ACOFP 2026 Health Policy
Advocacy Priority Number Five
Improve Outcomes and Reduce Costs Through Primary Care and Support for Family Physicians
The goal of any healthcare system is to improve the overall health of the patients it serves, and to achieve this goal, the importance of primary care must be recognized, and its greater use must promoted. Many studies show dramatic benefits in geographic areas that have higher primary care provider (PCP) use and higher ratios of PCPs per capita.[i]
A retrospective literature review by Dr. Barbara Starfield found that overall health is better in areas in the United States with more PCPs. Areas with higher ratios of PCPs per capita had better health outcomes, including lower rates of all-cause mortality, mortality from heart disease, cancer, and stroke, as well as infant mortality. In addition, areas with higher ratios of PCPs per capita had lower healthcare costs than other areas, possibly due to better preventive care and lower hospitalization rates. This contrasts with areas where there are higher numbers of specialists—characterized by more spending and worse health outcomes.[ii] ACOFP supports continuing to educate specialists about the vital role of PCPs in improving patient outcomes.
CMS provides reimbursement for several services, including transitional care management,[iii],[iv], chronic care management,[v],[vi] the Medicare Diabetes Prevention Program[vii],[viii] and advanced primary care management,[ix] to support the delivery of primary care, improve patient outcomes, and reduce costs. In addition, these programs provide physician payments for care coordination activities, which normally are not covered. Family physicians devote considerable time to ensuring patient care is efficiently and effectively coordinated among specialists and non-physicians. However, family physicians still face administrative challenges obtaining records and results when there are multiple physicians involved a patient’s care. The timely sharing of this information must be promoted or incentivized. These activities drive down costs for payers and hospital systems, while improving health outcomes for patients. With nearly half of primary care clinicians employed in health systems, attention should be paid to primary care payment methods in such settings.[x]
ACOFP supports CMS care models that emphasize the provision of primary care. Two such models, the Making Care Primary (MCP) Model and the Primary Care First Model, were concluded early on June 30, 2025 and December 31, 2025, respectively. However, the Accountable Care Organization (ACO) Primary Care (PC) Flex Model, launched on January 1, 2025, is currently operating and is expected to conclude on December 31, 2029. CMS is also launching a new model on July 5, 2026, the ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model, which provides a new co-management payment to primary care physicians for documented care review and coordination activities. Another Medicare value-based model (MAHA ELEVATE), launching September 1, 2026, is intended to support evidence-based, whole-person care approaches, including functional or lifestyle medicine interventions. However, the participation of solo, small, and rural physician practices may be limited because of the resources necessary to implement these types of models. The agency therefore must provide these physician practices with the resources necessary to participate in these models.
More needs to be done to support family physicians who have upgraded their EHR systems in compliance with federal programs, including QPP, at great expense. Implementing EHR software is both incredibly time consuming and costly. Many small, rural, and solo practices are unable to change their EHR system as rules shift annually, so policymakers should consider whether any new EHR requirements will require additional information technology (IT) systems investments. It is essential that federal policymakers do not implement policies that require physicians to invest additional funds in EHR updates, management, and repairs without adequate financial and technical support.
The Commonwealth Fund’s Task Force on Payment and Delivery System Reform recently emphasized that the United States will only achieve its goals to create a healthier population with more consistent access to primary care and a more equitable distribution of health care through changes in how and how much primary care is paid. Thus, focusing on primary care physician payment is a critical issue for the future of health care that must be addressed.[xi],[xii]
An important aspect of primary care also includes the administration of vaccines. Vaccines have been proven to be safe and effective and are critical to protect patients from life-threatening illnesses and diseases. Family physicians utilize vaccines in their practices to ensure their patients receive the highest level of care. We oppose efforts to limit access to vaccines. Instead, Congress and the Administration should take steps to ensure vaccines are accessible to all patients. According to the CDC, “…vaccines are the safest, most effective way to protect yourself and your family from many preventable diseases.”[xiii] Studies have also indicated that vaccines are considered “one of the most important advances in modern medicine and have greatly improved quality of life” because they have reduced or eliminated many serious infectious diseases.[xiv] High uptake of vaccines is critical to gaining herd immunity to protect vulnerable individuals and to public health. Many vaccine preventable diseases have no medication treatments because they have been so successful in prevention.
Moreover, recommendations regarding vaccines must be scientifically based. On January 5, 2026, the Trump Administration made dramatic changes in the childhood vaccine schedule. ACOFP strongly believes that any changes to vaccine recommendations in the United States must be based on scientific evidence to ensure that children continue to receive vaccines that have been proven to be safe, effective, and necessary to protect their health and wellbeing.
ACOFP is concerned that limiting access to vaccines could result in recurrences of infectious diseases that have been reduced or eliminated as a result of a vaccine. Congress and the Administration should not advance policies that could reduce access to vaccines.
ACOFP also supports measures to increase payments for vaccine reimbursement, as well as resources and regulatory flexibilities for providers administering vaccines—especially due to the costs associated with maintaining COVID-19 vaccines.
In addition, OMT, a clinically appropriate pain management treatment that can help reduce the need for addictive medications, is a valuable tool that can be used to provide holistic care and treatment to all patients. This underutilized service improves health outcomes and must be protected and made more available to patients. However, the CY 2026 PFS final rule imposes an efficiency adjustment on non-time-based services, including OMT services, resulting in a 2.5 percent reduction in work RVUs for OMT services, with additional cuts proposed every three years. ACOFP is concerned that this reduction in payment for OMT services will lead to even greater underutilization of these services.
Advocacy Positions:
- Support primary care models that empower and reward PCPs who focus on preventing chronic illness, managing patients, and appropriately using specialists.
- Educate specialists on the role of PCPs in coordinating care to ensure the patient is receiving high-quality care.
- Support reimbursement policies that reward care provided by family physicians who provide high-quality and improved patient outcomes.
- Ensure physicians are incentivized to perform care coordination activities, which are essential for improved outcomes and reduced healthcare costs.
- Ensure the timely sharing of patient information from specialists to family physicians.
- Recognize the significance of vaccination in primary care and their importance in ensuring patients receive the highest level of care from family physicians.
- Support access to vaccines as current evidence supports vaccine safety and efficacy.
- Prove appropriate reimbursement to family physicians through Medicare Part B for the administration of medically necessary vaccines (beyond influenza, pneumococcal, and the hepatitis B virus [HBV]) to reduce COVID-19 and maintain appropriate care coordination.
- Recognize the clinical value and cost savings from physician-led care coordination and establish appropriate reimbursement policies for such activities.
- Address the compensation and reimbursement imbalance across settings of care, including rural practices, across state lines, and between primary care and specialty care, to encourage high-quality care.
- Ensure that primary care practices have the resources to obtain and deploy the most up-to-date technology that assists with improving quality and reducing costs.
- Consider how new federal health program policies will affect EHR systems and provide support to physicians for any new policy that requires changes to existing EHRs.
- Support measures to increase payments for vaccine reimbursement, as well as resources and regulatory flexibilities for providers administering vaccines.
- Protect reimbursement for OMT and encourage OMT to be utilized as a tool to improve patient care.
[i] Shi L. The impact of primary care: a focused review. Scientifica (Cairo). 2012;2012:432892. doi:10.6064/2012/432892
[ii] Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457–502. doi:10.1111/j.1468-0009.2005.00409.x
[iii] Centers for Medicare & Medicaid Services. Care Management. Updated January 5, 2023. Accessed January 12, 2023. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Care-Management
[iv] Centers for Medicare & Medicaid Services. Medicare Learning Network. Transitional Care Management Services. 2022. Accessed January 11, 2023. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Transitional-Care-Management-Services-Fact-Sheet-ICN908628.pdf
[v] Centers for Medicare & Medicaid Services. Care Management. Updated January 5, 2023. Accessed January 12, 2023. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Care-Management
[vi] Centers for Medicare & Medicaid Services. Medicare Learning Network. Chronic Care Management Services. 2022. Accessed January 11, 2023. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagement.pdf
[vii] Centers for Medicare & Medicaid Services. Medicare Diabetes Prevention Program (MDPP) Expanded Model. Updated January 5, 2023. Accessed January 11, 2023. https://innovation.cms.gov/innovation-models/medicare-diabetes-prevention-program
[viii] Centers for Medicare & Medicaid Services. Medicare Diabetes Prevention Program (MDPP) Expanded Model Fact Sheet. Accessed January 11, 2023. https://innovation.cms.gov/files/x/mdpp_overview_fact_sheet.pdf
[ix] Centers for Medicare & Medicaid Services. Advanced Primary Care Management Services. Accessed January 24, 2025. https://www.cms.gov/medicare/payment/fee-schedules/physician-fee-schedule/advanced-primary-care-management-services
[x] National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Committee on Implementing High-Quality Primary Care. Robinson SK, Meisnere M, Phillips RL Jr, McCauley L, eds. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. National Academies Press; 2021. doi:10.17226/25983
[xi] Commonwealth Fund Task Force on Payment and Delivery System Reform. Health care delivery system reform: Six policy imperatives. 2020. Accessed January 11, 2023. https://www.commonwealthfund.org/publications/fund-reports/2020/nov/commonwealth-fund-task-force-payment-and-delivery-system-reform
[xii] Hill L, Artiga S. COVID-19 cases and deaths by race/ethnicity: Current data and changes over time. Kaiser Family Foundation, August 22, 2022. Accessed January 20, 2023. https://www.kff.org/racial-equity-and-health-policy/issue-brief/covid-19-cases-and-deaths-by-race-ethnicity-current-data-and-changes-over-time/
[xiii] Centers for Disease Control and Prevention, Explaining How Vaccines Work. August 10, 2024. Accessed January 9, 2025. https://www.cdc.gov/vaccines/basics/explaining-how-vaccines-work.html
[xiv] Amanna, I. J., & Slifka, M. K. (2020). Successful Vaccines. Current topics in microbiology and immunology, 428, 1–30. https://doi.org/10.1007/82_2018_102