Major change could be rolled into Senate reform bill expected in April
STATE HOUSE, BOSTON, March 4, 2026….Health care experts are finalizing the contours of a new primary care payment strategy for Beacon Hill to consider, but the model may not reach a large swath of the commercial market due to federal limitations.
Facing a March 15 deadline to submit their next report, Primary Care Task Force members hashed out recommendations Wednesday for a “multi-payer advanced primary care payment model” that would move away from a fee-for-service structure to predictable monthly capitated payments per member. The task force intends to ask the Legislature to approve the creation of this model, making it available in independent practices, pediatric practices, federally qualified health centers and hospital-affiliated practices.
The task force is laying the blueprint for a promised reform bill that’s expected to bolster investment in primary care, improve care access and address workforce development. Sen. Cindy Friedman, a task force member, last week said the Senate will release its bill in April, after the latest report is submitted.
“This has been incredibly informative,” Friedman, the Senate’s health care point person, said at Wednesday’s meeting. “The Senate is trying to ready a primary care bill, and we’re trying to stay in line with the Primary Care Task Force. So having this conversation is really critical.”
Senate President Karen Spilka called primary care reform a session priority more than a year ago.
The pending recommendations build on a December task force report that urged the Legislature to double the share of primary care spending as a percentage of total health spending or reach 15%, whichever is greater, within five years. That spending target is also likely to appear in the primary care reform bill.
The advanced primary care payment model would offer “enhanced” payments based on care delivery capabilities and performance outcomes, said Health Policy Commission Executive Director David Seltz. The model would also alleviate administrative burdens, including for reporting requirements.
Health plans that are vetted by state regulators must offer the new model, under the recommendation, but accepting it would be voluntary.
“This would be an offering,” Seltz said. “Primary care practices would opt in and have the opportunity — they would not be mandated to take this model.”
Lora Pellegrini, CEO of the Massachusetts Association of Health Plans, pressed the task force to refine the definition of “advanced primary care practice” and what types of care would qualify.
“As we talk about advanced primary care models, I think we’re just not clear exactly what that is,” Pellegrini said. “We’re all in on wanting to invest in primary care. We just want to ensure that things are going to be better for patients.”
Uptake for the proposed model faces a significant obstacle.
As of March 2025, about 60% of the state’s commercial insurance market is self-insured, translating to more than 2 million individuals, according to the Center for Health Information and Analysis. Those plans are not subject to state regulations tied to employer-sponsored benefits under federal law, Seltz said.
But Seltz’s presentation noted self-insured plans “often” choose to match state requirements. The draft report calls on the state to “essentially use every tool at its disposal to encourage (and) promote the adoption of the advanced model within the self-insured market,” Seltz said.
Dr. Barbara Spivak, past president of the Massachusetts Medical Society, warned that capitation has “failed miserably.” She said the model, which took off in the 1990s, did not bring “long-term innovation and changes” — though she did blame it for job losses and program closures.
“We need to be sure that that doesn’t happen,” Spivak said.
Dr. Ryan Schwarz, chief of MassHealth’s Office of Accountable Care and Behavioral Health, said the ’90s era of capitated payments lacked accountability guardrails. MassHealth has already embraced a capitated payment model for primary care within a broader framework of accountable care organizations.
“We did that very intentionally because every ACO is accountable to quality measures that hold them, I would say, guard against intentionally much of the travails of the ’90s, which was that you can be paying a capitation and doctors can go out and play golf because they are not accountable to actually delivering any services,” Schwarz said.
The task force’s proposed recommendation does not delve into how primary care practices are supposed to transition into the new model, said Dr. David Gilchrist, past president of the Massachusetts Academy of Family Physicians.
“I think there needs to be a little bit more explicit commitment to how to make that transition happen,” Gilchrist said. “What are ways that we are supporting practices? If there’s no additional dollars in investment, that’s going to be really hard to do upfront to make that transition happen.”
With the new model, the task force wants the Legislature to incorporate monitoring and accountability measures, such as around patient outcomes.
Still, the positive patient outcomes the task force is hoping for may not emerge “for quite some time,” Gilchrist said as he reiterated the need for state funding. A primary care stabilization fund may be needed “in order for our work to be successful,” said Dr. Stephen Martin, a professor at UMass Chan Medical School.
The task force will continue its work this spring. Members must turn to other recommendations due in mid-May for increasing the primary care workforce across the state.
