Keys to High-Quality, Low-Cost Care: Empanelment, Attribution, and Risk Stratification


 Download in PDF format

Supplement sponsor: American Academy of Family Physicians

Fam Pract Manag. 2020 Sep-Oct;27(5):37-40.

Finding Success in Value-based Payment

Value-based payment (VBP) ties physician payment more closely to improving patient outcomes and reducing costs when compared to the volume-based, fee-for-service (FFS) system. Success in a VBP model relies on identifying and prioritizing patients at risk for poorer health outcomes and directing preventive and other health care services to those patients.

There are two mechanisms to assign patients to a physician or practice during the course of the year: attribution and empanelment.


Commercial and government payers assign patients to physicians or practices who are held accountable for their care and associated costs. This process is known as attribution.1 As VBP models evolve, attribution will continue to determine payment to primary care physicians in these models. Identifying which payers have attributed which patients to your practice, and the impact of each VBP program your practice participates in will help your practice effectively allocate resources to improve care and reduce costs.1 Payers use two types of attribution: prospective and retrospective. Prospective attribution allows physicians to know which patients are assigned to them at the beginning of the measurement year for the next 12-24 months.1 However, this attribution list may only be updated annually or quarterly, based on the payer contract. Retrospective attribution alerts physicians of their assigned patients at the end of the year, and payers measure performance based on a look-back period—typically the previous 12-24 months.1 Attribution methodologies differ by payer and contract. However, some combination of patient choice and/or a claims-based algorithm is typically used to assign patients to physicians. These include:

• Voluntary attribution: Process in which patients select their primary care physician

• Claims-based attribution: Methodologies differ for this type of attribution, but some payers assign patients based on which physician


Copyright © 2020 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz


Jul-Aug 2021

Access the latest issue
of FPM journal

Read the Issue

FPM E-Newsletter

Sign up to receive FPM's free, weekly e-newsletter, "Quick Tips & Insights."

Sign Up Now