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Managed care contracts could be positioned as a valuable tool for state Medicaid programs seeking to promote racial equity. While contracts are far removed from the front lines of care, well-designed agreements between states and plans can begin the process of addressing inequities in the delivery of health care. States can use contractual provisions to encourage or require plans to perform activities that advance health equity goals, including collecting, classifying, and reporting data by race and ethnicity; incorporating input from community-based organizations in program design; and reimbursing for care teams that include community health workers or doulas.
The Center for Health Care Strategies (CHCS), with support from the Commonwealth Fund, has been helping state Medicaid agencies in Louisiana, Mississippi, Oregon, and Washington advance racial health equity by improving how they purchase primary care from managed care plans. Primary care is often patients’ first (and sometimes, only) contact with the health care system; patients often report they trust the advice of their primary care team. Drawing on the experience of these states, we suggest the following promising managed care contracting strategies for advancing health equity.