Start: May 2018

End: December 2020

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) worked with state Medicaid agencies to support high-performing primary care systems through their Medicaid managed care programs. The project focused 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 worked with five new states – Delaware, Nevada, Tennessee, Texas, and Virginia. In addition, Hawaii and Washington joined as alumni states to further their work.

Over the course of the initiative, CHCS synthesized lessons from participating states and developed a toolkit, Advancing Primary Care Innovation in Medicaid Managed Care, which offers strategies for states seeking to maximize the potential of managed care for strengthening primary care delivery.

In 2021, CHCS is launching a new initiative, Promoting Health Equity through Primary Care Innovation in Medicaid Managed Care Programs, that builds on the state successes in Advancing Primary Care Innovation in Medicaid Managed Care and will support states in designing, implementing, and scaling primary care innovations to advance health equity through their managed care programs.