Portland is planning ways to handle normal life as COVID-19 becomes top priority, and the Portland healthcare community will likely use its strengths—existing partnerships and a public safety net—to keep future transmission rates low. The challenges of higher unemployment and reduced tax revenues bring financial pressures only partially helped by federal aid packages. The shift to value-based contracting will be reconfigured in the COVID-19 age, while providers will be reluctant to take on more risk-based payments. Health systems are losing revenues from elective procedures and physician offices are losing patient volume, squeezing incomes and revenues. Medicaid enrollment will grow in the market as more people qualify, putting further pressure on the state budget. The state must establish a balance with providers who will be reluctant to participate in Medicaid since value-based payments rely on planning and predictions—luxuries providers do not have in this environment. The fallout from COVID-19 will bring major change to healthcare payment reform.