Getting Started with Primary Care Population-Based Payment: Four Decision Points for State Medicaid Programs

CHCS December 13, 2023
Anne Smithey, Kelsey Brykman, and Shilpa Patel, Center for Health Care Strategies

Payers across the country are launching population-based payment (PBP) models. This upfront, prospective, value-based payment (VBP) approach pays providers based on the number of patients served, as opposed to the number of services performed, and includes provider accountability measures for quality and cost of care. PBP models have the potential to improve health outcomes and promote health equity by incentivizing providers to keep patients well and giving providers greater flexibility in how they deliver services. The Centers for Medicare & Medicaid Services (CMS) Innovation Center and state Medicaid programs have been especially interested in primary care PBP models. As this momentum grows, Medicaid programs may be asking: how can we get started?

Early Decision Points for States Pursuing PBPs

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