September 2023: How To Accelerate Equity-Focused Practice Transformation

Dear friends,

The recent increase in state Medicaid funding and support for equity-focused practice transformation marks an inflection point in the national Upstream Movement. In California and beyond, frontline practices that have long served people with lower-incomes are now poised to get significant resources to advance their mission.

Many states are now scaling up support for clinics, hospitals, and community-based organizations to transform their practices to advance equity and address health-related social needs, prompted by federal Medicaid flexibility and new benefits approved in state Medicaid waivers. In California, for example, the state’s Medicaid agency recently launched a one-time $700 million primary care provider practice transformation program to advance health equity by funding practice transformation and “investing in upstream care models and partnerships to address health and wellness,” especially for historically marginalized populations such as foster youth and people experiencing homelessness.

But realizing the promise of new equity-focused Medicaid benefits won’t be easy. Courageous leaders will need solidarity, expert support, and action-oriented spaces to navigate challenges and share best practices.

As initiatives like this emerge across the country, we’re hearing healthcare leaders ask important questions: Are we ready to take on equity-focused practice transformation? Are there proven strategies and tools that we can use to meet equity-related performance goals? Can we incorporate this into our existing work rather than adding yet another item to our large to-do lists? And will we really be able to reduce inequities impacting our populations of focus?

For more and more courageous leaders whom we work with these days, the answer to those questions is yes.

Having worked with Medicaid-serving organizations across 29 states, we’ve learned what it takes for leaders to confidently answer these questions and drive equity-focused practice transformation. Here are two key steps.

Assess readiness to take on equity-focused practice transformation

Regardless of the number of Medicaid enrollees that a given practice may care for, a key step in any transformation process is assessing for relevant capabilities—and gaps—that exist in the organization. In some places, the tools that clinics must use to assess their readiness and their areas for improvement are well-defined. In California, for example, the state Medicaid agency recommends that practices complete a 50-item questionnaire to identify levels of readiness across eight domains (including leadership and culture, technology and data infrastructure, and population-based care) that are essential for practice transformation. We help practices complete these types of assessments and, as importantly, rapidly close identified gaps and strengthen specific equity-focused capabilities through supports such as our accelerator programs. In the process, practices are also learning how organizational assessments can help them prepare for emerging equity-focused accreditation standards like The Joint Commission’s Health Care Equity Certification Program.

Use proven strategies and tools to meet equity-related performance goals

As health care leaders assess and strengthen their organizational capabilities for practice transformation, we’re seeing a growing desire for proven equity-focused strategies and tools, especially ones that they can incorporate into existing workflows. This is where quality improvement resources like the Toolkit to Advance Racial Health Equity in Primary Care Improvement can be helpful. Developed with input from more than 50 primary care leaders, the toolkit describes seven concrete opportunities and associated strategies to advance health equity along a “roadmap of improvement.”

This is also where relevant technical assistance can be vital, especially for medium-size and smaller practices that lack internal capacity to drive all the elements of equity-focused practice transformation. In California, for instance, we’ll be helping Medicaid-serving practices implement state-required activities like governance for population health and quality improvement, stratification and analysis of patient data, and the design of strategies to reduce inequities impacting populations of focus. Practices also often seek our help with other important transformation activities to strengthen leadership, build an equity-focused culture, and implement social needs screenings and interventions.

As you ramp up efforts to implement, pay for, or support equity-focused practice transformation, please share your journey and stories. As always, we’d love to learn from, celebrate, and share your experiences with others in this growing community of Upstreamists.


Rishi Manchanda, MD, MPH.

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