MassHealth Designs Primary Care Risk Adjustment Model for Population-Based Payment
MassHealth developed a primary care-specific risk adjustment model to support population-based payment arrangements with primary care practices. The model accounts for patient complexity factors relevant to primary care settings, distinct from traditional encounter-based or specialty-focused risk scores. The Center for Health Care Strategies published lessons learned from MassHealth's design process to inform other states and Medicaid managed care organizations implementing similar value-based payment structures. The work provides operational guidance for payers structuring capitation or shared savings arrangements with primary care providers.
Primary care risk adjustment methodology directly affects how MCOs set capitation rates, distribute shared savings, and contract with primary care networks under value-based arrangements.
Managed Care · Finance
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