In a world of MACRA alternative payment models, accountable care organizations, and Medicare Advantage plans, primary care physicians have the opportunity to embrace risk-based payment models and capitation. While capitation may rekindle ghosts from managed care in the 1990s for some doctors, its promise has also fueled a flurry of investments, acquisitions, and growth of risk-bearing primary care providers. A recent example is Optum’s proposed purchase of the DaVita Medical Group in December 2017 for $4.9 billion, which is undergoing regulatory review. The promise of financial rewards for risk-based models of care has also led to the growth of innovative primary care groups that are forgoing the fee-for-service (FFS) model.