Summary
Value-based care (VBC) models have existed for fifteen years but have not made meaningful changes to health care delivery or spending in the United States. The COVID-19 pandemic and ensuing financial strain on hospital systems have made it evident that more dramatic and rapid change is required. The time has come for primary care to drive the innovative change in health care delivery and financing. Key drivers of change will be forward-thinking independent practice associations, medical groups, and health systems. These entities must determine how to work together to embrace ambulatory-first contracting strategies, and to expand delivery of care outside the walls of traditional acute care hospitals, while enhancing the access to critical care which only hospitals can provide.