Reform of Payment for Primary Care — From Evolution to Revolution

Abstract

Reforming payment for primary care has been on policymakers’ agendas for well over a decade. The impetus derives from primary care’s foundational role in a high-value health system and from troubling declines in the financial viability of primary care practices. Recent surveys found that 20 to 40% of respondents from primary care practices were considering sale, permanent closure, or consolidation, with safety-net practices appearing especially vulnerable. Moreover, primary care’s share of total U.S. health expenditures continues to decrease. In this context, questions about how best to pay for primary care, how much to pay, and how rapidly change needs to be implemented have reemerged as urgent considerations.