Health care providers — already in a state of uncertainty, due to a titanic congressional battle over the Affordable Care Act — are under a potentially damaging strain to primary care, crucial to the overall well-being of the country.

There’s of course the ACA repeal-and-replace drama in Washington unsettling many about how care will be delivered, and to whom.

But closer to home, island pediatricians worry whether a new payment structure now established by the Hawaii Medical Service Association (HMSA) will sustain good medical practice.

The doctors in the network for HMSA, Hawaii’s largest health insurance carrier, have been transitioning to the new payment scheme under a program called Mahie 2020.

The payment aspect is only part of the vision that HMSA describes as “a sustainable community system that advances the health and well-being goals of consumers, providers, employers, communities and government.” The current system is too fragmented, according to HMSA descriptions of the plan, to deliver on the goal to “maximize value to members, providers and employers.”

HMSA breaks this down further. The aims are to “improve member experience and quality of care … allow doctors to practice medicine the way they think it should be practiced, and … build a new value-based sustainable model of care.”

The outlines of the plan are attractive. This is meant to be more patient-centered — payments generally allotted for each patient’s overall care, not for each visit or interaction for which a fee could be charged.

A move away from the “fee-for-service” model has been long touted as the best way to contain costs and to make better patient outcomes the target.

Nobody can argue with the goals. Some of the pediatricians, however, are worried that the blueprint, as currently set up, can’t deliver on its promises.

On July 1, HMSA pediatricians became the last primary-care category of physicians to be enrolled in the new payment system. As described in a story by Honolulu Star-Advertiser reporter Kristen Consillio, the payment model is intended to give doctors more time in the office with sicker patients, also allowing them to tend to others through alternative contacts such as email, phone and text messages.

For pediatricians, though, the reality of early-childhood care often demands a more personal touch — and more frequently than is now recommended.

The upside for the doctors is that the new model can enable higher enrollment levels, which by itself does increase revenue. In fact, 96 percent of pediatricians who are part of a physicians organization have agreed to accept the mode.

But several who spoke to Consillio said that it’s difficult, if not impossible, for a pediatrician to forego some of the labor- and time-intensive practices needed to ensure proper care.

Especially during the first year, well-baby visits to the doctor are crucial to identifying potential problems that could loom large if not treated. There are immunizations, interventions for illnesses that are not ultimately serious but leave new parents needing a doctor’s support.

Pediatricians in particular shoulder the duty of attending to not only the patients themselves, but for their immediate circle of caregivers. They are educators as well as clinicians.

Dr. Galen Chock, a Honolulu pediatrician, estimated that a doctor will see each infant about 11 times the first year. He calculated that the new payment system would reimburse the doctor about $300 in the first year for a newborn, compared with about $1,000 under the fee-for-service model.

If that estimate is remotely typical, it represents a drastic, unacceptable cut in pay.

It is too early to say with certainty that pediatricians won’t be able to adapt to the system, but there are some physicians — 40-year veteran Dr. Jeremy Lam was one whom Consillio met — who are opting out. Lam decided to retire earlier than he intended.

As health care transitions to this system, primary-care physicians occupy a foundational position. The network of health providers can’t afford too much attrition.

So it falls to HMSA, in this case, to monitor the impact of this reform on the doctors and, ultimately, their patients, and to make adjustments accordingly.

That’s especially critical in this chaotic period of health policy reform.

In the early days following the 2016 election of President Donald Trump, the ACA overhaul seemed imminent. Michael Stollar, HMSA president and chief operating officer, was among the many with an eye on D.C.

The assumption already was circulating that Medicaid revenues would take a hit, and that many could lose coverage, putting health care institutions under duress, Stollar said in an interview with West Hawaii Today.

He is right. With that cloud of uncertainty hovering, executives must redouble efforts to protect the integrity of a system that, in turn, protects the community’s health.