Millions are struggling to access high-quality, whole-person primary care. Patients are facing long wait times and short visits when they do get in. And roughly one-third of Americans don’t have a long-term, trusted relationship with a clinician to partner with them on their care journey.
Deteriorating primary care access is the direct result of a broken system that consistently undervalues our health system’s front door. Although primary care delivers 35% of all visits, it receives less than 5 cents of every health care dollar. Luckily, policymakers are taking steps to fix this broken payment model.
Each year, Medicare updates its fees for physicians and other clinicians. In the 2026 Medicare Physician Fee Schedule, the Centers for Medicare and Medicaid Services (CMS) began reversing decades of undervaluing primary care, providing more resources for primary care teams to prevent and manage chronic conditions.
Importantly, the rule sets out a path for future policy reforms that Medicare, Congress, state policymakers and employers can follow to strengthen our nation’s health.
These policies move us down the path toward rebalancing our payment system. But to truly reinforce the foundation of the American health system, policymakers need to protect and expand upon these gains, eventually doubling primary care investment through value-based approaches.
Recognizing the Importance of Relationships
Historically, Medicare has put a premium on easily quantifiable procedures and tests. But time-intensive, relationship-based services that keep and restore people to health while improving wellbeing don’t fit neatly into this model. Medicare has also relied on surveys of clinicians estimating their time to inform pricing. These approaches have led to Medicare (and other payers) consistently undervaluing primary care.
To begin correcting this, Medicare will implement an “efficiency adjustment” starting in 2026. This will reduce overpayments for procedures and testing while protecting time-based services such as evaluation and management visits, behavioral health and care management. CMS will also be augmenting survey data with empirical data to inform pricing and invites submission of other empirical data — crucial to refining and targeting the efficiency adjustment’s impact over time.
These actions start to rebalance payment — so that primary care teams are supported in spending more time with patients to help them navigate their health journeys — but more intensive efforts are called for, including exploring additional data sources and approaches to inform Medicare pricing.
Addressing Chronic Conditions — Including Behavioral Health — by Bundling Codes and Payments
The piecemeal way we pay for primary care — there are thousands of codes — undermines clinicians’ ability to build the relationships that support patients in preventing or managing chronic conditions.
To simplify the process, CMS launched the Advanced Primary Care Management (APCM) code that bundles many primary care and behavioral health services and pays for these services prospectively without clinicians having to track time for each individual service. This can free up the primary care and behavioral health clinicians from paperwork and allow them more time with patients.
The APCM is a start — it could be considered a mini hybrid payment — but policymakers need to make the prospective payment more robust, covering 50% or more of services primary care provides. Other services that are important to incent could continue to be billed via FFS. Moreover, CMS should work to remove cost-sharing barriers to APCM and better support care transformation in practices participating in the Medicare Shared Savings Program.
Investing in Community-Based Primary Care
Independent, community-based practices are at a negotiating disadvantage compared to large facilities. Unfortunately, Medicare payment rates have favored large facility-based settings over smaller, community-based sites of care. This trend has led to a decline in independent practices and exacerbated growing consolidation, price increases and access barriers.
The new payment rule establishes a new site-of-service differential that will ensure local independent or community-based practices are less underpaid relative to better resourced systems.
Better support for independent, community-based practices ensures that underserved communities — especially rural America — have access to high-quality health care.
Building on Success
The 2026 MPFS doesn’t fix all — or even most — of the problems inhibiting Americans’ access to primary care. But the new regulations begin reversing underinvestment and provide a roadmap for policymakers to rebuild the foundation of our health care system.
As policymakers consider a significant overhaul of Medicare payment, it’s important they build on and accelerate these changes. By committing to policies that recognize the value of primary care and place a premium on relationships, local care teams and care coordination, policymakers will strengthen primary care. And that’s good for our health.
Ann Greiner is President & CEO of the Primary Care Collaborative, a national nonprofit that convenes organizations that are committed to improving the nation’s health by strengthening primary care.
Namrata Uberoi is the Director of Health Policy at the West Health Policy Center, a nonpartisan, nonprofit organization based in Washington, DC, focused on lowering healthcare costs to enable successful aging.