Primary care is essential to the effective and efficient functioning of health care delivery systems, yet there is an impending
crisis in the field due in part to a dysfunctional payment system. We present a fundamentally new model of payment for primary
care, replacing encounter-based imbursement with comprehensive payment for comprehensive care. Unlike former iterations of
primary care capitation (which simply bundled inadequate fee-for-service payments), our comprehensive payment model represents
new investment in adult primary care, with substantial increases in payment over current levels. The comprehensive payment
is directed to practices to include support for the modern systems and teams essential to the delivery of comprehensive, coordinated
care. Income to primary physicians is increased commensurate with the high level of responsibility expected. To ensure optimal
allocation of resources and the rewarding of desired outcomes, the comprehensive payment is needs/risk-adjusted and performance-based.
Our model establishes a new social contract with the primary care community, substantially increasing payment in return for
achieving important societal health system goals, including improved accessibility, quality, safety, and efficiency. Attainment
of these goals should help offset and justify the costs of the investment. Field tests of this and other new models of payment
for primary care are urgently needed.
Key words primary care - comprehensive payment - capitation - resource-based relative value scale (RBRVS) - compensation