Last year, the Center for Health Care Strategies (CHCS) reported in their policy brief 10 key factors for reducing disparities. Focused on small practices serving high volumes of low-income and racially and ethnically diverse patients with diabetes, their conclusions highlight what is needed to support these practices that are overburdened with both complex chronic illnesses and adverse social determinants of health.
This three-year study of 36 practices east of the Mississippi River showed that there are key themes that improve care for the 2,781 diabetics enrolled. While no improvements were noted in clinical outcomes, an analysis of processes in the practices documented the following findings:
- Practice leadership and culture being the most important – and subjective – factors for success.
- Maintaining practice engagement was a major challenge.
- 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.
- The belief that the practices would ultimately “take over” and provide care management activities proved unrealistic.
- Investment in the practices needed to be ongoing, more flexible and “hands-on” because the practices did not have the capacity for uninterrupted or smooth changes.
- Although financial incentives were viewed as important, incentives were not the primary motivator or driver of change.
- Healthcare IT was too overwhelming for most practices to implement to its fullest capacity.
While practices associated with MCOs embraced the opportunity to improve, the day-to-day application of Quality Improvement was more challenging for them. Improving quality and reducing disparities in practices will likely be more sustainable when assisted by primary care case management programs or the state Medicaid agency.
State Medicaid agencies could support small practices by identifying overburdened practices, encouraging support for these critically important practices, by facilitating some of all of the following:
- Reimbursement Health Homes for quality and volume
- Learning collaboratives, initiatives to link small practices with more specialists including behavioral health specialties
- Technical Assistance
- Analytic information and support
- Care management teams
- Leadership, vision and focus
“Medicaid agencies can partner with health plans and other payers to provide ongoing supports and technical assistance to practices, and ensure that small practices are not left behind.” CHCS
