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As the Senate readies its debate on a long-awaited primary care bill, the chamber's health care point-person Sen. Cindy Friedman is clear: this isn't an immediate solution to a sector in crisis.

"Are you going to see it tomorrow? No. But this is a huge shift in the system. It takes time," Friedman told MASSterList, adding that she sees the bill both improving access and lowering costs.

Along with requiring providers in the system to shift dollars to primary care, the bill would also charge a group with coming up with an "alternative payment model" that would pay primary care physicians for providing care, not specific services, Friedman explained.

"Right now, you go in, you pay for a wellness visit, you pay for a lab test," she said of the existing "fee-for-service" model. "Now what we're saying is, primary care should be paid by a per-member, per-month payment that covers the work of primary care."

The systemic change would let a physician decide what patients need when they need it, shifting to a "value-based" system, she said. The bill also aims to take away some of the administrative burden and increase financial support for medical students who are coming into the primary care sector. 

The state spends about 6% to 7% of all of its health care dollars on primary care, Friedman said. Under the bill, the primary care spending target would require 9% of total health care spending to be dedicated to primary care by 2028. In 2029, that figure would jump to 12%, and in 2030, to 15%. Center for Health Information and Analysis data shows total health care spending in 2024 was $83.3 billion. A 15% target would place primary care spending around $12.5 billion.

Where are systems pulling money from to support that eventual 15% threshold?

"That is the opportunity that we give to the health care systems. We're not saying where you have to take this money [from]," Friedman said. "Not our decision. But you find a way." She called this bill "the first step" in systemically changing the incentives associated with primary caregiving.

The Massachusetts Health and Hospital Association called the target "a simple and well-intended concept in theory." Its Vice President of Policy and Regulatory Affairs Leigh Simons said the group is looking forward to "engaging" with the Legislature "while urging serious caution" around measures including those that “would inadvertently layer on even more complexity, overlook the innovation and investments already in motion, and replace the critical flexibility hospitals need to treat patients with a one-size-fits-all approach that discounts the unique nature of each organization and population."

Friedman said she has heard from some providers who want the alternative payment model to be voluntary, insurers who want to have flexibility in the benefit plans they provide, and some who think the bill's enforcement isn't strong enough. But if it's voluntary, it won't happen, Friedman said. And on enforcement, she said the stakeholders were part of the discussions.

“I think overall, the general criticism is not valid,” she added. As of this morning, senators have filed 72 amendments to the draft (S 3116) being taken up on Thursday.

As for the House's response: "I've heard no feedback from the House, but they know exactly what's coming," Friedman said. – Ella Adams

Ella Adams is a reporter for the State House News Service. Reach her at [email protected].

Ask your Senator to support S. 1114 and S. 1124 for Clean Slate legislation because an old CORI should not mean a lifetime of blocked opportunities.

10:00 | Gov. Healey makes an announcement regarding a statewide initiative related to wrong-way vehicle detection and prevention systems | State Police, Danvers Barracks, 485 Maple St., Danvers

10:00 | Special Commission on Pappas Rehabilitation Hospital for Children holds a hearing | Room B-2 | More Info and Livestream

10:00 | USS Constitution goes underway to commemorate the Battle of Bunker Hill | Charlestown Navy Yard

10:30 | Massachusetts League of Community Health Centers hosts its annual State House Day | Great Hall

11:00 | House meets in a full formal session. Roll calls on an early literacy conference committee report (H 5511) and a $3 billion environmental borrowing bill (S 3064, with Ways and Means redraft H 5510 pending as an amendment) are slated to begin after 1 p.m. | House Chamber

11:00 | Senate Democrats meet in a caucus | Senate President's Office and Virtual

12:00 | House Democrats meet in a caucus ahead of roll call votes in a formal session | Hearing Rooms A-1 and A-2

1:00 | Emergency Room Nurses Association, Massachusetts Association of Emergency Physicians, the Massachusetts Nurses Association, 1199SEIU and the Massachusetts Health and Hospital Association rally to urge Senate passage of a bill (H 4767 / S1718) to require healthcare employers to develop and implement programs to prevent workplace violence | State House steps

12:00 | Mass. Department of Transportation Board meets | 10 Park Plaza, MassDOT Board Room, Boston | More Info

3:15 | Boston Mayor Wu delivers remarks at the 251st Commemoration of the Battle of Bunker Hill and the 250th Anniversary of the United States | Bunker Hill Monument, Monument Square, Charlestown

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EARLY LITERACY ON LOCK: House and Senate negotiators announced an agreement Tuesday on a bill set to overhaul early reading instruction by establishing statewide standards for evidence-based reading instruction in kindergarten through third grade, requiring universal literacy screening, expanding teacher training requirements and more. — State House News Service

ENVIRONMENTAL BOND MOVING: The House is expected to pass an environmental bond bill on Wednesday, a version of what the Senate passed two months ago but without the Senate-proposed ban on single-use plastic carryout bags at retailers or restrictions on disposable utensils and other plastic food service products. — State House News Service

BALLOT QUESTION DEADLINE: Ballot question campaigns today face a deadline for the second round of signatures needed to get on the ballot in November. Campaigns have to file 12,429 signatures with local clerks, after which they face a final deadline to file with the Secretary of State's office on July 1.

As electricity demand rises heading into the summer cooling season, National Grid is already taking steps to reduce risk, improve the customer experience, and support businesses and economic activity across the Commonwealth, helping bring energy to power possibilities for customers and communities. Investments in system reliability, coupled with proactive planning and newer technologies, help minimize disruptions and avoid costs that ultimately impact customers. — LEARN MORE

AMHERST BUDGET APPROVED: The Amherst Town Council approved a $107.1 million fiscal 2027 budget Monday, complete with a $120,000 boost to the proposed fiscal 2027 elementary school budget to restore math and reading interventionists. — Daily Hampshire Gazette

LOGAN BATHROOM MAKEOVER: Massport began renovations on Logan International Airport’s bathrooms earlier this year, a $30 million project to address 10 restrooms — eight of which were ready by the time World Cup fans hit Logan. Over the next two years, 20 more bathrooms will be renovated in part due to a federal grant. — WBUR

DEATON VS. MOULTON: Much of the focus of the debate between Democratic challenger Congressman Seth Moulton and presumptive Republican nominee for U.S. Senate John Deaton was incumbent U.S. Sen. Ed Markey, who was not on the debate stage. — Boston Globe

CAPE FARM SAVED: Neighbors and a local land trust raised $1.5 million to save a 300-year-old Dennis farm dating back to 1713.— Cape Cod Times

WORCESTER LAST CALL: While some bars in Worcester served alcohol until 3 a.m. last weekend via the state’s last call extension, that didn’t apply to their entertainment licenses, so TVs, music and games had to stop at 2 a.m. — Telegram & Gazette

National Grid brings energy to power possibilities across Massachusetts, supporting homes, businesses, and communities every day. Through continued investment in reliable electric and natural gas systems, the company helps keep energy flowing when it matters most. National Grid is strengthening the energy system to support communities, economic growth, and future development across the region.

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