Leading the Way: State Innovations in Primary and Chronic Care Delivery

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<p>While there have been a number of recent federal and state initiatives to support the delivery of primary care—the backbone of an effective health care delivery system—these efforts have disproportionately focused on larger, multispecialty physician group practices. Spreading change to smaller practices remains a challenge. <br /><br />A new <a href="/publications/fund-reports/2010/dec/strengthening-primary-and-chronic-care-state-innovations">report</a> from The Commonwealth Fund and the National Academy for State Health Policy (NASHP) examines how a diverse group of states is attempting to reorganize the delivery of primary and chronic care services, with a particular emphasis on small practices. In short case studies of efforts under way in Colorado, Michigan, North Carolina, Oklahoma, Pennsylvania, and Vermont, the authors highlight changes focused on leadership and the convening of stakeholders, payment incentives, support for infrastructure, information feedback and monitoring, and certification and recognition. For example: <br /><br /></p>
<li>The legislatures and governors of Pennsylvania and Vermont have spearheaded initiatives to improve chronic care management and control costs.  </li>
<li>Colorado funds community-based "medical home navigators" to help practices connect patients to community resources. </li>
<li>One regional network in Pennsylvania uses a shared-savings model to pay providers for desired outcomes, while Michigan leverages managed care contracts to support components of medical homes. </li>
<p>Leaders in the studied states recognize that well-coordinated provider payment reforms are critical to effecting change in primary care practice. According to NASHP's Mary Takach, the report's lead author, "States as payers alone can have an important impact on the delivery system, but their ability to bring multiple payers to the table and join with them in initiatives can have perhaps the greatest impact on the system." <br /><br />"With the passage of the Affordable Care Act, many states will have expanded opportunities to experiment with payment and delivery models to strengthen primary care and develop needed infrastructure and workforce," adds coauthor Anne Gauthier. "The innovative demonstrations and broad-based initiatives under way in the leading states should inform these efforts." <br /></p>