Start: May 2018

Funder: The Commonwealth Fund

Primary care is the essential backbone of any health care system, particularly for low-income populations. Across the United States, a variety of advanced primary care models — including patient-centered medical homes, Medicaid accountable care organizations, and Comprehensive Primary Care Plus programs among others — are offering new ways to enhance primary care delivery. Despite the growth of these models, however, low-income individuals have consistently low rates of primary care utilization as well as poor health outcomes. With more than 80 percent of the nation’s Medicaid beneficiaries enrolled in managed care, strengthening primary care delivery through managed care levers offers one option to improve access, quality, and efficiency of health care services for this often at-risk population.

Under Advancing Primary Care Innovation in Medicaid Managed Care, made possible by The Commonwealth Fund, the Center for Health Care Strategies (CHCS) works with state Medicaid agencies that are supporting high-performing primary care systems for vulnerable populations through their Medicaid managed care programs. The project focuses on using states’ managed care purchasing authority to advance primary care models that aim to address one or more of the following care delivery components: (1) addressing social determinants of health; (2) integrating behavioral health into primary care; (3) using technology to improve access to care; and (4) enhancing team-based primary care approaches that better meet the community’s needs.

  • During phase I (2018-2019), CHCS supported five states — Hawaii, Louisiana, Pennsylvania, Rhode Island, and Washington — in advancing these efforts through tailored one-on-one technical assistance, as well as peer-to-peer information sharing, convening, and learning opportunities.
  • During phase II (2019-2020), CHCS is working with five new states – Delaware, Nevada, Tennessee, Texas, and Virginia. In addition, Hawaii and Washington will join as alumni states to further their work.

Over the course of the initiative, CHCS will synthesize lessons from participating states, which will be shared nationally. In particular, a CHCS-developed toolkit, Advancing Primary Care Innovation in Medicaid Managed Care, offers strategies for states seeking to maximize the potential of managed care for strengthening primary care delivery.