By Katie Daigle-Alexander

Primary care is the foundation of healthcare. By providing preventative care and chronic disease management, primary care has the potential to relieve some of the most pressing challenges in healthcare, including financial pressures and Emergency Department capacity challenges.  

Yet, Massachusetts’ primary care sector has long suffered from a dwindling workforce, systemic underfunding, and administrative burden – making it more difficult for clinicians and caregivers to practice preventative medicine and for patients to receive the nonemergency medical care they need, when they need it. 

With primary care considered essential to the stability of the healthcare ecosystem, Massachusetts is taking steps to identify and develop tangible solutions that can alleviate strain and support the primary care field. 

In January 2025, Massachusetts Governor Maura Healey signed into law Chapter 343 of Acts 2024, “An Act Enhancing the Market Review Process.” This act established the Primary Care Access, Delivery and Payment Task Force, a 25-member group of elected officials, policymakers, medical professionals, healthcare advocates, and payers, among others, asked to study and provide recommendations on how to enhance and ensure the sustainability of primary care in the Commonwealth.  

In the weeks ahead, work on this task force will be ramping up as they approach a December deadline to provide a recommendation on spending targets for payers and healthcare providers in the primary care space. Through May 15, 2026, the Primary Care Task Force will also be advising on reimbursement, health equity, monitoring service needs and delivery to residents, and workforce development. 

Participants from across the Massachusetts healthcare marketplace are closely watching this task force, as the desire for substantive change in primary care has reached a boiling point. 

Primary Care in Crisis 

The difficulties facing primary care in Massachusetts are manifold, but predominantly driven by financial, administrative, and labor-related factors. 

• Underinvestment and under-reimbursement: Primary care is chronically underfunded and receives low reimbursement for the services delivered to patients. According to the Massachusetts Health Policy Commission (HPC), only $0.06 to $0.07 of every healthcare dollar is spent on primary care, meaning that 94 percent of patient spending is on non-primary care related services. The HPC also found that commercial health insurance plans only spend $500 on primary care per person each year, while spending more than $2,100 per person on hospital outpatient services. Primary care physicians are also paid much less than specialists. Low reimbursement, paired with comparatively low compensation, makes primary care a less attractive field for emerging medical professionals, disincentives investment from healthcare providers, and undermines the financial sustainability of offering primary care.  
• Administrative burden: Primary care providers are responsible for completing significant administrative work, leading to less time for patient care and high rates of burnout among physicians and staff. One study found that every hour of direct patient care requires two hours of administrative and clerical work, which can include documentation, billing and coding, inbox management, navigating insurance requirements, and more. Due to the time it takes to complete administrative tasks and provide patient care, most primary care doctors work 60 to 70 hours each week.    
• Workforce: Massachusetts has the most physicians per capita in the U.S., but among the lowest proportion of primary care doctors. This is, in part, due to the rise in doctors who are leaving the primary care sector altogether or retiring, with one Center for Health Information Analysis and Massachusetts Health Quality Partners report finding that 33.7 percent of primary care doctors in 2019-2020 were over the age of 60. Fewer medical students are also electing to enter the primary care workforce. In the same study, just 22 percent of Massachusetts medical school students were found to be practicing primary care in the six to eight years following graduation. 

Against this backdrop, healthcare providers continue to implement ways to improve primary care through innovative means, like establishing their own Accountable Care Organizations to enhance health outcomes, while lowering cost; empowering nurse practitioners and physician assistants to deliver more patient-facing care; and introducing innovative technologies, like AI, to streamline administrative burden. However, many of these initiatives continue to face hurdles – limiting what can be accomplished. 

The Human Cost of a Strained Primary Care System 

The instability of primary care in Massachusetts has measurable impacts on patients, the whole healthcare ecosystem, and the perception residents have about the healthcare options available to them. In 2023, a survey discovered that 41.2 percent of Massachusetts residents had difficulty accessing the healthcare services they needed over the 12 months prior.  

By underinvesting in, and under-reimbursing, foundational medical services that focus on comprehensive health, preventative care, and chronic disease and symptom management, patients are forced to seek the care they need in higher-acuity healthcare settings that may not be medically appropriate. For instance, it’s estimated that 40 percent of Emergency Department visits could have been treated or prevented by appropriate primary care.  

With Black and Brown patients more likely to face barriers in accessing regular, preventative care, healthcare often takes place in the most expensive care settings that are stretched thin, counteracting the goal of primary care to diagnose and treat conditions before they worsen.

 All Eyes on the Task Force 

The breadth of what the Primary Care Access, Delivery and Payment Task Force has been asked to do is far reaching. As the collaborative effort advances, it’s likely that solutions regularly raised from within the healthcare industry will be on the table, such as: 

• Reducing administrative burden on primary care physicians through decreasing or streamlining prior authorization requirements in primary care settings; 
• Transitioning away from fee-for-service payment models to other payment structures that better reimburse primary care practices and incentivize investment in preventative care by rewarding physicians for keeping patients healthy; 
• Reducing the costs of medical education for those entering the primary care field, such as through tuition reimbursement programs that help physicians who commit to practicing primary care within the Commonwealth for a specified period of time; 
• And funding new family-medicine residency programs that bolster training in both academic medicine and community health center settings to share the financial cost of offering primary care, while increasing the number of training opportunities in the primary care field. 

Massachusetts has the rare opportunity to reimagine its primary care ecosystem by addressing issues that have long hindered health equity, patient access, financial sustainability and workforce burnout in primary care. However, meaningful change will require more than policy recommendations. The potential of primary care to enhance patient outcomes and public health, more broadly, demands a commitment to investment, collaboration, and valuing primary care as the key to a healthier, more equitable healthcare system.  

If the task force succeeds, Massachusetts can lead in building a primary care model that works for everyone.