Developing Primary Care Population-Based Payment Models in Medicaid: A Primer for States

Primary care is the backbone of a strong health care system. As such, state Medicaid programs are testing policies to strengthen primary care, including new payment approaches. Primary care population-based payment (PBP) models are upfront, prospective, value-based payment approaches that include provider accountability both for quality and cost of care. PBP models seek to move away from volume-based, fee-for-service payments and toward predictable “budgets” that support population health management, flexible service delivery, and financial stability for participating providers and the states implementing these models.

This primer explores six key design choices that state Medicaid programs need to make when developing or refining a PBP model and the implications of these choices, including impacts on health equity for patients and providers. The resource, developed by the Center for Health Care Strategies through support from The Commonwealth Fund and Arnold Ventures, draws from examples of existing state and federal primary care PBP models, models in the design phase, and other primary care models that may be translated for PBP model design.