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. More recently, spurred by the COVID-19 pandemic, states have made it a priority to address health inequities and support primary care providers, creating a unique window to use VBP models to transform how primary care is delivered to Medicaid enrollees.

One opportunity for states to improve care delivery in primary care is through population-based payment models (PBPs) — a VBP approach described by the Health Care Payment Learning and Action Network as offering per-member per-month payments, tied to quality incentives, to manage individuals’ health care needs within a defined set of services. By providing flexible and predictable upfront provider payments through a primary care PBP, Medicaid agencies can support whole-person, integrated, accessible, and equitable care.

Helping States Develop Primary Care PBPs

Building on the Center for Health Care Strategies’ (CHCS) prior work helping states promote more equitable advanced primary care, the Medicaid Primary Care Population-Based Payments Learning Collaborative, made possible by The Commonwealth Fund and Arnold Ventures, is helping leading-edge states design and implement primary care PBPs that support high-quality, equitable care.

The learning collaborative is working with five state Medicaid agencies — in Connecticut, Colorado, Massachusetts, Montana, and New Mexico — to design and launch a new primary care PBP model or improve an existing one. States participating in the collaborative are also incorporating approaches to advance health equity within their primary care PBP models. Participants will engage in peer-to-peer learning activities and receive one-on-one technical assistance from experts at CHCS. Promising practices learned throughout the initiative will be shared publicly.