Primary care association briefs House panel on Medicaid alternative payment methodology for health centers

The Michigan Primary Care Association told the House Appropriations Subcommittee on Medicaid and Behavioral Health that an alternative payment methodology (APM) will convert part of federally qualified health centers’ Medicaid reimbursement from per-visit payments to a predictable monthly amount tied to assigned patients, with guardrails to protect quality and budget neutrality.

Philip Bergquist, CEO of the Michigan Primary Care Association (MPCA), said the APM’s purpose is to change “how” health centers are paid so teams—physicians, nurses, community health workers and others—can deliver population-health and team-based care without being constrained by a per-visit billing model.

Bergquist reviewed the rationale and timeline. He said Michigan and federal policy have relied on the prospective payment system (PPS) for roughly 25 years and that Michigan adopted the federal approach in 02/2001. He told the committee that, under the current PPS structure, health centers are reimbursed at levels that increasingly lag the cost of delivering care—an average shortfall of about $99 per…