Prioritizing Primary Care in Value-Based Care: A Prescription for Better Outcomes
Primary care is the backbone of a high-performing health system, yet in the United States it has long been underfunded and constrained by fee-for-service (FFS) payment. FFS rewards volume over value, pushing clinicians to cram in visits instead of managing population health. It’s no surprise that more than half of U.S. primary care physicians report burnout, driven by unsafe, unsustainable patient loads. To fix this, health care leaders are turning to value-based care (VBC), which ties payment to outcomes rather than the number of services provided.
Value-Based Care: Aligning Incentives With Outcomes
VBC shifts focus to quality, outcomes, and patient value. Instead of being paid for every test and appointment, providers are rewarded for keeping patients healthy—meeting preventive care benchmarks, controlling chronic conditions, and avoiding unnecessary hospitalizations. Many models include prospective or per-member payments that give teams flexibility to deliver the right care at the right time, rather than optimizing for billable visits. By realigning incentives, VBC aims to improve quality and equity while curbing costs.
Momentum is building. The Centers for Medicare & Medicaid Services (CMS) aims for all Medicare and most Medicaid beneficiaries to be in VBC models by 2030. Accountable Care Organizations (ACOs) are a leading vehicle: networks—often anchored by primary care—take responsibility for cost and quality for a defined population and share in savings when they reduce avoidable spending. Participation is expanding across community health centers, and bringing the remaining majority of primary care practices into VBC is essential to achieving national gains.
Evidence of Better Care and Outcomes
Early results are encouraging. Clinics in ACOs deliver more preventive care—such as cancer screenings, tobacco cessation support, and cardiovascular prevention—than non-ACO peers, leading to earlier detection and better disease control. VBC arrangements also correlate with stronger chronic disease management and improved coordination for patients with complex needs. Primary care physicians in value-linked payment are more likely to participate in team-based models like ACOs or patient-centered medical homes, which have demonstrated quality improvements alongside cost reductions. These practices are also somewhat more likely to screen for social needs such as food or housing insecurity, enabling interventions that address key drivers of health.
Crucially, VBC supports health equity. Federally Qualified Health Centers (FQHCs) and community clinics disproportionately serve low-income, racially diverse, and dually eligible patients. Accountable care models increasingly include explicit incentives to close gaps in care; programs like ACO REACH tie rewards to reducing disparities. With value-based contracts, FQHCs can invest in outreach, education, language access, and transportation—services that improve access and outcomes for underserved communities.
What Providers Need to Succeed
Yet transitioning to VBC is challenging, especially for safety-net clinics and small independent practices operating on thin margins. Many rely on low Medicaid rates and grants, making financial change feel risky. Common hurdles include insufficient payment levels and the need for culture change—from volume-driven visit counts to proactive population management. Practices need adequate payment, predictable cash flow, and targeted investment to build the capabilities VBC requires: robust data infrastructure, care management, and performance analytics. Policymakers and payers can accelerate adoption by pairing financial incentives with technical assistance. Priority investments might include:
• Upgrading EHRs and data interoperability
• Integrating predictive & prescriptive analytics to stratify risk, track quality measures, and target interventions.
• Advancing comprehensive patient profile by combining behavrioural and social data along with the clinical.
• Supporting change management to redesign workflows and embed team-based care.
Public grants, private capital, and partnerships with VBC enablement organizations can help practices scale these capabilities. When primary care teams have the tools to track performance, identify gaps, and act on insights, they can deliver more preventive, coordinated, and equitable care—while reducing avoidable utilization.
Bottom Line
Value-based care offers a clear path to revitalizing U.S. primary care. By paying for outcomes, it empowers clinicians to keep people healthy, advances equity, and makes smarter use of limited resources. With the right payment, infrastructure, and support, primary care can fulfill its central role in a high-value health system.
Sources:
-Commonwealth Fund – Horstman, C. et al. Advancing Accountable Care in Community Health Centers: Progress and Future Directions (Issue Brief, Aug. 2025)
-Commonwealth Fund – Horstman, C. & Lewis, C. Engaging Primary Care in Value-Based Payment: New Findings from the 2022 Survey of Primary Care Physicians
-CMS Blog – Rawal, P. et al. The CMS Innovation Center’s Strategy to Support High-Quality Primary Care
-BCG – Brown, A. et al. Meeting the Unique Health Care Needs of Dual-Eligible Individuals (Article, Apr. 2025)
