Commercial insurers pay Massachusetts primary care providers very different prices for the same visits and, by providers' own estimates, extra payments beyond those prices widen the gap, according to a report released Nov. 10 by Attorney General Andrea Joy Campbell. The office's 2026 health care cost trends report found rates ranging from 127 percent to 244 percent of Medicare rates for the same primary care services in 2024.
The highest contracted rate in the study, Mass General Brigham's, was 244 percent of Medicare. The lowest, Community Care Cooperative's, was 127 percent. By our arithmetic that is a gap of about 1.9 times. The report says Signature Healthcare and Community Care Cooperative receive significantly lower commercial rates for the same services while serving a higher percentage of Medicaid patients, and that the lowest-paid providers often serve the most public-insurance patients and provide the most uncompensated care.
The extra payments
Insurers pay primary care in two ways. Fee-for-service payments are tied to a specific visit. "Supplemental payments" are not tied to a claim. The report lists examples: incentive and performance payments, shared-savings payments and payments for infrastructure.
In 2024, commercial insurers across Massachusetts paid $489 million in supplemental payments across all services, compared with $1.6 billion in fee-for-service payments for core primary care. Most of the supplemental money went to a small number of large provider systems. At Tufts Medicine, supplemental payments equaled 87 percent of its primary care fee-for-service payments, and 62 percent at Optum.
Providers told the attorney general's office that they passed between 22 percent and 48 percent of those extra payments to primary care providers, with one reporting none. When the office added those estimates to the visit payments, relative rates changed and, in the office's words, providers with higher shares of Medicaid patients "fell further behind the rest of the market." The estimates come from the providers themselves, and the report says the money cannot be cleanly traced to primary care.
Employer plans beyond state rules
For one large insurer, 64 percent of primary care visits were for members of self-insured plans. In those plans an employer carries the financial risk, and the report says they are regulated under federal law and exempt from most state insurance rules. That limits how far a state mandate on primary care payment can reach.
What the report recommends
The office recommends directing new primary care money by need, collecting market-wide data on supplemental payments, finding ways to bring self-insured plans into state primary care efforts, and keeping new spending within the state's health care cost growth benchmark. The report notes an executive order in August directing MassHealth to raise primary care spending to 12 percent of its medical spending by 2028.
The report is a set of findings and recommendations. It does not itself change any payment rule. It is based on a sample of insurers and 10 provider organizations, and the release does not identify which insurers supplied the data.
