This policy brief from the Center for Health Care Strategies describes the challenges faced by small group primary care practices to improve health care quality and outcomes. Based on a three-year project funded by the Robert Wood Johnson foundation, Reducing Disparities at the Practice Site, working with Medicaid programs in Michigan, North Carolina, Oklahoma, and Pennsylvania. Among the lessons learned:
- Practice leadership and practice culture are the most important – and subjective – factors for success
- Practices needed both practice facilitation and care management support.
- Practice facilitation was most effectively provided by an entity external to the practice with the relevant experience and skill set.
- Receptivity to care management/coordination supports by practices was mixed, and the belief that the practices would ultimately “take over” and provide care management activities proved unrealistic.
- Financial incentives were not the primary motivator or driver of change.
- HIT was too overwhelming for most practices to implement to its fullest capacity.
- Improving quality and reducing disparities in the practices will likely be more sustainable in medical home models.
Ignatius Bau 