The Primary Care Investment Gap Is Driving Healthcare Costs

PROACTIVE CARE, including primary care, is the most effective way to reduce preventable inpatient utilization and slow the continued rise in total cost of care year-over-year, yet providers who deliver this care remain in short supply. This imbalance is the result of years of short-sighted decisions, including broad reductions in provider reimbursement rather than strategic investment, a lack of clear definition around high-value care, and a system that prioritizes cost-cutting at all costs while consistently valuing specialists over primary care providers, paying significantly more to treat morbidity than to prevent it. Those bearing financial risk must first address these supply and demand gaps by reversing the incentives that created them, recognizing that the healthcare market moves to where the money is.

Today, we signal a preference for reactive care by paying more for it each year; instead, we must invest appropriately and intentionally in primary care by increasing reimbursement, aligning rates with specialists, expanding provider time per member, and reducing patient load constraints so providers can “do today’s work today” and prevent higher downstream costs. These changes would also help address burnout and retain high-quality providers, ultimately increasing access to PROACTIVE CARE and reducing total cost of care. Importantly, rising primary care costs should not be mistaken as the problem, they are the solution. At the same time, primary care providers are increasingly organizing through independent groups to strengthen their position, as workforce shortages worsen due to lower compensation, higher stress, and practice closures, with projections showing a deficit of up to 86,000 primary care physicians by 2036 and a growing number of patients unable to access care (Brown, 2026; Brender et al., 2026). In this environment, collaboration with independent, high-value providers, rather than consolidation into health systems, offers a more aligned path forward.

Finally, while value-based arrangements are often positioned as the answer, continuing to leverage and refine the existing fee-for-service system may offer a more practical, scalable, and transparent approach, with stronger alignment, clearer data through coding, and more sustainable financial accountability over time.

Brender, T. D., Rittenberg, E., Durant, R. W., & Ganguli, I. (2026). A different lens on the primary care workforce shortage—Who is accepting new patients? JAMA Internal Medicine, 186(3), 283–284. https://doi.org/10.1001/jamainternmed.2025.7462

Brown, K. (2026, February 16). Primary care is in trouble. Doctors are banding together to increase market power. NPR. https://www.npr.org/2026/02/16/nx-s1-5715996/primary-care-independent-physician-association-ipa-medicaid-cuts-value-based-reimbursement