Over the past decade, Medicaid programs have been transitioning from fee-for-service provider payment to value-based payment models. Some states are now taking the next step by adopting more advanced arrangements that can accelerate primary care transformation efforts and promote more comprehensive, whole-person care for Medicaid members. One such option is population-based payment (PBP), where primary care practices receive an upfront payment tied to the population they serve and are held accountable for quality and total cost.

The following case studies highlight implementation strategies and early lessons from state Medicaid primary care PBP programs. The case studies detail program goals, payment approach, key design decisions, and implementation lessons. They are part of an ongoing series featuring innovative state primary care PBP models in Medicaid.

• Colorado’s Alternative Payment Model 2 – Launched in 2022, this voluntary model lets practices choose the share of revenue they receive as upfront per-member per-month payments and offers chronic-condition shared-savings incentives, aiming to give providers flexibility and financial stability while linking payment to quality for Medicaid members.
  
• Massachusetts’ Primary Care Sub-Capitation Model – Rolled out statewide in 2023 as a requirement of the state’s accountable care organization (ACO) program, this model channels prospective per-member per-month payments through ACOs to more than 75 percent of MassHealth primary care practices, pairing tiered practice-transformation requirements with increased primary care investment.

This case study series is a product of the Medicaid Primary Care Population-Based Payment Learning Collaborative, an initiative working with Medicaid agencies across the U.S. to design or refine primary care PBP approaches. The initiative is led by the Center for Health Care Strategies through support from the Commonwealth Fund and Arnold Ventures.