The rapid spread of COVID-19 is threatening health systems and physicians in the Raleigh market with new financial challenges that will impact growth strategies in the near term. Although the market’s largest health systems have not announced layoffs, efforts to reduce costs, such as delaying construction projects, are underway. Physicians in Raleigh are reducing hours due to the decline in patient visits caused by the COVID-19 pandemic but are expanding the use of telemedicine to maintain operations and access to care. Blue Cross and Blue Shield of North Carolina is working with UNC Health Alliance to advance performance bonuses to primary-care practices as part of the Blue Premier program to help practices facing financial struggles. As the market grapples with COVID-19, look for payers and providers to temporarily decelerate value-based care transformation.