Press Release  AG Campbell Issues 2026 Health Care Cost Trends Report Examining Primary Care Payments

BOSTON — Attorney General Andrea Joy Campbell today released her office’s 2026 Health Care Cost Trends Report, examining disparities in primary care payments across Massachusetts and calling for greater transparency into how health insurers compensate providers. The report highlights significant variation in payments to primary care providers, including disparities that may disadvantage safety net providers serving lower-income communities, and offers recommendations to strengthen access to affordable, high-quality primary care across the Commonwealth.  This is the latest Health Care Cost Trends report from the Attorney General’s Office (AGO) in its ongoing work to promote health care access and affordability in Massachusetts. 

The report looks at primary care payments in a sample of the Massachusetts health care market to shed light on how “supplemental payments” from commercial health insurers affect primary care financing. Supplemental payments – such as incentive payments, infrastructure payments, or any other payment not tied to a specific health care claim – are significant for some providers, but data on how such payments are used is limited. Informed by estimates from provider organizations about the share of supplemental payments that go to primary care providers, the report presents the varied allocations of these payments across providers and an estimate of the impact of these payments on overall primary care spending. 

“Primary care is the foundation of a strong health care system, but too many Massachusetts residents are struggling to access the care they need,” said AG Campbell. “We must confront the disparities in how primary care is funded and ensure that investments are reaching the providers and communities that need them most. This report underscores the urgent need for greater transparency, targeted investments, and meaningful reforms that improve access to affordable and high-quality care for every resident in Massachusetts.”   

Using 2024 data from a sample of Massachusetts providers and payers, the report finds that total commercial supplemental payments represent a significant source of funding relative to traditional fee-for-service primary care payments, with most supplemental payments going to a small number of large provider systems. The report also found substantial variation in the rates commercial insurers pay different providers for the same primary care services, consistent with longstanding disparities in the Massachusetts health care market.  

To better understand the impact of supplemental payments, the AGO collected estimates from provider organizations regarding the share of their supplemental payments distributed to primary care providers. When these estimates were added to fee-for-service primary care payments, relative primary care payment disparities increased, with some safety net providers who serve a larger population of lower income residents falling behind the rest of the market.  

The report also examines the share of primary care visits paid by self-insured plans, which are usually sponsored by large employers and regulated by the federal Employee Retirement Income Security Act.  For one major commercial insurer examined in the report, nearly two-thirds of its primary care visits were covered by self-insured plans, underscoring the importance of engaging this segment of the market in statewide primary care reform efforts. 

To address these findings, the report recommends: 

• Directing new funding toward expanding access to advanced primary care statewide, with consideration of provider payment disparities, public payer mix, and support for independent practices.  
• Monitoring changes in access to both primary care and specialty services by payer type and region.   
• Improving market-wide data collection on supplemental payments and how they support primary care to better assess payment disparities and evaluate alternative payment models.  
• Exploring ways to encourage participation by the self-insured market in statewide primary care initiatives.  
• Ensuring new primary care investments remain consistent with the state’s health care growth benchmark and do not exacerbate existing payment disparities.  

This report is part of the AGO’s ongoing efforts to identify the drivers of rising health care costs, promote transparency, and improve access to care for Massachusetts residents. Prior cost trends reports from the AGO have focused on medical debt, ambulance billing, and approaches to health status adjustment.   

This year’s report was prepared by Assistant Attorneys General Chloe Cable and Michael Wong, Health Care Analyst Maeva Veillard Perry and Paralegal Gaëlle Bouaziz of the AGO’s Health Care Division, and Assistant Attorney General and Senior Health Policy Advisor Sandra Wolitzky of the AGO’s Health Care and Fair Competition Bureau.

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