By: Christopher Koller and Margaret O'Kane

The Health Care Cost Institute (HCCI) released its analysis of 2016 health spending for a group of commercial insurers last month. The report is a trove of information that, like all good analyses, suggests more questions than it answers. Buried in the report—in figure 15—is an alarming trend that should rise to the top of analysts' areas for further investigation. How can it be that during an era of increasing focus on health care value, the portion of health spending going to primary care actually went down?

The cost-effectiveness of primary care is well documented, going back to Barbara Starfield, who demonstrated that health care systems which have more comprehensive primary care improve population health at lower costs and with greater equity. Summarizing international comparisons Eric C. Schneider and David Squires point to the lack of "primary care orientation" as one of the four factors accounting for the miserable performance of the US health care system.