Delivering predictable revenues so that primary care providers can focus on their patients’ health.
MassHealth is shifting towards value-based payment models to improve health outcomes and promote health equity while managing health care costs. As part of this effort, MassHealth introduced the Primary Care Sub-Capitation (Sub-Cap) Program in 2023 for providers participating in any of MassHealth’s Accountable Care Organizations (ACOs).
Through this program, MassHealth pays participating primary care practices for a set of primary care services through a fixed per-member, per-month payment, which is set annually, rather than through a fee-for-service model. The program was designed to deliver consistent and reliable monthly revenue to primary care practices and to increase investment to help primary care providers enhance their care delivery.
MassHealth aims to advance primary care sub-capitation alongside other payers, such as Medicare and commercial insurers, to expand Massachusetts residents’ access to coordinated, high-quality primary care and improve population health over time. At the practice level, MassHealth hopes to improve both the patient’s quality of care and the experience of the primary care provider. Along with other value-based payment initiatives in Massachusetts, this program is also designed to manage overall health care costs by investing more in primary care.
Program Impact: By the Numbers
92% of Eligible Members
~900 Practices
$150M / Year Investment
92% of members eligible for a MassHealth managed care plan are enrolled in an ACO and are a part of the Sub-Cap program.
~900 practices participate in the Sub-Cap program across Massachusetts, including every major health system and all Federally Qualified Health Centers (FQHCs).
Between 2023 and 2025, MassHealth increased overall primary care spending by at least $150 million per year.
