Objective: To develop an analytic and descriptive profile of Medicaid PCCM programs in 15 states. While HMO type Medicaid managed care program options have had mixed enrollment and operational success across states, PCCM is a viable option. Methods: In depth information was collected from 15 geographically diverse states. Data was collected through in-person meetings, telephone conversations with key state Medicaid program employees, ands from published and unpublished documents. Results: There is considerable variability among states in their approach to managed care. Some of the variability is attributed to overall market penetration of managed care and the legal framework for managed care/insurance in the states. Evolving forms of provider network models emphasize partnerships and coalitions with various public and private entities, a feature not found in a traditional indemnity, fee-for-service based PCCM model. Many of the PCCM management programs have developed programs in disease management in which additional payments are made to providers, over and above the PCCM fee. Conclusion: PCCM remains a viable option for states in the delivery of Medicaid services, particularly with the mixed success of other forms of managed care programs. The various approaches to disease management, as well as partnership-coalition building found in provider networks, are efforts that are likely to improve the quality of care for recipients and to improve the operational efficiency for the delivery of care.
Learning Objectives: At the conclusion of the session, participants will be able to: 1. Identify major organizational features of Primary Care Case Management(PCCM) in a geographically diverse number of states; 2. Recognize uniques features of provider network structures; 3. Identify essential areas of comparability and diversity across state in their approach to Medicaid managed care; 4.Describe successful and unsuccessful strategies employed by state Medicaid programs in establishing PCCM programs
Keywords: Medicaid, Managed Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.