Advancing Primary Care Payment Reform in the Commercial Sector: A Report and State Policy Playbook
Apr 28, 2025
The United States has the highest spending per person on health care in the world but lags behind other high-income countries in terms of health outcomes. Primary care improves health outcomes, lowers costs over time, and reduces disparities. However, this critical foundation of the health care system is crumbling. People across the country are struggling to access primary care, and practices face challenges in recruiting and retaining providers. Workforce shortages are driven by large and pervasive issues plaguing primary care, including historic underfunding relative to other specialties and reliance on fee-for-service (FFS) payment. Payment reform is urgently needed to strengthen primary care.
Shifting away from FFS to alternative payment models (APMs) is one approach to better support primary care and address poor health outcomes and rising health care costs in the United States. APMs are designed to improve care delivery, reward quality, and incentivize cost control.
With recent federal cuts to primary care APM demonstration projects, state work is more important than ever. Our research examines five states that are advancing primary care APM policy for the commercial sector, with the goal of better supporting the foundation of the health care system. Insights from these states provide useful takeaways and points of caution for others beginning this work.
The policy playbook presents a step-by-step guide for state policymakers and policy influencers looking to support high-quality primary care by transforming payment. In addition to policies advancing APMs for state-regulated commercial plans, the playbook also covers related areas of primary care payment reform found to be critical to their success: primary care investment and multi-payer alignment.
The full report delves into the detailed findings of the research, as well as a more comprehensive listing of recommendations for states advancing primary care payment reform.
State snapshots provide a brief overview of major policies in primary care payment reform in Arkansas, Colorado, Delaware, Rhode Island, and Washington.