Aligning Payers and Practices to Transform Primary Care: A Report From the Multi-State Collaborative

We are learning two things about restructuring health care in the United States in the post-Affordable Care Act (ACA) environment: Primary care transformation is essential to a well-performing health care delivery system and payment reform works best when it is consistent across payers.

These things are easier said than done, but the evidence and experience indicate they are possible. A Milbank Memorial Fund report, “Aligning Payers and Practices to Transform Primary Care: A Report from the Multi-State Collaborative,” describes the efforts in states to take on these challenges.

The report details the experiences of the Multi-State Collaborative (MC), a voluntary group composed of representatives of state-based, multi-payer primary care transformation initiatives that are themselves collaborations between payers, providers, employers and state officials. With support from the Milbank Memorial Fund since 2009, the MC has provided a forum for member states to share data, participate in collaborative learning, and advocate for improved collaboration between the states and the federal government on primary care transformation. The report, which is based on a 2013 observational survey of the MC states and interviews with their leaders, looks at the similarities and differences in the activities of each state.

The implementation of the ACA may have focused much attention on insurance provisions, but the real challenges and opportunities for health reform lie in improving the performance of the medical care delivery system. The lessons learned here have implications not only for primary care transformation, but also for state-convened provider payment reform initiatives and any effort at health care transformation requiring alignment across multiple payers.