Abstract This study leverages a natural experiment resulting when legislative action in Minnesota established state standards for patient-centered medical homes (PCMH) and mandated quality reporting. The initial UNITED study was the first to identify the specific care management processes implemented through PCMH redesign that are associated with significant improvements in diabetes performance measures. Our qualitative work informed a new understanding of transformational stages and highlighted the importance of workforce challenges in primary care. In this continuation, we expand our evaluation of primary care redesign to add changes in workforce models to the initial focus of changes in care management processes, and extend our observation window through 2024. The Minnesota experiment continues to evolve. Analysis of changing care delivery and outcomes provides an unparalleled opportunity to evaluate how redesign of primary care delivery influences diabetes care and to provide decision-makers with evidence for introducing effective models of care. Through our data partnerships we observe: (a) Patient-level clinical measures captured in statewide, mandatory performance reporting of diabetes outcomes. (b) Detailed health plan administrative data from two of the three largest health plans in the state from which we develop patient-level measures of health care utilization for the majority of Minnesota adults with diabetes. (c) Practice-level descriptors of the primary care workforce resources from surveys providers must complete during annual licensure. To these data sources we add another two rounds of practice-level measures of care management processes in place from our biennial survey of practices (greater than 70% response rate in 2017 and 2019). In 2021 and 2023 these surveys will be expanded to include new measures of team roles and functions. We leverage this rich dataset (2014-2024) and qualitative inquiry to accomplish the following specific aims: 1. Determine the impact of changing care management processes in primary care on measures of optimal diabetes care and health care utilization. 2. Identify the characteristics of the health care professional workforce that most effectively improve measures of optimal diabetes care and health care utilization in a primary care practice. 3. Qualitatively identify practice-specific factors, organizational factors, and social determinants not observable in the quantitative data that are associated with improvement in optimal diabetes care. Our team has a history of collaboration and use of the data sources on which this work relies. The team has extensive clinical experience, strong relationships with clinical practices in the state, an understanding of methodologies that control for the lack of randomization in natural experiments, extensive experience manipulating claims data, and expertise in collecting and analyzing qualitative data. We have expertise in the best practices of disseminat...