The Vital Role of State Primary Care Offices: Ensuring Access to Quality Care

January 10, 2019|3:06 p.m.| ASTHO Staff

Ensuring access to competent primary care is an essential function of state and territorial health agencies. Research findings indicate that access to regular primary care is associated with higher rates of receiving preventive care and lower rates of preventable emergency department visits. To improve access to primary care in their jurisdiction, state and territorial health officials rely on their state primary care offices (PCO) to coordinate and execute this systems-level work.

PCOs play an important role in supporting the healthcare workforce through their work assessing primary care needs statewide and linking those needs to shortage designations where appropriate. They provide technical and other non-financial assistance to community-based providers, particularly around improving the care and health outcomes of vulnerable and underserved populations. Activities that PCOs undertake include statewide needs assessments, shortage designation coordination, and overseeing workforce programs like the J-1 Visa Waiver Program. PCOs typically partner closely with their state offices of rural health when they are not the same office.

An effective PCO also helps to educate and prepare primary care providers for state policy changes that seek to enhance access or performance of primary care.

Maryland’s Primary Care Office Transformation

Maryland recently launched the new Maryland Total Cost of Care (TCOC) Model. The goals are to coordinate care for patients across both hospital and non-hospital settings, improve health outcomes, and constrain the growth of healthcare costs in Maryland. The model expands on Maryland’s earlier all-payer model, which focused on controlling total per-capita expenditures for hospital services.

The TCOC model will operate for a 10-year term, and the state anticipates savings because of this care transformation redesign. One component of the new TCOC model is the Maryland Primary Care Program (MDPCP). MDPCP incentivizes primary care providers in the state to offer advanced primary care services by offering an additional payment per-member-per-month for care management and related services. The MCPCP also offers performance-based incentive payments to providers that meet quality metrics related to reducing hospitalization rates and improving quality of care for Medicare beneficiaries.

The Maryland Department of Health has been working across its offices and programs to implement this model. The Maryland Primary Care Office is housed within Maryland’s Office of Population Health Improvement and has also been working to identify ways to support these care transformation efforts. Like other PCOs, the Maryland PCO coordinates healthcare professional shortage designations, facilitates the allocation and distribution of federal resources to those shortage designation areas, and provides technical assistance for communities.

In addition, the PCO is deploying a provider survey not only to inform data required for HRSA for shortage designations, but to also evaluate how best practices in federally qualified health centers and other primary care offices can inform the Maryland Primary Care Program. The PCO is conducting regional meetings to engage with stakeholders in local jurisdictions about their needs and share information about care transformation activities underway in Maryland. ASTHO will be working with Maryland as part of the ASTHO Primary Care Intensive Learning Community to support this work.


ASTHO also supports PCOs through the Primary Care Office Training Academy, hosted in partnership with the National Organization of State Offices of Rural Health. Interested state and territorial health agency staff working within PCOs are encouraged to review the request for applications and apply for this year’s Training Academy by Jan. 24.

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