Barbra G. Rabson, M.P.H., is the President and CEO of Massachusetts Health Quality Partners, a nonprofit organization dedicated to improving the quality and equity of patient experiences through data-driven insights and collaboration. Rabson represents MHQP on the Massachusetts Primary Care Access, Delivery, and Payment Task Force, which was established by legislation signed by Governor Healey earlier this year. The Primary Care Collaborative recently honored Rabson with the Primary Care Community Leadership Award. She serves on the board of the American Board of Family Medicine and is a member of the Milbank Advisory Committee for the Health of U.S. Primary Care Scorecard. She talks with Patient Safety Beat about efforts to improve primary care in Massachusetts. 

Patient Safety Beat: Earlier this year, MHQP and the Center for Health Information Analysis (CHIA) released an updated dashboard of data used to measure the health of primary care in Massachusetts. Please describe this project and MHQP’s interest in primary care. 

Barbra Rabson: MHQP first became aware of the fragility of our primary care system pre-COVID when we asked clinicians how to improve access for patients, and they said, “You don’t understand. Primary care is so fragile right now. We can’t take on one more thing.” That signaled the urgency of this problem, which should be shouted from the rooftops since primary care is the foundation of our health care system.  

MHQP is fundamentally a measurement organization. We've been measuring the performance of primary care for decades, and more recently decided to pivot and measure the health of primary care. We consulted experts across all aspects of primary care and came up with hundreds of potential metrics, which we narrowed down to four domains: finance, performance, equity and capacity.  

We partnered with CHIA to create the first primary care dashboard in the country, which we released in January 2023. Our goal is to monitor the health of primary care in the state, to raise awareness, and to inform policy formation around primary care in Massachusetts. We've issued three dashboards so far, and they all show that measures tracking the health of primary care continue to get worse. 

Patient Safety Beat: What are some of the key findings shown on the updated dashboard? 

Barbra Rabson: Looking at financing, we separated out the primary care spend by payer. MassHealth has the highest primary care spend as a percent of total medical expense. They've been working very intentionally to support primary care practices, and it shows. About 7.5% of MassHealth’s total medical spend goes to primary care, and it’s growing. Commercial primary care spend is closer to 6%, while Medicare Advantage is under 5%, and both have decreased by a full percentage point since we began tracking this. These numbers are quite alarming, and every year, we have seen the percentage of total medical expenses spent on primary care decrease in Massachusetts. 

In terms of capacity, the aging workforce and the declining number of new physicians choosing to work in primary care create access challenges. Our first dashboard showed that over 30% of primary care physicians were age 60 and older. Only 19.2% of Massachusetts medical school graduates are practicing in primary care 6-8 years post-graduation. In our latest dashboard, 41% of Massachusetts residents reported difficulty obtaining necessary health care in the past 12 months. That’s up from 33% in a previous CHIA report—a huge jump in the wrong direction. On equity, we found that 48% of non-white patients or patients reporting multiple races had difficulty accessing necessary health care. 

Combining those statistics with other measures, the dashboard provides a complete picture. The fact that all domains are getting worse calls for urgent attention. 

Patient Safety Beat: Discussing Dire Diagnosis, a 2025 report on primary care from the Massachusetts Health Policy Commission, a presenter commented that lack of access to primary care can have “adverse ripple effects” on safety. Do you agree? How are these efforts to improve primary care addressing patient safety? 

Barbra Rabson: Yes. I think of physician researcher Barbara Starfield in this context. In the 1980s, she identified the four Cs of primary care: comprehensiveness, first contact, coordination, and continuity. Primary care clinicians look at the whole person and ensure that comprehensive and coordinated care is available across different specialists and institutions. Primary care clinicians also gain knowledge of the patient over time, and that helps build trust in the relationship. Lack of access to primary care means less coordination and continuity of care for patients, which can lead to preventable medical errors and negative outcomes.  

In addition, a recent article in The BMJ focused on the “rookie factor” in primary care, which is something else to consider in the context of safety. Cost and the risk of patient harm both increase when the health care workforce includes a disproportionately high number of inexperienced or newly qualified staff compared to experienced staff. 

This phenomenon is concerning in primary care, especially in the management of complex, long-term conditions that require a high degree of clinical judgment and experience. The dashboard and other data show an exodus of experienced primary care doctors since COVID and a growing number of relatively inexperienced, newly trained replacements. It can be very challenging if you don't have a really experienced clinician guiding you. The ratio of experienced to inexperienced clinicians is something we need to pay attention to. 

Patient Safety Beat: Do you have specific recommendations—technologies, policies, regulations, etc.—that you think would help increase the capacity and safety of primary care?  

Barbra Rabson: The first thing to know is that there’s no simple or single solution. We need action on multiple fronts, and clearly, we need to invest more in primary care. We also need to leverage the use of technology to reduce the administrative burden on primary care clinicians. 

We want to make primary care clinicians’ jobs more manageable. Recent advances in ambient recording of visits, ambient scribes and other AI applications have significantly helped, especially regarding inbox management. At the same time, we need to ensure that patients are aware of what's happening. So far, there hasn't been enough patient engagement or transparency about how artificial intelligence is being used to support primary care physicians. 

Patient Safety Beat: It’s clear that you're passionate about primary care. What drives your interest? 

Barbra Rabson: I could talk about primary care forever. It's just something that I care deeply about. I think back to my master’s degree when I studied public health and learned the importance of prevention, of managing diseases and keeping people healthy—all of that work is foundational to primary care and a high-functioning health care system. 

This interview was edited for length and clarity.