The Milbank Medicaid Transformation Network: Collaborating to Improve Primary Care

Medicaid is the health care safety net for millions of Americans, providing people facing poverty and those with disabilities — including many from marginalized groups — with health insurance. Primary care is only part of the health care system that results in longer lives and lower disparity rates. Yet, the portion of total US health care spending going to primary care is decreasing at a time of increasing inequity and low pandemic resilience.

To help Medicaid officials advance primary care transformation, we at the Fund have launched the Milbank Medicaid Transformation (MMT) Network, a collaborative of state Medicaid agency leaders and partners.

Participants hail from eight states (Arkansas, Connecticut, Maryland, North Carolina, Oregon, Virginia, Vermont, and Washington) that are actively engaged in multipayer efforts to create and sustain high-quality primary care for their citizens. The 2021 National Academies of Science Engineering and Medicine primary care report defines high-quality primary care as “the provision of whole-person, integrated, accessible, and equitable health care by interprofessional teams that are accountable for addressing the majority of an individual’s health and wellness needs across settings and through sustained relationships with patients, families, and communities.”

The MMT Network’s priorities are to:

• Address access to high-quality primary care in historically and currently underserved populations
• Leverage state leadership to increase multipayer primary care investment
• Transform the delivery system through primary care payment mechanisms and multidisciplinary structural supports

Within these priority areas, network members have chosen to focus on primary care’s role in advancing health equity and on value-based primary care payment models, as well as on creating and implementing assessments of the efficacy of these efforts in their states.

The network’s monthly meetings include a mix of peer-to-peer discussions and relevant topical presentations by guest experts, such as Andrey Ostrovsky, MD, a managing partner at Social Innovation Ventures, on social risk adjustment, and Craig Jones, MD, of Capitol Health Associates, on effectively using data to measure progress toward health equity goals.

Although the MMT Network is a newly formed group, the members have rapidly become very comfortable and candid with each other. The group follows the mold of other successful learning networks convened by the Fund such as the Milbank Multipayer Primary Care Network. By serving as a trustworthy neutral entity, the Fund provides a safe and collegial space for sharing observations, strategies, successes, and failures.

“I’ve appreciated the opportunity offered through the Milbank Medicaid Transformation Network to engage in learning opportunities and in-depth conversations with representatives from other states who are on a journey similar to Oregon’s,” said Chris DeMars, director of the Delivery System Innovation Office at the Oregon Health Authority.

According to Chad Perman, deputy director of Maryland Department of Health’s Program Management Office, the network “has provided an invaluable platform for state Medicaid agencies to discuss the critical issue of expanding and implementing advanced primary care as a foundation for our health care delivery system.”

In addition to decreasing the burden on primary care clinicians, this type of interstate and multistakeholder cooperation has been shown to be catalytic for adoption of strategies to enhance primary care quality. Such collaboration also appears to lead to an increased likelihood of sustaining hard-won improvements. State Medicaid agencies can serve as neutral convening “backbone” organizations for primary care models (in Vermont, Washington and Oregon, for example), leading to a sustainability that transcends administration transitions.

Given how quickly the MMT Network has jelled, I am excited to see what strides these states can make as they can simultaneously teach and learn from each other.