Population-based payment (PBP) models — an advanced value-based payment approach — are gaining increased interest in health care as a way to achieve often hard-to-reach goals, such as controlling health care costs, improving care quality, enhancing patient and provider experience, and advancing health equity. These models align provider and payer incentives by encouraging providers to keep their patients well, rather than rewarding them for a large volume of reimbursable services. The strong financial incentives in PBP models represent a significant opportunity to transform how health care is delivered in Medicaid.

This report, developed by the Center for Health Care Strategies with support from Arnold Ventures, can help states design and implement effective Medicaid PBP models. The report includes a landscape scan of Medicaid PBP approaches, promising design and implementation strategies, and considerations for state and federal policymakers to support PBP efforts. The report also includes state profiles of PBP models used in Colorado, Maryland, Massachusetts, New York, Pennsylvania, and Washington State. The profiles explore the varied approaches used by each state and highlight examples of primary care, hospital, and total cost of care models.