“How do we thread the needle to achieve both access and affordability?” Experts discuss primary care at LOWN26

The recording below is from a panel at LOWN26: Confronting Healthcare Affordability. All panel recordings are available on Youtube.

Study after study confirms that robust primary care is the foundation of an affordable health system. Yet American medicine has systematically left it undervalued and underfunded leaving many clinicians burnt out or pushed to choose other medical specialities. This begs a harder question: What if working within the system is itself the problem? 

To find out what it will actually take for primary care to become the backbone of a more affordable system, watch the video recording above and review some key insights from the panelists below:

• Reshma Ramachandran, MD, Assistant Professor, Yale; Co-director, Yale Collaboration for Regulatory Rigor, Integrity, and Transparency; 2025 BLASR winner (Moderator)
• Michael L. Barnett, MD, Professor of Health Services Policy & Practice, Brown University School of Public Health
• Paul Carlan, MD, President, Valley Medical Group
• Zirui Song, MD, Associate Professor of Health Care Policy and Medicine, Harvard Medical School
• Kenneth Qiu, MD, Founder, EuDoc Direct Primary Care

Alternative models for primary care 

Every primary care provider can talk about the problems they face: Primary care is underfunded relative to specialty care, the administrative burden is too high, and they often don’t get enough time with patients. Panelists proposed alternative models of care to address these issues, some that work within the current system, and some outside of it.

Dr. Kenneth Qiu’s practice, EuDoc Direct Primary Care in Midlothian, VA, is one of many practices seeking to flip the script. By utilizing a monthly subscription model, patients pay a flat fee regardless of insurance status, leaving price negotiations and on-site dispensing entirely up to the practice. This approach—widely known as direct primary care—is grounded in the idea that by bypassing insurance overhead and reserving traditional coverage for catastrophic care like hospitalizations, primary care becomes significantly more accessible. Removing insurance from the equation allows Qiu’s practice to negotiate prices with labs, use on-site dispensing for medications, and take on other cost-cutting measures that benefit both their practice and patients. 

“Direct primary care is like Ozempic to the healthcare system.”

Dr. Kenneth Qiu, EuDoc Direct Primary Care

Inspired by the battle between issues of affordability and access, Dr. Zirui Song and colleagues propose a primary care “common fund,” which would gather funding from multiple payers and purchasers, redistributing these funds to primary care providers directly. This approach would reduce the physician burden that comes from dealing with multiple payers while not impacting the rest of the healthcare delivery system, and giving states the option of using alternative payment models for primary care if they choose. Policymakers in Massachusetts and California are considering similar models, Song said.

“How do we thread the needle to achieve both access and affordability?”

Dr. Zirui Song, Harvard Medical School

Amplifying physician voices

Novel and innovative primary care models are just one side of the coin when it comes to reimagining primary care in the U.S. healthcare system. Dr. Paul Carlan, President of Massachusetts-based Valley Medical Group, spoke of their 2025 decision to withdraw from their years-long affiliation with hospital-aligned physician organizations, joining independent physician association (IPA) Arches instead. 

The decision to switch to an IPA was largely driven by the misalignment between hospital and primary care incentives and a desire to drive change in primary care. “Ownership structure really matters,” said Carlan, “I think that the people who are making decisions are members of the community. They live and work with the patients we take care of. We see them at the dump on Saturdays when we take our trash, or drop our kids off at school.”

“When you remove physicians from the line of sight on the cost of care, they can’t help solve the problem.”

Dr. Paul Carlan, Valley Medical Group

Being independent enables the 400 staff members, 100 of whom are physicians, to manage their own contracts with insurers. This allows them to retain the value their providers create, rather than seeing that revenue diverted to specialists and hospitals. 

Another way primary care physicians are advocating for the best interests of their patients is through unionization. Dr. Michael Barnett, a practicing physician at Boston’s Brigham and Women’s Hospital, shared that he and nearly 90% of his primary care colleagues voted to unionize this past year. The large amount of support behind Mass General Brigham (MGB) Primary Care Physicians Union was a result of the desire to hold their employers accountable and ensure that both physician and patient voices are taken into account in the system’s decision making processes.

While many health systems have been slashing benefits and suspending population health programs, unionizing gives MGB physicians an opportunity to push back against these trends, Barnett observed. By giving physicians a seat at the table, they can weigh in on matters that impact their work, while simultaneously advocating for policies that improve the quality of primary care delivered to the community. Strategies such as collaboration councils on frontline-driven improvement and leadership development are just some of the ways that MGB Primary Care Physicians Union is working to retain and advance primary care’s value in the broader healthcare landscape.

“Our job is to improve population health. We don’t tell any other specialty ‘You only get money if you save us money.’”

Dr. Michael Barnett, Brown University School of Public Health

Ultimately, the insights from LOWN26 make one thing clear: The status quo doesn’t work for patients, physicians, or the system writ large. Whether it’s working within the system or outside of it, these new organizational and payment models provide promise for better access to affordable primary care.