The authors provide a five-point framework based on value for patients to improve primary care:
1. Primary care should be organized around subgroups of patients with similar needs.
2. Team-based services should be provided to each patient subgroup over its full care cycle.
3. Each patient’s outcomes and true costs should be measured by subgroup as a routine part of care.
4. Payment should be modified to bundle reimbursement for each subgroup and reward value improvement.
5. Primary care patient subgroup teams should be integrated with relevant specialty providers.
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