When medical groups and health systems look for ways to make primary care sustainable in an era of razor-thin or nonexistent margins, there’s often a defensive posture over being accused of just trying to “cut pay.”

Confronted by CMS fee schedule shifts that spiked work RVUs for the same visits and warped legacy pay plans, leaders at Conway Regional Health System in Arkansas rebuilt compensation for 23 advanced practice providers (APPs) around a single production model with clear quality incentives — and they did it without losing a single clinician.

“We really had not made that move from fee-for-service to value-based care, and we're still, today, not completely in that space, but we knew we needed to start taking steps to do that,” said Rebekah Fincher, chief administrative officer for Conway, during her presentation at the 2025 MGMA Leaders Conference.