Worcester, MA – A new report released by Attorney General Andrea Joy Campbell on Tuesday highlights stark disparities in commercial insurance payments to primary‑care providers across Massachusetts. The 2026 health‑care cost trends report, which examines 2024 payment data, shows that UMass Memorial Health is among the highest‑paid primary‑care organizations in the state.
Payment gaps between providers
The study compared contracted primary‑care rates—averaged across participating insurers—to the Medicare fee schedule for 2024. Rates ranged from 127% to 244% of Medicare, with UMass Memorial at the upper end of that spectrum. By contrast, federally qualified health centers operating under the Community Care Cooperative (C3) received some of the lowest commercial rates.
According to the report, providers that treat a larger share of Medicaid patients and deliver more uncompensated care tend to receive lower commercial rates. C3 and Signature, both serving high numbers of public‑payer patients, illustrate this trend.
Supplemental payments widen the divide
Insurers also make supplemental payments that are not tied to specific claims—such as incentive or infrastructure payments. In 2024, commercial payers disbursed $489 million in these supplemental funds, on top of $1.6 billion in core fee‑for‑service primary‑care payments.
A handful of large health systems captured the bulk of this money. Optum, the parent of Reliant, led with $115.1 million, followed by Tufts Medicine ($76.2 million), Mass General Brigham ($71.8 million), Steward ($65.2 million) and Beth Israel Lahey Health ($54.7 million).
How systems allocate supplemental funds
When asked how much of the supplemental money they received was passed on to primary‑care physicians, one organization told the AG’s office it passed none of the funds to its doctors. The other nine systems reported allocating between 22% and 48% of supplemental payments to primary‑care providers.
When those supplemental allocations are added to base rates, the payment gaps widen further, leaving providers with higher Medicaid volumes even farther behind their market peers.
Impact of self‑insured plans
At one large commercial insurer, self‑insured plans—typically sponsored by large employers and regulated under the federal Employee Retirement Income Security Act (ERISA)—accounted for 64% of primary‑care visits. This underscores the role of employer‑sponsored health coverage in shaping payment dynamics.
State response and policy goals
Governor Maura Healey has signaled a commitment to boosting primary‑care spending. In August, she signed Executive Order 657, directing MassHealth to allocate 12% of its total medical expenses to primary care by December 31, 2028. Additionally, the Primary Care Access, Delivery and Payment Task Force, created by lawmakers, recommends a statewide target of at least 15% of total health‑care spending for primary care, while keeping growth within cost‑benchmark limits.
The Attorney General’s office recommends that the Commonwealth address funding disparities, ensure new investments reach underserved providers, and protect federal safety‑net funding that faces significant cuts.
Why this matters for Worcester families
Primary care is the foundation of a strong health‑care system, as AG Campbell emphasized. When community health centers receive lower commercial rates, they may struggle to sustain services that families rely on—especially for uninsured or under‑insured patients. Ensuring equitable payment structures helps preserve access to quality care for Worcester’s families and supports the broader goal of a healthier, more resilient Commonwealth.
Stakeholders, including health‑care leaders, insurers, and patient advocates, are expected to review the report’s findings and work toward policies that narrow the payment gap while maintaining the financial stability of both large systems and safety‑net providers.
Original reporting: This Week in Worcester — read the source article.
