Addressing the Primary Care Access Crisis for Medicare Beneficiaries

The United States faces a growing crisis in primary care access, particularly for Traditional Medicare (TM) beneficiaries. With a projected shortage of 57,000 primary care physicians (PCPs) by 2040 and a 29% decline in Medicare payments since 2001, the healthcare system is under strain [1]. A 2024 MedPAC survey found that one in 10 Medicare beneficiaries sought a new PCP in the past year, and half faced challenges finding one [2]. Against this backdrop, a study published in Health Affairs Scholar (May 2025) offers evidence that adopting a multi-payer, full-risk value-based care (VBC) model, supported by an enablement organization, can help preserve access to primary care for TM beneficiaries [3]. For healthcare providers, this research highlights VBC as a strategy to maintain open patient panels and address the access crisis.

The Study: Key Findings

The Health Affairs Scholar study, conducted by Benjamin S. Kornitzer and colleagues, analyzed Medicare claims data from 2019 to 2023 using a difference-in-differences approach [3]. It compared two groups: 208 PCPs who adopted a full-risk VBC model in 2022, supported by an enablement organization, and 3,657 PCPs who continued with traditional payment models. Both groups had at least 50 TM patients, ensuring active primary care practice. The VBC model covered 100% of Medicare Advantage and over 90% of TM patients, with the enablement organization providing data analytics, clinical protocols, contract infrastructure, and performance coaching.

The results are significant. PCPs adopting VBC saw, on average, 8 more new TM patients annually than non-adopters [3]. In 2023, VBC adopters welcomed 22.6 new TM patients, while non-adopters experienced a sharper decline in new patient intake. Additionally, VBC adopters kept their panels open to new TM patients for 0.7 more months per year, ensuring more consistent access [3]. These findings suggest that VBC can mitigate the decline in primary care access, offering a lifeline for TM beneficiaries.

Why Full-Risk VBC Supports Access

In contrast to the fee-for-service (FFS) model, where payments are tied to individual services, full-risk VBC (Category 4, per the Health Care Payment Learning & Action Network) provides fixed payments based on patient demographics and complexity [4]. PCPs are accountable for total medical spending and care quality, incentivizing proactive, team-based care with staff like care managers and nurses, as well as services like preventive and palliative care [5]. The study identifies several mechanisms by which VBC preserves access:

Economic Incentives: Full-risk VBC ties revenue to effective patient management, making it financially viable to accept new TM patients despite declining Medicare reimbursements [3].

Investment in Resources: When most of a PCP’s Medicare patients are under VBC contracts, it becomes feasible to invest in tools like population health analytics and additional staff, enabling larger patient panels without compromising care quality [3].

Operational Efficiency: A multi-payer, full-panel VBC model simplifies payer-specific rules, allowing PCPs to focus on consistent care delivery across new and existing patients [3].

The enablement organization’s support is critical, streamlining the transition to VBC by addressing administrative and operational challenges. This assistance makes adopting VBC more accessible, particularly for practices with limited resources.

Broader Implications

With 67.7 million Medicare beneficiaries and 2 million new enrollees annually, ensuring primary care access is a national priority [6]. Primary care reduces mortality, lowers costs, and improves outcomes for chronic conditions like diabetes and heart disease [7, 8]. However, many communities risk becoming “primary care deserts,” and even well-funded health systems are limiting new patient intake [9]. The study’s findings position full-risk VBC as a potential solution, enabling PCPs to accept more new TM patients and keep panels open longer, thus preventing beneficiaries from losing access to care [3].

Notably, 18.7% of the study’s comparison group was already in full-risk models for TM patients, suggesting that the benefits of VBC could be even greater compared to a pure FFS system [3]. The specific design of the VBC model, combined with enablement support, appears to amplify its impact on access.

Challenges and Future Directions

The study has limitations. Its nonexperimental design raises the possibility of selection bias, as PCPs who adopted VBC may differ from non-adopters in unmeasured ways [3]. The short follow-up period means long-term effects are unclear, and results may not generalize to other VBC models, regions, or patient populations. Additionally, the study does not specify the practice changes (e.g., staffing or technology) that enabled VBC adopters to accommodate more patients, leaving practical implementation details uncertain.

Future research should investigate these gaps, including whether VBC benefits extend to patients with commercial or Medicaid insurance and what proportion of a PCP’s panel must be in VBC to impact access [3]. Studies should also explore how VBC affects care quality, equity, and patient experience, building on prior research in these areas [10].

Policy and Practice Recommendations

The study’s findings carry significant implications for policymakers and providers. With the Centers for Medicare & Medicaid Services (CMS) aiming to enroll all Medicare patients in accountable care models by 2030, VBC adoption could be a cornerstone of addressing the access crisis [11]. Key recommendations include:

Incentivize VBC Adoption: Higher payments for PCPs participating in full-risk VBC could encourage adoption, stabilizing practices and supporting continued acceptance of TM patients [3].

Support Practice Transformation: CMS could fund practice facilitation and interoperable data tools to ease the transition to VBC, particularly for smaller practices [3].

Expand Quality Metrics: Incorporating claims-based metrics for new patient access into CMS’s quality measures would reward PCPs who maintain open panels and enhance beneficiary choice [3].

For providers, adopting full-risk VBC offers a path to financial stability and operational efficiency while preserving access for TM beneficiaries. Enablement organizations can bridge the gap, making VBC adoption feasible even for resource-constrained practices.

The primary care access crisis demands urgent solutions. The Health Affairs Scholar study provides compelling evidence that full-risk VBC, supported by enablement organizations, can help PCPs accept more new TM patients and maintain open panels [3]. For TM beneficiaries, this means better access to essential care. For providers, it offers a sustainable model to navigate the challenges of modern healthcare. Policymakers and practices must act on these findings to ensure that primary care remains a cornerstone of the healthcare system.

References

MedPAC. Report to the Congress: Medicare and the Health Care Delivery System. June 2024.

MedPAC. Survey of Medicare Beneficiaries. 2024.

Kornitzer BS, Yao A, Peikes DN, Rao K. Impact of a multi-payer full-risk model on preserving primary care access for traditional Medicare beneficiaries. Health Affairs Scholar. 2025;3(5):qxaf093. doi:10.1093/haschl/qxaf093