Payment Reform Readiness is No Longer Optional

For years, many primary care practices have been able to treat payment reform as something happening somewhere else far away. That is getting harder to do. Today, value-based care is showing up more clearly in federal models and state strategy, and this evolution is likely to shape how physician practices operate for the next several years or longer. That does not mean every practice needs to jump into downside risk tomorrow. It does mean practices should be getting ready now. The groups that prepare early will be in a much better position to benefit from new funding opportunities, stronger contracts, and more control over care models. Groups that delay may find themselves reacting to a care model already in place.

A good example is the AHEAD model. In plain English, AHEAD is a voluntary state total-cost-of-care model from CMS that is meant to drive multi-payer alignment, strengthen primary care, and improve population health while lowering costs. Vermont is now listed by CMS as an AHEAD participant in cohort two. CMS also says AHEAD includes a primary care track, PC AHEAD, under which participating practices can receive prospective, risk-adjusted enhanced primary care payments, with quality adjustments and four payment pathway options, including pathways that replace part or all of certain Medicare fee-for-service primary care payments. In AHEAD, primary care is not being treated as secondary—it is being treated as core infrastructure. [i]

Payment reform readiness is about much more than whether a practice is willing to take financial risk. It is about whether the practice understands where its revenue is heading, whether its operations match what newer payment models expect, whether it can manage access and follow-up well, and whether leadership is organized enough to respond when an opportunity appears.

Another reason to prepare now is the amount of rural health funding set to move through the system. [ii] CMS says the Rural Health Transformation Program will allocate $50 billion over five fiscal years, with $10 billion available each year from 2026 through 2030, and CMS has announced awards in all 50 states. For Vermont specifically, CMS’s state spotlight lists $195 million in FY26 funding. The same CMS summary says Vermont’s plan includes stronger rural networks, shared technology infrastructure, telehealth and remote monitoring, AI-powered medical scribes, referral tracking, workforce support, and a per-member-per-month payment for practices that meet access requirements. [iii]

For physicians, preparation is important because anyone that has participated in these programs knows, new dollars do not just arrive in the mail as a simple check. They come via new expectations, new partnerships, meeting access standards, growing infrastructure, or payment models that reward practices ready to participate. Any practice would be in a much better position if it already understands its contracts, workflows, staffing pressures, reporting capacity, and operational weak spots before these opportunities arrive.

Beyond AHEAD and rural transformation funding, the larger Medicare value-based landscape is still moving in the same direction. CMS says there will be 511 ACOs in the Medicare Shared Savings Program for 2026, up from 476 in 2025, and that 82.8% of Shared Savings Program ACOs in 2026 are in tracks that qualify as Advanced APMs. [iv] CMS is also continuing to test primary-care-focused payment approaches. One example is ACO PC Flex, which began on January 1, 2025, and runs through December 31, 2029. CMS says participating low-revenue ACOs receive a one-time Advanced Shared Savings Payment and monthly prospective primary care payments designed to make primary care revenue more predictable and less tied to visit volume.

So, what should primary care practices be doing now to get ready? 

First, meticulously understand your practice’s current position. Which contracts already carry value-based expectations? Where is your practice operationally exposed? Where are you missing opportunity? That assessment is rarely straightforward, because the real answers sit at the intersection of contracting, payer strategy, operational capacity, financial performance, and the day-to-day realities of running a practice—exactly the kind of complexity Mansfield is built to help untangle.

Second, you should strengthen the capabilities that are most likely to matter over the next few years. Those are access management, care coordination, follow-up workflows, data use, contracting, and practical financial planning. Because these capabilities are deeply interconnected, strengthening them requires a thoughtful, practice-specific approach that accounts for operations, staffing, contracts, reimbursement, and the broader direction of the market—exactly the kind of work Mansfield is designed to support.  

Third, make sure someone is diligently tracking what CMS, the State of Vermont, the Agency of Human Services, the Department of Vermont Health Access, commercial payers, and ACO partners are building next. Payment reform does not pause while practices are busy. These developments emerge across multiple agencies, payers, and partners at once. Tracking them effectively requires sustained attention and an experienced understanding of how policy direction turns into operational and financial consequences—exactly the kind of oversight Mansfield is built to provide.

In a moment like this, readiness is not about chasing every new model. It is about being organized enough to choose the right ones, on the right timeline, for the right reasons. Mansfield Primary Care Support can help practices understand what matters, prepare before they are forced to react, and make smart practical decisions about contracts, operations, funding opportunities, and partnerships.

[I] https://www.cms.gov/priorities/innovation/innovation-models/ahead

[ii] https://www.cms.gov/priorities/rural-health-transformation-rht-program/overview

[iii] https://www.cms.gov/files/document/rural-health-transformation-50-state-spotlights.pdf

[iv] https://www.cms.gov/newsroom/fact-sheets/2026-medicare-accountable-care-organization-initiatives-participation-highlights