaborative notes, the healthcare system underinvests in primary care relative to the value that comprehensive primary care provides. “Disparities in payment by insurer lines of business (Medicaid vs. Commercial) and care settings (hospital affiliated vs. independent) create payment imbalances across the healthcare system. While demand for a broad array of services within the primary care setting has increased, payment models are not aligned across the system to support this model of care.”

Tony Germann, M.D., M.P.H., is a family physician and medical director of Salud and Pacific pediatrics clinics of the Yakima Valley Farm Workers clinic system (FQHC). On LinkedIn, he called the committee’s creation an important step toward strengthening primary care and improving health outcomes across Oregon. “I’m proud to help champion and serve as the liaison from the Oregon Health Policy Board on this effort. We hope to collaborate with committed partners to shape a shared, sustainable strategy that centers patients, providers, and communities. This work matters—strong primary care is the foundation of an equitable, high-performing health system. Looking forward to the conversations and progress ahead.”

In the past, Healthcare Innovation has reported on Oregon’s efforts in this area. During a 2022 Center for Health Care Strategies webinar, Summer Boslaugh, a transformation analyst for the Oregon Health Authority (OHA), described Oregon’s work to develop policies to measure and increase primary care spending over time. A bill passed by the Oregon Legislature requires coordinated care organizations (CCOs), which are Oregon's Medicaid ACOs, and commercial carriers to allocate 12 percent of their medical spending to primary care by 2023. The state is both reporting on and setting a target for primary care expenditures. Primary care spending by payer is publicly reported annually, she said. 

The Oregon Health Authority has since reported in a dashboard that in 2023, primary spending by commercial plans averaged 13.3 percent of total medical spending. 

The 2015 legislation also directed OHA to create the Primary Care Payment Reform Collaborative, which is comprised of 36 members representing primary care providers, health plans, CCOs, behavioral health providers, patients and other stakeholders. The charge of the collaborative is to assist OHA in the implementation of a Primary Care Transformation Initiative, which encompasses all the work that OHA is doing to increase investment in primary care.

“It's about improving and increasing primary care spend, as well as aligning that payment in a way that is more supportive of the care that primary care practices deliver and the way that they would like to be able to deliver care with more flexibility,” Boslaugh said, including by investing in the social determinants of health. Another goal is to facilitate the integration of primary care behavioral and physical health care. The Primary Care Payment Collaborative has developed a value-based payment model for primary care.