Advisory Committee on Primary Care
This advisory committee is a subcommittee of the Health Care Cost Transparency Board (Cost Board).
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Learn more about the Advisory Committee on Primary Care!
The Advisory Committee on Primary Care helps with work related to Washington state’s 12 percent primary care spending target. Notably, the committee recommended a definition of primary care which the Cost Board adopted.
The committee’s work also includes recommending standards for reporting and measuring claims- and non-claims-based spending.
See who's on the Advisory Committee on Primary Care.
Meetings
All Advisory Committee on Primary Care meetings are public meetings. We encourage you to join us and share your input. Find upcoming meetings and more on the Cost Board's meetings and materials page.
Defining and measuring primary care
Background
The Washington Legislature set a goal in 2021 that 12 percent of all state health care dollars should be spent on primary care services. To track the state’s progress toward this goal, we need a shared definition of what counts as primary care spending. In 2024, the Health Care Cost Transparency Board (Cost Board) adopted a new definition of primary care that it will use for all its measurement activities.
Primary care is the foundation of any high-functioning health care system. As the front door to the health care system, primary care providers (PCPs) keep communities healthy and help people connect to the services they need. People with a regular source of care tend to have better outcomes, as shown by a RAND Corporation study. Moreover, a John Hopkins University study showed they’re much less likely to rely on the emergency room than people without a PCP.
The Advisory Committee on Primary Care developed the new primary care definition. The committee met with experts and explored different approaches to primary care measurement. Then the committee voted to adopt the new definition in its October 26, 2023 meeting. The Cost Board adopted the definition in its 2024 legislative report.
Definition
Under the Cost Board’s primary care definition, primary care spending includes a claims- and non-claims-based definition.
Primary care definition spreadsheet
For a detailed definition including taxonomy and procedure codes, download our primary care definition spreadsheet.
- Claims-based definition
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The claims-based definition of primary care refers to spending identifiable from a health care claim on specific services when provided by specific providers at specific locations. In order to be considered primary care, the spending must meet all three criteria (what, where, and by whom).
This means that the same service (for example, vaccination) may be considered primary care when provided by a pediatrician, but not when provided by a cardiologist. Likewise, vaccination may be considered primary care when provided by a pediatrician during an office visit, but not when provided by a pediatrician during a hospital stay.
Some examples of the services, providers, and locations included in the definition are listed below.
Services
- New patient visits
- Preventive visits
- Treatment visits
- Contraceptive care
- Routine and developmental screenings
Providers
- Physician assistants, nurse practitioners, and clinical nurse specialists specializing in pediatrics, gerontology, adult health, women’s health, and more
- Family medicine physicians
- Internal medicine physicians specializing in geriatric or adolescent medicine
- Pediatricians
Locations
- Schools
- Tribal and Indian Health Service facilities
- Outpatient offices
- Telehealth
- Federally Qualified Health Centers (FQHCs)
- Non-claims-based definition
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The non-claims-based definition of primary care refers to payments from carriers to primary care providers that may not appear on a claim form. This includes but isn’t limited to:
- Capitation
- Salaries
- Incentives
- Population health payments
- Practice support payments
Common questions
- What changed in the new definition?
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The Cost Board previously used the Office of Financial Management’s definition of primary care. That definition included two provider lists and two service lists (with a narrow and broad list for each) but did not include a location of service component. This format created four possible combinations of narrow and broad lists of services and providers.
The new definition is simpler, with one specific definition at the intersection of services, providers, and locations.
- How does the Cost Board use the primary care definition?
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The Cost Board will use the primary care definition to track and monitor primary care spending. It will also monitor the state’s progress toward achieving the Legislature’s goal that such spending represents 12 percent of total health expenditures in Washington.
- Does the new definition affect payment or coverage for primary care services?
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No. The new definition applies only to tracking and monitoring primary care spending.
- Who else should use the new definition?
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Insurers and health systems that are interested in aligning their tracking of primary care spending with HCA may choose to adopt the new definition.