From Cost Benchmarks to Care Architecture: Reconstructing Primary Care in Massachusetts for Access, Equity, and Cost Containment

Massachusetts is known to be a leader in health policy innovation, especially its near-universal insurance coverage and national benchmark on health care cost growth. However, despite such an advanced policy infrastructure, the Commonwealth is still experiencing increased health care expenditure, limited access to primary care, and long-standing disparities in health outcomes. Current policy studies rightly identify the causes of cost increase, such as administrative complexity, price dispersion, unnecessary utilization, and endemic under-investment in primary care, but fail to go further to identify a structural failure underlying that: the lack of care delivery designs that can transform cost standards into operational change at the point of care.

This paper will contend that Massachusetts has exhausted reforms that are focused on measurement, accountability, and refinement of policies in small steps. The second step of reform needs to be a transition to cost benchmarks as retrospective control systems into the intentional design of primary care as an architectural form of care- one that coordinates legal authority, administrative form, workforce placement and payment models around access, equity, and cost containment all at the same time.

Based on health policy analysis, health law, health economics, and administrative realities guided by national medical group benchmarks, the paper illustrates why cost containment strategies have not increased access and reduced inequity despite a wide agreement on underlying causes. It determines the structural contradictions inherent in existing delivery models and demonstrates how administrative complexity, misaligned payment, and fragmented governance serve as hidden taxes on access.

The conclusion of the analysis is that a sustainable reform within cost growth limits demands rethinking primary care not as a collection of services or care locations, but as a care architecture. In the absence of this change, cost benchmarks will persist as diagnostic, but not system transformation tools, and the policy leadership of Massachusetts will not be connected to lived patient and provider experience.