Advancing Primary Care

Opportunities to Support Care Delivery Redesign in Practices Serving Medicaid and Racially and Ethnically Diverse Patients

Primary care is at a crossroads. Practices are transforming from procedure-based, physician-centric care delivery to more advanced primary care models that put patients and their families at the center. These advanced practice models improve care delivery through meaningful use of health information technology, expanded access to care, targeted care management, ongoing quality improvement activities, and care coordination across providers. Across the country, myriad stakeholder groups, such as the Robert Wood Johnson Foundation’s Aligning Forces for Quality (AF4Q) alliances, are promoting opportunities to support advanced primary care models.

Little is known, however, about the capacity of practices serving large numbers of low-income patients, including many who are racially and ethnically diverse, to implement advanced primary care models. This study surveyed 126 practices in four communities that are participating in the AF4Q regional quality improvement effort, as well as in two additional states (Arkansas and Oklahoma). The analysis sought to: (1) assist practices in assessing their own capacity; (2) help local community alliances better target efforts to improve care delivery; and (3) assist state agencies across the country in better preparing the nation’s primary care system to deliver high-quality care to Medicaid beneficiaries.

The findings offer information on both areas of strength in practices caring for underserved populations and areas of opportunity where primary care offices may need external resources to facilitate care delivery redesign. The findings can inform regional improvement coalitions, like the AF4Q communities, as they attempt to build ambulatory quality improvement infrastructure in their markets and pursue payment reform strategies. Findings also can help guide Medicaid agencies as they pursue strategies to improve primary care for the current 60 million, soon to be 80 million, beneficiaries under health reform.