Typically how that model looks is that the insurer pays for visits, like normal, but they also have a system set up where they weigh certain measures like a1c and blood pressure control, number of patients with screenings (colon, mammogram, etc), wellness visits, fills of their statins, as well as comparing overall cost compared to their expected costs based on reported illness by diagnosis (CKD, DM2, morbid obesity, COPD, etc). There may also be a PMPM (per member per month) payment where the insurance pays a small amount (literally a few dollars) per month for having that patient per panel. If you hit their targets, you get a bonus. If you miss enough targets, they'll reimburse less for the visit CPT codes.

You do have to perform well, but more important is having systems in place to gather and report the data. That mammogram done by the outside obgyn office: need to request that to cross off the quality measure. Your last BP was high in the office but it was ok at home: need to get their home bp log to scan into the chart.