With the announcement of the Family Health Organization Plus (FHO+) model in Ontario, many family physicians, both new and established, are seeking clarity on how it compares to existing primary care physician enrollment models (PEMs). Whether you’re deciding how to structure your new practice or considering a transition, understanding these models is key to choosing the right fit for your practice style, income goals, and patient care approach.
In this blog post, we compare the major PEMs available in Ontario: Fee-for-Service (FFS), Comprehensive Care Model (CCM), Family Health Group (FHG), Family Health Network (FHN), and the new FHO+ model, to help you understand how each one works and what’s changing under the latest 2024–28 Physician Services Agreement (PSA).
What Are the Different Physician Payment Models Available for Ontario Family Doctors?
Ontario’s physician enrollment models vary from pure service-based billing to fully rostered, capitation-focused structures:
- FFS: A fully volume-based model where physicians bill OHIP per service.
- CCM/FHG: Blended models offering FFS compensation with roster-based incentives.
- FHN/FHO+: Capitation-based models with added bonuses, shadow billing, and shared after-hours coverage.
All roster-based models (CCM, FHG, FHN, FHO+) use enrollment forms and Q-codes to attach patients and access model-specific payments.
A Closer Look at Each Physician Enrollment Model
1. Fee-for-Service (FFS)
Under FFS, physicians are paid for each service they provide, based on OHIP Schedule of Benefits codes.
Compensation structure: 100% of the OHIP fee code for each service or procedure, with no roster or capitation component.
Highlights:
- Physicians bill OHIP directly for each service
- No patient roster or continuity obligations
- Most flexible model with minimal administrative requirements
- Income depends directly on the visit volume
- Requires accurate billing to avoid missed revenue.
Best suited for: Physicians who prefer independence, often working in urban, walk-in, part-time, or mixed-practice environments.
2. Comprehensive Care Model (CCM)
CCM is a blended FFS model for solo physicians that adds capitation payments and enhanced fees for enrolled patients on top of traditional FFS billing.
Compensation structure: Fee-for-service billing + Comprehensive care capitation payments + Preventive care incentives
Highlights:
- A hybrid model that blends fee-for-service with capitation
- Includes preventive care bonuses tied to core services
- Offers some income stability through base capitation for rostered patients
- No mandatory after-hours coverage
- Simpler than group-based models like FHO or FHN, but with limited access to team-based incentives
- Participation has declined in recent years as more physicians move toward FHG or FHO models
Best suited for: Solo family physicians or small practices offering ongoing patient care without joining a larger group.
3. Family Health Group (FHG)
FHG is a group-based model that blends FFS billing with additional incentives for rostered care, preventive services, and shared after-hours coverage.
Compensation structure: Fee-for-service billing + 10-20% FHG Premium + Comprehensive care capitation payments + Preventive care bonuses + Attachment incentives
Highlights:
- Minimum three-physician group structure.
- Physicians bill FFS primarily with added roster-based premiums
- Additional comprehensive care payments for rostered patients
- Eligible for preventive care bonuses (e.g., cancer screening, vaccinations)
- After-hours access requirements are tied to the number of physicians in the group
- Lower administrative burden than capitation-driven models
Best suited for: Physicians who prefer FFS billing but want added stability and shared after-hours responsibilities within a group setting.
Important update: Under the 2025 PSA arbitration award, the FHG premium increases from 10% to 15% in 2026 and 20% in 2027.
4. Family Health Network (FHN)
FHN is a legacy capitation-based model that emphasizes longitudinal care and continuity, offering stable monthly income, shadow-billing incentives, and acuity-based payments for complex patient panels.
Compensation Structure:
Base capitation payments + Comprehensive Care capitation + Shadow billing + Special premiums and bonuses + Attachment incentives
Highlights:
- Minimum of three physicians per group
- Monthly capitation payments for rostered patients providing stable baseline income
- Includes the acuity modifier, rewarding complex care
- Shadow billing supplements capitation and reflects service activity.
- Eligible for all the special premiums and bonuses categories
- Strong focus on access and after-hours care
- Higher administrative expectations (roster management, reporting, after-hours scheduling)
Best suited for: Physicians looking for a predictable income and strong support for continuity in a structured group setting.
Important update: The Ministry of Health is no longer establishing new Family Health Networks (FHNs), shifting its focus to other primary care models. This change is part of the province’s primary care strategy, which emphasizes team-based care models over expanding the FHN model.
5. Family Health Organization Plus (FHO+)
FHO+ represents an important advancement in Ontario’s primary care compensation. It builds on the FHO model and introduces modernized payments that better recognize the full scope of family physicians’ work, including both direct and indirect care.
Compensation Structure:
Base capitation payments + Hourly time-based payments ($80/hour) + Enhanced 30% shadow billing + Special premiums and bonuses + Attachment incentives
Highlights:
- Hourly Time-Based Payments: $80/hour for direct care, indirect care, telephone care, and clinical administration (billed in 15-minute increments).
- Higher Shadow Billing: Most in-basket services paid at 30% of FFS; select procedures at 50%.
- Enhanced After-Hours Premium: Increased from 30% to 50%.
- Expanded Rostering Incentives: Higher attachment bonuses and new Q-codes for maternity and newborn care.
- Proposed Changes to Accountability: Introduction of a 75% continuity of care requirement on in-basket services, replacing mechanisms such as the access bonus and negation.
- Updated Formation Rules: Minimum group size reduced to 2 physicians per location; co-location rules simplified; and 240 new FHO entry spots available annually.
Best suited for: Physicians providing full-scope family medicine who value stable, diversified income and compensation for both clinical and indirect work.
Ontario Primary Care Models Comparison
Model | Payment type | Incentives | Patient enrollment | Income predictability | Admin load | Best for |
FFS | 100% OHIP fee-for-service | Minimal | No | Low | Low | Walk-in or episodic care |
CCM | Partial capitation + FFS | Preventive care | Yes | Medium | Moderate | Solo comprehensive care |
FHG | FFS + 10–20% premium + partial capitation | Preventive + after-hours | Yes | Medium | Low–Moderate | High-volume group practices |
FHN | Capitation + shadow billing + bonuses | Acuity + after-hours | Yes | High | Higher | Longitudinal comprehensive care |
FHO+ | Capitation + shadow billing + hourly pay + bonuses | Acuity + attachment + after-hours | Yes | Very High | Moderate | Comprehensive, team-based care |
Choosing the Right Physician Enrollment Model for Your Practice
Many factors determine the best model for a physician, including your preferred style of patient care, administrative capacity, and revenue goals.
However, for most physicians delivering full-scope family medicine, FHO+ is expected to become the most sustainable and comprehensive option, particularly with its recognition of indirect work and the elimination of administrative penalties such as negation and access-bonus tracking.
How DoctorCare Supports You Across All Models
DoctorCare works with thousands of Ontario physicians to help optimize billing and maximize revenue under every model. Whether you work in FFS, CCM, FHG, FHN, or FHO, we help physicians:
- Optimize billing and minimize errors: Ensure every eligible fee code and incentive is captured correctly while reducing billing errors and missed revenue.
- Manage rosters and patient attachment: Reconcile roster discrepancies and streamline patient enrollment processes, enhancing preventive care performance.
- Navigate payment model transitions: Support physicians through transitions between payment enrollment models.
- Prepare for FHO+: Set up workflows for time-based billing, track indirect care accurately, and maximize new attachment bonuses.
- Administer FHO Groups: Provide end-to-end support for forming, operating, and optimizing FHO groups, including governance, onboarding, compliance, and performance monitoring.
With experience forming over 58+ FHOs, adding 200+ physicians to groups, and managing over 100 active FHO practices, DoctorCare is uniquely equipped to help you navigate these changes.
If you need help evaluating your current model or preparing for FHO+, contact DoctorCare today. We’re here to support your practice every step of the way.
References and Additional Resources
- Ontario Medical Association and Ontario Ministry of Health. Physician Services Agreement (2024–28) Arbitration Award, September 2025.
- Ontario Medical Association and Ontario Ministry of Health. FHO+ Model – Proposal Summary, July 2025.
- Ontario Medical Association. Primary Care Models. https://www.oma.org/practice-professional-support/starting-your-practice/primary-care-models/
- Health Force Ontario. Family Medicine Compensation and Practice Models in Ontario. https://www.healthforceontario.ca/en/Home/All_Programs/Practice_Ontario/Resources
- DoctorCare blog. A Closer Look at OMA’s 2024-2028 PSA Proposal and It’s Impact on Ontario Physicians.
- DoctorCare blog. Understanding the Proposed FHO+ Model: What Ontario Family Physicians Need to Know.
