When a group of health care practitioners, policymakers, and industry leaders gathered last week to continue their examination of Massachusetts’s faltering primary care system, the discussion turned more than once to Albert Einstein.  

Attendees were not hopeful that general relativity or a mathematical proof might provide the key to reinvigorating a shrinking workforce or to cutting the months-long wait patients face for new appointments. Instead, they referenced a quote often attributed to Einstein: “Insanity is doing the same thing over and over again and expecting different results.” 

Stephen Martin, a physician and UMass Chan Medical School professor, invoked the famous – and likely apocryphal – quote to urge his counterparts to take big swings in their work.  

“The arrangements we have going forward, if they are not different from what we have now, we should expect failure, just as Einstein said many, many years ago,” Martin said at a meeting of the state’s primary care task force earlier this month. “If there’s not a delta in what we eventually come to, we should be wary of any constructive results.”  

Some policymakers and advocates have spent years trying, and failing, to convince legislative leaders the state should force new investments in primary care. Former Gov. Charlie Baker twice filed bills that would have required providers and insurers to boost their spending on primary and behavioral health care. Those provisions never earned a vote in the House or Senate, and Baker reflected shortly before he left office that his effort to overhaul the payment model “freaked everybody out.” 

But as conditions on the ground worsen for patients and burnt-out providers, supporters say they sense growing momentum for a primary care spending goal that would steer more money toward the system’s front lines.  

“I would be surprised if by the end of this legislative session, there was not major primary care legislation that included a primary care spending benchmark,” Wayne Altman, a physician and founder of the Massachusetts Primary Care Alliance for Patients, told CommonWealth Beacon.   

Massachusetts already has a benchmark in place for total health care spending, designed to set a goal for keeping cost growth limited. It’s had limited success: Total health care expenditures per capita increased 8.6 percent in 2023, more than twice the 3.6 percent benchmark.  

Some advocates and lawmakers have been clamoring to add a primary care-specific spending target to state law, a metric that would dictate how much more providers and insurers need to spend or what share of their health care dollars need to go toward primary care.  

While many industry leaders and elected officials tout the value of primary care, only a small fraction of health care dollars actually flow its way. In 2023, the most recent year with state data available, MassHealth spent about $35 per member per month on primary care services, or 7.5 percent of its total health care expenses. The share of spending on primary care was even lower for commercial health plans (6.7 percent) and Medicare Advantage (4.2 percent). 

Significantly more money goes to other areas of spending. In 2021, commercial health plans spent about $2,108 per person per year on hospital outpatient care, such as surgeries and drug infusions, according to Health Policy Commission data. They spent less than one-quarter as much – $500 per person per year – on primary care.  

A hospital oversight law Gov. Maura Healey signed in January created the 25-member task force and assigned it with crafting recommendations on how the state should define and track primary care services, strengthen the workforce pipeline to bring new providers into the field, and set a specific spending target for primary care.