States are increasingly moving their Medicaid recipients into managed health care. Research has shown that Medicaid recipients name finding the right doctor for themselves or their child, especially a doctor who would provide quality care, as the main reason for selecting a managed care (MC) plan. Because of the importance of the gatekeeping role in managed care, primary care physicians (PCPs) are key to successful Medicaid MC programs.
As part of an evaluation of a mandatory Medicaid MC program, individual and focus group interviews were conducted with a sample of PCPs under capitated HMO arrangements. Narrative and objective data addressed PCPs experiences regarding: 1) administrative and clinical practice issues in providing primary care to Medicaid patients under traditional fee-for-service arrangements and under MC, 2) differences in commercial and Medicaid MC patients, 3) the impact of MC arrangements on meeting primary health care needs of low-income women and children receiving Medicaid. Administrators of the participating HMOs also were interviewed to assess the correspondence between administrators' and PCPs' perceptions.
Because of historically poor access to timely, appropriate healthcare, Medicaid recipients often present challenges to PCPs who already face pressures in providing quality care in an evolving health system. Study results have implications for formulating policies and designing programs that remove barriers and enhance PCP participation as providers of quality, cost-effective care for Medicaid recipients under managed care.
Learning Objectives: List three factors cited by primary care physicians as barriers to providing quality care for Medicaid recipients in a mandatory managed care system. Describe three organizational strategies to enhance physician participation as primary care providers in Medicaid managed care programs
Keywords: Medicaid Managed Care, Physicians
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Research funded by NC Dept. of Health and Human Services, Division of Medical Assistance