New Report from Milbank on Prospective Payment for Primary Care

It’s widely accepted that fee-for-service payment, the principal payment mechanism used for primary care in the U.S., is incompatible with achieving accessible, patient-centered, high-quality care. The COVID-19 crisis and resulting financial pressures on vital primary care services have further demonstrated the hazards of such a payment system.

Prospective payments for primary care are an alternative mechanism that offers flexibility and greater revenue certainty. While questions remain about how best to structure prospective payments, past experience provides important lessons. In a new Milbank report, Erin Taylor, Michael Bailit, and Jennifer Sayles of Bailit Health analyze earlier primary care prospective payment models such as those commonly employed in the 1990s.

The authors offer insights for designing prospective payment for primary care and review payment design considerations such as eligible provider types, attribution, risk adjustment, included services, and quality performance incentives, as well as implementation factors.

Read the report.