CHCS June 5, 2024
How the U.S. health care system pays for health services shapes the care patients receive. Traditional fee-for-service (FFS) payment incentivizes a higher volume of services, often prioritizing quantity over quality. As states seek to promote value-based, equitable care for Medicaid members, primary care population-based payment (PBP) models are one promising approach that have been recommended by the National Academies of Sciences, Engineering, and Medicine and adopted by multiple states.
Primary care PBP models pay primary care providers (PCPs) an upfront, set amount for each patient served and incorporate provider accountability both for quality and cost of care. This payment approach discourages excessive service volume. Instead, it provides predictable “budgets,” offering providers flexibility to deliver more personalized care and support non-billable...
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