Primary Care and Behavioral Health Care (PCBH) Spending

Overview

Primary care and behavioral health services play a critical role in improving health outcomes across the Commonwealth, advancing health equity and helping moderate overall health care costs. However, these services have historically been under-resourced, making it difficult for many Massachusetts residents to obtain timely and affordable access to this vital care.

To provide insight into investments in these services, CHIA collects primary care and behavioral health spending data from health plans covering Massachusetts residents. This report focuses on spending for members enrolled in private commercial, MassHealth, and Medicare Advantage plans for calendar years (CY) 2023 and 2024.

Key Findings

Primary care continues to represent a modest share of total health care spending, with divergent trends across payer types. 

• • In 2024, primary care accounted for 6.6% of commercial, 8.4% of MassHealth, and 4.2% of Medicare Advantage spending.
    
    
  • The share declined for commercial members but increased for MassHealth and Medicare Advantage.

Behavioral health accounts for a substantially larger share of spending in MassHealth, with growth concentrated in that population. 

• • In 2024, behavioral health represented 8.1% of commercial, 22.4% of MassHealth, and 2.3% of Medicare Advantage spending.

• • Spending shares were stable for commercial and Medicare Advantage, but increased for MassHealth.

Children receive a greater share of care through primary care and behavioral health compared with adults. 

• • Pediatric members in commercial plans had a higher proportion of spending in both categories than adults.  

Non-claims and full-risk payments represented a substantial portion of Mass Health primary care spending as a result of the new Primary Care Sub-Capitation Program.

• • In 2024, non-claims accounted for 68.6% of MassHealth, 0.1% of private commercial, and 2.0% of Medicare Advantage primary care spending.

Full Description

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

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

Recommended Links

Primary Care Dashboard

Behavioral Health Dashboard

Total Medical Expense (TME) Trends Across Massachusetts Communities