Establishing and sustaining patient-centered medical homes will require new investments in primary care. The Payment Reform Task Force of the Patient-Centered Primary Care Collaborative consensus statement recommends a blend of different payment strategies for the majority of patients in a practice along with risk adjustment. It also recommends shifting focus to value, ensuring that the working environment for primary care is improved, optimizing administrative practicality and relying on pilots with systematic evaluation and review to evolve the best strategy.