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Health Care Delivery System Reform

Primary health care is the foundation of a high-performing health system. Evidence consistently shows that comprehensive, coordinated, and continuous primary care is associated with better health outcomes, greater equity, and lower costs. Yet, primary health care in the U.S. is falling short of its potential, with access to high-quality care dwindling for patients, and providers facing growing burden and burnout.

The Commonwealth Fund’s Health Care Delivery System Reform program seeks to strengthen primary health care, particularly for underserved populations. The program supports efforts in two key areas.

Promoting primary care payment reform.

For many people in the United States, especially those with complex health and social needs or low income, people of color, and rural residents, high-quality primary care is simply not available, or the services provided are not meeting their needs. Decades of underinvestment and issues related to how we pay for care are two major reasons.

The Commonwealth Fund aims to promote evidence-based payment reforms for primary health care, ensuring providers are adequately paid to deliver accessible, comprehensive care. Our work in this area includes promoting value-based payments and increased investment in primary care through Medicare and Medicaid and exploring opportunities to engage safety-net providers, particularly federally qualified health centers.

Supporting provider retention, particularly in the safety net.

Primary care providers themselves are experiencing increased burden and burnout, as administrative requirements and workloads increase and investments decrease. Many are retiring early or leaving the field for other medical specialties. This exacerbates already severe workforce shortages and health care access challenges, particularly in rural areas.

The Commonwealth Fund seeks to support the retention of existing primary care providers, particularly in the safety net. Our work in this area includes identifying strategies to reduce administrative burden and assessing the effects of the consolidation and commercialization of primary care on providers and care delivery.

Program Contact:

Corinne Lewis, Program Officer, Health Care Delivery System Reform

2024 Program Funding Priorities

  • Assessing, improving, and promoting the adoption of primary care payment reform models in Medicare, Medicaid, and the safety net
  • Building consensus and momentum among states to support the adoption of primary care payment reforms and increased investment
  • Generating evidence and identifying policy options to support the retention of the existing primary care workforce, particularly through reducing burden on providers and assessing the impacts of commercialization

Our Experts

Corinne Lewis

Program Officer, Delivery System Reform

Celli Horstman

Senior Research Associate, Delivery System Reform

Alexandra Bryan

Senior Program Assistant, Delivery System Reform