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 VBP 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

The Medicaid Primary Care Population-Based Payment Learning Collaborative, led by the Center for Health Care Strategies (CHCS), is designed to support state Medicaid agencies in transitioning primary care away from fee-for-service and enabling more flexible and sustainable financing for physicians. Made possible by Arnold Ventures, the learning collaborative is currently supporting eight states — Colorado, Connecticut, Hawaii, Maine, Montana, North Carolina, Oregon, and South Dakota — to design, launch, or improve a Medicaid primary care PBP model that promotes high-quality care. Participating states engage in peer-to-peer learning activities and receive one-on-one support to advance a primary care PBP approach.

With earlier support from the Commonwealth Fund, the learning collaborative has provided in-depth technical assistance to 13 Medicaid agencies since 2022. Past state participants include Louisiana, Massachusetts, New Mexico, New York, and Washington State.

Throughout the initiative, CHCS is distilling lessons and sharing best practices nationally to support other states seeking to adopt primary care PBP models. Resources are below.