Advancing Primary Care Innovation in Medicaid Managed Care: A Toolkit for States

Recognizing the importance of primary care, state Medicaid agencies are looking to support advanced primary care models. States are asking not only if an individual has a relationship with a primary care provider, but also whether that patient and provider is adequately supported by a multidisciplinary care team, and how that team addresses the diverse needs of patients — including behavioral health and social needs. But, defining how managed care organizations can best support primary care innovation can be challenging.

This toolkit is designed to help states leverage their managed care purchasing authority to advance primary care innovation. Based on the experience of states participating in CHCS’ Advancing Primary Care Innovation in Medicaid Managed Care — a national learning collaborative made possible by The Commonwealth Fund — the toolkit outlines design considerations and shares sample contract and procurement language within four key areas (see below).

In addition, the section titled, State Approaches to Patient-Centered Medical Homes, compares how three leading states — New York, Ohio, and Oregon — are advancing high-quality primary care in key domains and how they are leveraging managed care and specific payment methods to reimburse for patient-centered medical homes. See also Primary Care Innovation in Managed Care State Profiles to learn how select states are advancing their primary care models.