Aligning primary care models with evolving market dynamics

Across the United States, primary care is experiencing significant contrasts. Traditional primary care clinics, emphasizing high-quality care and high patient volume and throughput across large patient panels, still dominate the predominantly fee-for-service (FFS) landscape. However, evolving market dynamics and the rise of value-based reimbursement are prompting a reconsideration of care delivery models.

This article explores how primary care has evolved from traditional volume-based models to emerging, patient-focused care, highlighting how providers can adapt their primary care service portfolios to remain competitive.

The current state of primary care

The standard primary care experience is familiar to most patients:

• Patients are greeted by a check-in staff member who verifies personal information and directs them to a waiting area.
• Shortly after, they are called into an exam room by a medical assistant who records their vital signs, documents their health history, and confirms the primary reason for the visit.
• The provider then conducts a focused, standardized examination, and following the consultation, patients visit the checkout desk to receive follow-up care instructions and/or schedule subsequent appointments as needed.

This model has historically functioned as the engine for the entire system. A single visit to a primary care provider could generate advanced imaging referrals, laboratory tests, and consultations with specialists, each step culminating in higher-margin services (e.g., office- or hospital-based procedures, infusions, or surgeries). For health systems reimbursed based on volume, this interdependent arrangement makes economic sense and solidifies primary care’s role as the gateway to a broad array of downstream services.

However, the traditional primary care model, built for volume and efficiency, often prioritizes throughput over personalization. Once prized for its ability to drive volumes and referrals, primary care faces pressure to modernize in response to employer and consumer demands and changing reimbursement structures.

Challenges of the traditional model

The traditional model often leaves patients feeling like just another number. Visits are typically limited to 10 minutes or less, and provider interactions rarely allow for the depth of conversation needed to understand and manage a person’s health.

Several factors are challenging the sustainability of this model:

• Access delays: Patients frequently face long wait times (averaging 29 days for new family medicine appointments), which drives them toward emergency and urgent care services.¹
• Limited preventive care: The emphasis on acute symptoms often sidelines proactive, preventive health measures.
• Declining financial viability of FFS: Reduced reimbursements, escalating labor costs, and shifting payer mix — especially as baby boomers transition to Medicare — are eroding the economic foundation of FFS-based practices.
• Overreliance on ancillary services: Health systems increasingly find that high-margin ancillary services, once critical to profitability, are increasingly unsustainable.

Consequently, independent practices face closures or acquisitions, and even major retail entrants such as Walmart² and Walgreens³ have struggled to sustain their healthcare operations under this model.

Moreover, the traditional model struggles to meet the growing demands of value-based care and alternative payment models. As reimbursement shifts toward rewarding outcomes and managing total cost of care, organizations with legacy volume-driven structures often can’t adapt. Investments once optimized for a volume-based practice model are at risk of becoming ineffective in a healthcare landscape that prioritizes quality and cost-efficiency.

Disruption through innovative models

Recognizing the growing limitations of the traditional primary care model, innovators across the country are reimagining how care is delivered. The CMS Innovation Center’s Transformation Initiative is one such national effort to prioritize patient-centered, preventive, and tailored approaches to care delivery.⁴

At the local level, Cleveland Clinic’s Clinical Access Team (CAT) exemplifies how integrated care models can improve patient and provider experiences. By combining multidisciplinary care teams with advanced scheduling systems, CAT ensures patients receive timely care while easing the administrative burdens of patient message response and clinical documentation for physicians. This reengineered support structure improves patient access, boosts caregiver morale, and helps avoid high-cost services, demonstrating how the FFS model can evolve to support coordination and quality alongside efficiency.⁵

Membership medicine models

Membership medicine — including concierge medicine,⁶ direct primary care (DPC),⁷ and advanced primary care — offers alternative approaches tailored to consumer needs while promoting financial sustainability.

Population- or condition-specific primary care

Beyond membership-based approaches, a growing number of primary care models are being designed around the specific needs of distinct populations. These tailored models are gaining traction as the limitations of one-size-fits-all approach may become increasingly apparent. Driven by consumer demands for personalization and relevance, this shift signals a future in which patients actively seek out providers and care models that reflect their unique health profiles and preferences.

Many of today’s emerging care platforms share characteristics of membership medicine, including the integration of advanced technologies and a strong emphasis on personalized, relationship-based care. The landscape for these segment-specific platforms is dynamic — programs frequently sunset while new ones appear in short order — spotlighting the sector’s responsiveness to evolving consumer demands. Below, we explore two rapidly growing, patient-centric models that are redefining primary care delivery.

Women’s health

Investment in women’s health has steadily increased over the past decade, spanning innovations in femtech, research engagement and practice models designed to address women’s unique health needs throughout their lives. These practice models create numerous opportunities for innovative care delivery, such as:

• Integrating well-woman exams into standard primary care visits
• Implementing advanced care models focused on managing symptoms related to menopause, incontinence, and other health issues
• Strengthening partnerships between primary and specialty care — particularly in areas with a high disease burden for women (e.g., heart disease/cardiology, behavioral health, weight management, geriatrics).

Given that women account for approximately half the population, are more frequent users of healthcare services, and often serve as the primary healthcare decision-makers for their families, improving primary care engagement offers substantial opportunity to drive better outcomes and system-wide value.

Geriatric care

From small, community-based practices to large, multistate organizations, an increasing number of primary care models cater to older Americans, particularly those enrolled in Medicare or Medicare Advantage (MA) plans. These models are structured to offer the necessary time, attention, and tailored support required to effectively address the complex needs of aging patients.

A key advantage of geriatric-focused care is the use of broad, multidisciplinary teams including clinical and nonclinical care coordinators, Medicare benefits specialists, mental health professionals, and wellness providers. These teams collaborate to provide holistic care, with a strong emphasis on preventive screenings and proactive health maintenance. The goal is to reduce or eliminate costly health interventions such as hospitalizations and ER visits before they escalate.

Key considerations for competitive adaptation

Consider the data

To remain competitive in the primary care space, healthcare leaders must understand two foundational elements: their practice’s individual strengths and opportunities and their local market trends. Use it to answer the following key questions:

• Where is the market headed, and what new provider models are emerging?
• What can local demographics reveal? For example, is the population aging or are young families expected to increase in the area?
• Are certain conditions projected to increase based on these demographic trends?
• What new care models are needed in your region? Are there any niche practice areas or desired clinical services not yet offered?

State demographic databases and local health department websites are valuable resources for identifying these population trends. The insights can help narrow your focus and develop a strategy. Keep in mind that the complexity of your patient base may require layering multiple care models to fully meet community needs. 

Align patient interests with your own

Once you’ve built a demographic fact base, evaluate it alongside your organization’s core competencies and interests. Identify specific patient populations, medical conditions, or care delivery models that resonate with your team or patient base. Research what others are offering and consider how to develop a program in response to these findings.

Consider payer trends

Despite uncertainty around new government programs, existing models like MA have seen strong growth — particularly among patients who are dually eligible for Medicaid and Medicare.⁸ To support value-based care, payers are increasingly turning to value-based enablers as partners for smaller primary care practices.⁹ Additionally, CMS initiatives — like its vision for all Medicare beneficiaries to be in accountable care arrangements by 203010 — will continue to influence practice development. Monitoring the prevailing payer trends and conducting a readiness assessment will help determine your organization’s ability to succeed under these alternative payment models. 

Charting a future-ready path for primary care

While the traditional primary care model remains significant in FFS environments, the landscape is shifting. Healthcare organizations must adapt to dynamic consumer expectations, payer incentives, and the increasing prominence of value-based care. Innovative models offer opportunities to improve access, satisfaction, and financial sustainability. The path forward isn’t binary; it’s about aligning care delivery models with changing market dynamics. Forward-looking organizations can test new models through pilot programs or strategic partnerships — integrating innovation without abandoning core strengths. In a time of disruption, adaptation isn’t surrendering the past. It’s investing in the future.

Notes:

1. Moody J, McMillen S, Petroff N, Berenbeym A. “The Waiting Game: New-Patient Appointment Access for US Physicians.” ECG Management Consultants. Available from: https://bit.ly/3SQ3RjZ .
2. “Walmart Health Is Closing.” Walmart. April 30, 2024. Available from: https://bit.ly/4jh2ndm .
3. Khemlani A. “Walgreens turnaround strategy, sale of VillageMD boosts 2025 Q1.” Yahoo! Finance. Jan.10, 2025. Available from: https://bit.ly/4jggIXt .
4. CMS. “The CMS Innovation Center’s Transformation Initiative At-a-Glance.” Available from: https://bit.ly/4mBbR6k .
5. ConsultQD. “Cleveland Clinic Launches New Primary Care Access Model in Florida.” The Cleveland Clinic. Jan. 22, 2025. Available from: https://bit.ly/4kFmqU5 .
6. Scott M, Muckerman A. “Looking at the Current Concierge Medicine Competitive Landscape.” ECG Management Consultants. April 13, 2022. Available from: https://bit.ly/3HOSwyk .
7. Muckerman A. “Health Systems Turn to Direct Primary Care in Response to Patient, Employer Demand.” ECG Management Consultants. April 30, 2025. Available from: https://bit.ly/43JhyaB .
8. Singhai S, Patel N, Jain A. “What to expect in US healthcare in 2025 and beyond.” McKinsey & Company. Jan. 10, 2025. Available from: https://bit.ly/4kdh0zO .
9. Althoff C, Barrigan L, Heineman K, Hougaard M, Lyons C, Pappas GC, Poku MK. “Looking Toward 2025: How Payers Will Evolve.” Healthcare Strategy Review, Vol. 1, Issue 3. Jan. 24, 2025. Available from: https://bit.ly/4mxCbhk .
10. Fowler L, Rawal P, Fogler S, Waldersen B, O’Connell M, Quinton J. “The CMS Innovation Center’s Strategy to Support Person-centered, Value-based Specialty Care.” CMS. Nov. 7, 2022. Available from: https://bit.ly/43gtPU1 .