This issue brief from the Robert Wood Johnson Foundation’s Aligning Forces for Quality (AF4Q) program highlights lessons learned from efforts to support primary care delivery redesign in practices serving racially and ethnically diverse and Medicaid patients. The issue brief was prepared by the Center for Health Care Strategies, based on surveys from 126 practices in four communities that are participating in AF4Q regional quality improvement, as well as in two additional states, Arkansas and Oklahoma. The AF4Q program seeks to assist practices in assessing their own capacity, help local community “alliances” better target efforts to improve care delivery, and assist state agencies across the country in better preparing the nation’s primary care system to deliver high-quality care to Medicaid beneficiaries.
Among the responding practices, they scored high on measures of:
- Comprehensiveness of Services Available
- Comprehensiveness of Services Provided
- Family-Centeredness
- Clinical Information Systems
However, they were more challenged on measures of:
- Community Orientation
- First Contact: Access
- Health System
- Delivery System Redesign
The following are the key lessons learned:
*Regional improvement collaboratives such as AF4Q can play an essential community leadership role in articulat- ing the goals of practice transformation and helping practices connect the dots between multiple national, state, and local efforts. Medicaid agencies can rely on these regional improvement partners to help align efforts and create a unified community message.
*Regional quality improvement alliances should connect with smaller practices in their communities and provide assistance with practice redesign and practice networking activities. Alliances and other regional coalitions can help direct national, regional, and local resources to smaller practices, given those practices’ lack of support from parent organizations.
*Alliances and other regional coalitions can build community and regional capacity to train primary care practices and test different training models (including collaboratives, on-site training, mentorship programs, and virtual models). Alliances could help “pool” funding from multiple sources, including Medicaid, to create more centra- lized training functions in many communities.
*The Alliances could help practices effectively leverage the new technology. Payers could provide or fund sup- ports such as quality improvement coaches or deliver technical assistance through peer-based learning collabora- tives to help build practice capacity to leverage EHRs and other technologies effectively. Such activities would support practices in using technology to identify areas for improvement and undertake quality improvement projects.
*Alliances and other regional health partnerships can seek opportunities for new or redirected funding from Medi- caid agencies, Medicaid managed care organizations, or the Affordable Care Act to support team-based care. For example, many states seeking to create health home programs could potentially use the 90 percent federal match to fund team-based services for Medicaid beneficiaries with multiple chronic conditions and mental illness. States are also evaluating the effectiveness of shared savings mechanisms as a vehicle for funding practice re- sources without incurring additional expenditures. In addition, Alliances can partner with Medicaid to seek po- tential grant opportunities under the Center for Medicare and Medicaid Innovation to deploy care team members to these high-opportunity practices.
Ignatius Bau 