Primary care is the backbone of a high-functioning health care system and payment reform is a foundational building block for supporting high-quality, equitable primary care delivery. Over the past decade, Medicaid agencies have made significant progress in adopting value-based payment (VBP) models. Recently, many states have made it a priority to pursue advanced VBP models to further support primary care transformation and address health inequities for Medicaid enrollees.

One opportunity for states to improve care delivery in primary care is through population-based payment (PBP). Primary care PBP models are upfront, prospective, value-based payment approaches that include provider accountability both for quality and cost of care.  These approaches are designed to overcome the limitations of fee-for-service and offer providers more flexible and predictable payments to support whole-person, integrated, accessible, and equitable care.

Helping States Develop Primary Care PBPs

To support state efforts in transitioning primary care away from fee-for-service and enabling more flexible and sustainable financing for practices, the Center for Health Care Strategies (CHCS) launched the Medicaid Primary Care Population-Based Payment Learning Collaborative. Made possible by the Commonwealth Fund and Arnold Ventures, the learning collaborative works with states to design and implement primary care PBPs that support high-quality, equitable care.

Since 2022, the learning collaborative has provided in-depth technical assistance to help five state Medicaid agencies — Connecticut, Colorado, Massachusetts, Montana, and New Mexico — design, launch, or improve primary care PBP models. States participating in the collaborative engage in peer-to-peer learning activities and receive one-on-one support to advance a primary care PBP approach, including a focus on advancing health equity.