MassHealth, the Massachusetts Medicaid program, could play a leading role in implementing dramatic changes to the health care payment system. This report outlines how so-called global payments could be used in MassHealth, which provides insurance coverage to roughly 1.2 million people in the state. Global payments have been recommended by both the Special Commission on Health System Payment and the Massachusetts Health Care Quality and Cost Council as a means of reigning in health care cost increases and improving care coordination.