Acknowledging my own bias as a physician, I believe providers — in particular primary care physicians (PCPs) — are the central decision nodes whose incentives have been repeatedly overlooked in prior iterations of value-based payment models. There are nearly 300,000 primary care providers across the country, who function every day as powerful patient advocates, clinical experts, and decision makers; although their services account for <5% of total medical spend, they directly influence >80% of downstream healthcare costs. But we’re currently neither incentivizing them nor empowering them to provide holistic, value-based care.

By and large, PCPs today remain tethered to fee-for-service payment rails: only 17% of Medicare Advantage (MA), 4.4% of traditional Medicare, and 2.5% of commercial reimbursement currently flows through capitated population-based alternative payment models. This means that most PCPs are still paid per episodic patient visit, and are hamstrung by short-term payment hurdles, rather than sharing in access to the value generated by keeping their patients healthy long-term.

In an alternate future universe, the work of a PCP could be radically different. Instead of running through 22 separately billable patient encounters each day, providers could be paid on a per-patient-per-month fee structure, with access to upside (and downside) financial risk based on each patient’s overall health (and total cost of care). In this regime, providers might shift towards managing panels of patients, grouped by condition. They could be empowered to focus on prevention, and always-on triage. They could make their own informed decisions about when to spend an hour with a patient in their home vs when to simply check in with a patient over text message. And PCPs deeply embedded in their local communities could remain financially independent, retain their unique practice styles, engage their patients to address health inequities day in and day out — and be recognized for the long-term value they provide their patients.

But until we radically change the financial incentives for individual providers, the outcomes will not change. Moreover, until we empower providers with the technology and tools they would need to actually succeed against these new incentives, they will not be able to participate effectively.

Acknowledging my own bias as a physician, I believe providers — in particular primary care physicians (PCPs) — are the central decision nodes whose incentives have been repeatedly overlooked in prior iterations of value-based payment models. There are nearly 300,000 primary care providers across the country, who function every day as powerful patient advocates, clinical experts, and decision makers; although their services account for <5% of total medical spend, they directly influence >80% of downstream healthcare costs. But we’re currently neither incentivizing them nor empowering them to provide holistic, value-based care.

By and large, PCPs today remain tethered to fee-for-service payment rails: only 17% of Medicare Advantage (MA), 4.4% of traditional Medicare, and 2.5% of commercial reimbursement currently flows through capitated population-based alternative payment models. This means that most PCPs are still paid per episodic patient visit, and are hamstrung by short-term payment hurdles, rather than sharing in access to the value generated by keeping their patients healthy long-term.

In an alternate future universe, the work of a PCP could be radically different. Instead of running through 22 separately billable patient encounters each day, providers could be paid on a per-patient-per-month fee structure, with access to upside (and downside) financial risk based on each patient’s overall health (and total cost of care). In this regime, providers might shift towards managing panels of patients, grouped by condition. They could be empowered to focus on prevention, and always-on triage. They could make their own informed decisions about when to spend an hour with a patient in their home vs when to simply check in with a patient over text message. And PCPs deeply embedded in their local communities could remain financially independent, retain their unique practice styles, engage their patients to address health inequities day in and day out — and be recognized for the long-term value they provide their patients.

But until we radically change the financial incentives for individual providers, the outcomes will not change. Moreover, until we empower providers with the technology and tools they would need to actually succeed against these new incentives, they will not be able to participate effectively.