As CMS winds down two of its most ambitious primary care payment models—Primary Care First and Making Care Primary—many independent practices are navigating an uncertain transition: the infrastructure support that made value-based care feel manageable is disappearing. While CMS has made clear this shift does not signal a retreat from value-based care, the end of these models does mark a transition, which challenges practices to adapt, refocus, and prioritize what matters most: physician alignment in value-based care.
These models weren’t perfect, but they gave independent physician groups some room to breathe. With upfront care management payments, population-based reimbursements, and flexibility to grow into risk, they served as a financial and operational cushion.
Now, with those supports winding down, the path forward depends less on external incentives and more on internal strategy. It’s not a setback. It’s a signal. The next phase of value-based care will be led by organizations that know how to align from within.
At VBC Transformation Partners, we believe that future belongs to practices who activate their clinical teams, lead with clarity, and build systems that last. That journey begins with one foundational shift: physician alignment in value-based care.
The Real Impact: Not Just Lost Revenue—Lost Margin for Error
As practices lose model-based revenue—up to 33% in PCF and up to 36% in MCP (Wirth et al., 2025), what they also lose is predictability. These programs buffered early-stage transitions and subsidized capacity building. Without that buffer, internal clarity becomes non-negotiable.
Those models didn’t just bring money, they brought predictability. They funded care teams, enabled risk-free experimentation, and gave early-stage VBC organizations a glide path to sustainability. They gave practices space to move forward without risking financial instability.
Without them, practices are exposed.
Suddenly, the things that were optional before—tight workflows, efficient spend, physician alignment—are now essential. While you can’t control CMS timelines, you can control how your organization responds.
Why Physician Alignment Is the Strategy That Scales
Too often, organizations respond to model loss with cuts, complexity, or top-down mandates, but real sustainability doesn’t come from reacting, it comes from aligning.
Physician alignment isn’t just about buy-in. It’s about shared goals, transparency around trade-offs, and clearly structured incentives. When physicians are trusted and equipped to lead, they don't just participate in value-based care, they drive it.
That leadership shows up in places we often overlook. Take clinical purchasing decisions, for example. Physicians often control which products are used, how care is delivered, and how variation impacts both quality and cost. According to McKinsey & Company, 80% of physicians believe they can help reduce supply costs without harming care quality, yet fewer than 30% are engaged regularly in these decisions. That’s not just a missed financial opportunity, it’s a missed opportunity for alignment.
When physicians are engaged in performance discussions—whether about clinical variation, quality gaps, or spend—they make smarter, more cost-effective decisions. Not because they’re told to, but because the data, context, and incentives make sense.
That kind of decision-making doesn’t happen in the abstract. It happens in the everyday practice of care. The margin CMS models once protected will now depend on aligning clinical judgment with system strategy, and nowhere is that more visible than in the decisions physicians already own.
In most independent practices, physicians may not be negotiating supply contracts, but they do shape what’s used, how often, and why. Supply decisions come to life in exam rooms, through routine ordering patterns, care workflows, and clinical preferences that drive both cost and quality. Physicians already influence utilization, outcomes, and resource use every day, but too often, they make those choices without the data, feedback, or support needed to connect clinical actions to financial or quality outcomes.
That’s where physician alignment becomes transformational. When engagement is structured thoughtfully, physicians don’t just drive savings, they share in the rewards. This is not about top-down cost-cutting. It’s about collaborative, bottom-up, performance-driven alignment.
You Don’t Need Another Model. You Need a Map.
Practices that built care teams, analytics, or population health functions under PCF or MCP are already ahead of the curve, but even for those who didn’t participate, the message is clear: sustainable value-based care can’t wait for the next CMS program. Whether you're optimizing existing investments or starting from scratch, the challenge now is building internal infrastructure that lasts.
At VBC Transformation Partners, we help practices do exactly that. We bring deep expertise in building internal alignment:
- Physician engagement strategies grounded in clinical realities.
- Compensation models that reward both effort and outcomes.
- EMR and workflow redesigns that streamline performance tracking.
- Operational coaching that connects leadership goals to frontline execution
This is how practices stay resilient: by investing in the people, systems, and strategies.
The Upshot: Physician Alignment Is the New Infrastructure
What the last few years proved is that value-based care works best when clinicians lead.
Forward momentum takes more than good intentions. It takes focus, clinical alignment, and a strategy built from within. The shift starts with one essential move: physician alignment in value-based care. Our physician-led model aligns autonomy with accountability because that’s how transformation lasts.
Let’s design a blueprint for value-based care that reflects your goals, your team, and your future.
Ready to Move Forward?
Let’s talk about how you can strengthen your value-based care strategy through smarter use of data—today and tomorrow.
