Primary Care and Behavioral Health Care (PCBH) Spending

Overview

Primary care and behavioral health comprise an array of vital services that can meaningfully shape patient outcomes and is foundational to a well-performing Massachusetts health care system. However, comprehensive spending data for these services has been limited. CHIA collects data and reports on payments made by health plans to primary care and behavioral health service providers—including payer-paid and member-cost sharing amounts—as part of its efforts to inform policy initiatives, investments, and delivery system reforms.

This report focuses on spending for primary care and behavioral health services for members enrolled in private commercial, MassHealth, and Medicare Advantage plans for calendar years (CY) 2022 and 2023.

CHIA collects spending and diagnosis prevalence for mental health and substance use disorders (SUD) services separately; however, combined spending on these two service categories represents total behavioral health expenditure figures referenced in this report. Additional analyses in this report include primary care and behavioral health spending metrics by age group, payer, and managing physician group.

Note: The primary care and behavioral health data presented in this report cannot be compared with CHIA’s previous primary care reporting due to differences across data collection periods.

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