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

Recognizing the importance of primary care, 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 supported by a multidisciplinary care team, and how that team addresses the diverse needs of patients — including behavioral health and social needs. Yet, defining how managed care organizations (MCOs) can best support advanced primary care can be challenging.

This toolkit, made possible through support from The Commonwealth Fund, is designed to help states use their managed care purchasing authority to advance innovations in primary care. A product of CHCS’ Advancing Primary Care Innovation in Medicaid Managed Care initiative, the toolkit outlines strategies to support states in: (1) defining primary care priorities and advancing core functions; and (2) achieving primary care innovation goals through managed care contractual levers. It also includes design considerations for advanced primary care initiatives, and example state approaches and managed care contract language.

Conceptualizing and Designing Core Functions

These modules outline considerations for how states can define primary care priorities and advance targeted primary care delivery goals:

Using State Levers to Drive Uptake and Spread

These modules describe managed care contracting levers that can be used to promote primary care innovation investment and MCO and primary care practice payment, which can be used to support the primary care functions above: