When Medicaid Quality Performance Stalls, Change How Improvement Reaches Providers

States set the quality, access, and value-based care priorities. A statewide approach can create greater focus, consistency, and accountability across health plans while directing provider transformation resources where they can have the greatest impact.

EHP helps state Medicaid agencies align contracted plans around shared priorities, equip provider-facing teams with a common transformation model, strengthen provider participation, and measure what creates greater lift.

The Statewide Opportunity

A statewide approach can align the resources already working on provider performance across contracted health plans. States can prioritize the measures that matter most, establish common expectations, strengthen provider participation, and give plan teams a shared method for translating performance priorities into provider-level change.

The result is a more coordinated provider experience and a scalable transformation infrastructure that can reach across health plan networks.

A Stronger Statewide Approach

Scale Through the Workforce Already in the System

Statewide impact comes from equipping the health plan teams already responsible for provider performance. EHP can train and calibrate provider relations, quality, network, clinical, and practice transformation teams across contracted plans to use a common transformation model.

Plan teams become the primary delivery infrastructure across their networks. EHP serves as the transformation architect, capability builder, calibration partner, and escalation resource, with direct coaching concentrated where additional intensity is most valuable.

EHP can also help states investigate the mechanisms available to strengthen provider participation and accountability, including managed care requirements, provider contracts, value-based agreements, incentives, and aligned participation expectations across plans.

Evidence That Provider Transformation Can Create Greater Lift

A Common Success Factor Across the Top-Performing TCPi Networks

CMS launched the Transforming Clinical Practice Initiative (TCPi) to build and test scalable approaches to practice transformation and readiness for value-based payment.

Across the three top-performing Practice Transformation Networks in the country, EHP was the common practice transformation coaching partner. EHP Masters Coaches supported Pacific Business Group on Health / California Quality Collaborative, Rady Children’s Southwest Pediatric PTN, and L.A. Care’s Los Angeles Practice Transformation Network.

Together, the three California TCPi networks reached approximately 9,800 physicians serving 5.9 million patients and reported more than $345 million in avoided healthcare costs. EHP’s work across the networks applied a consistent transformation discipline: readiness assessment, change packages, direct coaching, data use, workflow redesign, PDSA testing, performance measurement, and sustainability.

Since TCPi: Applying the Model Across California Medicaid

EHP has supported Health Net of California since 2021 through successive provider quality, transformation, and implementation initiatives. The relationship began with Quality Edge, covering 94 assigned practices, 15 measures, and seven priority regions, and expanded through QIPM, PQCI, Equity and Practice Transformation, data integration, access improvement, and related provider-performance work.

In PQCI, EHP catalogued 4,047 provider-level barrier observations in a structured dataset that could be examined by practice, measure, coach, and barrier type. Fifty-seven percent were workflow-related. EHP used the findings with payer and practice data, root-cause analysis, and measure-specific best-practice inventories to build robust solution sets, action plans, workflow changes, and data strategies for participating practices.

Selected county comparisons: greater year-over-year improvement among participating providers

Comparisons reflect Health Net PQCI participating providers versus comparable non-participating providers in the specified county/cohort; results vary by measure and geography.

Provider Engagement at Scale

Through California’s DHCS Equity and Practice Transformation program, EHP helped Health Net engage Medi-Cal practices in a statewide transformation opportunity. Early work supported 156 applications, 152 approvals, and 1,375 committed transformation activities. By July 2026, practices receiving regular coaching were completing 30% more transformation milestones than practices without regular coaching.

The experience reinforces the importance of provider engagement, clear expectations, practical support, and accountability as core elements of the transformation infrastructure.

California Medicaid & Safety-Net Transformation

Since TCPi, EHP has continued to apply and refine its transformation model across California health plans, delegated networks, FQHCs, independent practices, community organizations, and public-sector initiatives. The portfolio includes multi-year Health Net/Centene provider-performance programs, DHCS Equity and Practice Transformation, PATH Technical Assistance Marketplace engagements, HCCN transformation, CalAIM/ECM implementation, and county and public-health quality collaboratives.

Across these initiatives, EHP has built change packages, maturity assessments, provider engagement strategies, coaching systems, data and workflow solutions, learning collaboratives, and train-the-trainer approaches that inform the statewide model.

Explore the State Medicaid Provider Transformation Framework

Download the executive brief for the full statewide model, including plan alignment, provider participation, workforce upskilling, tiered support, measurement, and implementation considerations.

Have an Immediate Medicaid Performance Need?

Working on a current quality, provider transformation, managed care, or value-based care priority? Schedule a 20-minute conversation with EHP.