As health reform expands the Medicaid population by 16-20 million individuals over the next decade, efforts to strengthen the primary care delivery system are increasingly critical. Small primary care practices, which serve high volumes of Medicaid beneficiaries and racially and ethnically diverse populations, often lack infrastructure and staff needed to improve patient care delivery. These “high-opportunity” providers can particularly benefit from practice-based supports around care management and quality improvement.

This technical assistance brief outlines how states are using two types of practice supports — care managers and quality improvement coaches — to help Medicaid primary care practices provide higher-quality, more patient-centered, and cost-effective care. It draws from the experiences of states participating in Reducing Disparities at the Practice Site, a CHCS initiative made possible by the Robert Wood Johnson Foundation, as well as additional states with innovative programs to support primary care. The brief describes:

  • Two key roles that practice supports can play;
  • Models for deploying these supports to primary care practices;
  • Different approaches that states are taking to hiring and paying for these individuals;
  • How Medicaid programs are using practice supports within a managed care delivery system; and
  • Early lessons that Medicaid is learning about these practice supports.

States exploring new federal funding opportunities made possible through the Affordable Care Act (e.g., health home services) to reimburse practice supports for primary care providers can learn from the experiences of states outlined in this brief.