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.

Managed Care · Finance