HJAR Mar/Apr 2026

HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2026 19 health, and preventing avoidable deterioration long before it requires expensive downstream intervention. Measurement would move beyond crude process metrics and utilization counts toward tracking functional status, disease progression, complication rates, and sustained improvements in health over time. In such a system, technology would not exist to maximize billing efficiency, but to surface risk early, guide proactive outreach, and support teams in keeping populations healthy rather than simply documenting how sick they have become. Most importantly, a health-producing system would change what success looks like financially. Providers and health systems would win not by doing more, but by achieving better outcomes with fewer resources. Hospitals would succeed by keeping beds empty, not full. Specialists would be rewarded for preventing complications, not for fixing them after the fact. And innovation would be aimed at reducing the need for high-cost care altogether, rather than making it more efficient to deliver ever-increasing volumes of it. This is not theoretical — it already exists in pockets where organizations bear real accountability for the total cost of care. But until these models move from the margins to the mainstream, healthcare will continue to behave exactly as it is currently designed to behave. You don’t bend the cost curve by changing who holds the money; you bend it by changing what the system is built to do. If a health-producing system is the goal, then advanced primary care must be its foundation — but only if it is financed in a fundamentally different way. The current fee-for-service model treats primary care as a low-margin, high- throughput entry point into the rest of the system, rewarding short visits, reactive care, and endless documentation while penalizing prevention, coordination, and longitudinal management. In that environment, primary care cannot function as the organizing engine of health; it is structurally constrained from doing so. Advanced primary care requires prospective, population-based financing that gives primary care teams the time, resources, and flexibility to manage risk, intervene early, and address the upstream drivers of disease. Without that financial reset, calls to “strengthen primary care” amount to little more than asking clinicians to do more with less inside a system designed for volume, not value. That same economic reality applies to how primary care physicians are compensated. You cannot ask physicians to take accountability for population health while paying them as if their only job is to generate visits and relative value units. In a health-producing system, primary care clinicians must be paid to think, plan, coordinate, and prevent — not just to document and bill. Compensation should reward outcomes such as reduced hospitalizations, better chronic disease control, improved functional status, and sustained patient engagement over time. When primary care is properly financed and clinicians are compensated for keeping people well, the entire delivery system begins to reorganize around prevention rather than rescue. Advanced primary care is not a boutique add-on or a luxury model; it is the necessary economic reconfiguration required to move healthcare from a system that profits from sickness to one that produces health. An advanced primary care model is not built around a single heroic physician; it is built around a deliberately constructed team with complementary skills. At its core is the primary care physician, supported by advanced practice clinicians, pharmacists, nurses, care managers, behavioral health specialists, and, increasingly, data and analytics support. Each member of the team practices at the top of their license, allowing routine care, medication optimization, chronic disease management, and patient outreach to occur continuously rather than episodically. This structure undeniably costs more than a traditional visit- based primary care practice — but it also does far more. It reduces unnecessary specialty referrals, prevents avoidable emergency visits and hospitalizations, improves chronic disease control, and catches deterioration earlier, when it is cheaper and easier to address. The mistake is to view these additional team members as expenses rather than as productive capacity in a system whose primary output is health. For this model to work at scale, financing must be both sufficient and flexible. Primary care teams need prospective, population- based payments that cover the real cost of team-based care while creating the opportunity to generate margin through better outcomes and lower downstream utilization. Just as importantly, the payment model must allow “The current fee-for-service model treats primary care as a low-margin, high-throughput entry point into the rest of the system, rewarding short visits, reactive care, and endless documentation while penalizing prevention, coordination, and longitudinal management. [...] Advanced primary care requires prospective, population-based financing that gives primary care teams the time, resources, and flexibility to manage risk, intervene early, and address the upstreamdrivers of disease.”