The 130th Annual Meeting of APHA

Abstract #46430

Curtis Florence, PhD¹, E. Kathleen Adams, PhD¹, and Janet M. Bronstein, PhD². (1) Health Policy and Management, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, (2) School of Public Health, University of Alabama at Birmingham, RPHB 330, 1665 University Blvd, Birmingham, AL 35294, 205-975-8962, cfloren@sph.emory.edu

Introduction: Primary Care Case Management (PCCM) requires that Medicaid enrollees obtain primary care and referrals for specialty, emergency and hospital care through a primary care physician (pcp). As long as there are sufficient numbers of participating office physicians in a market, the implementation of PCCM is expected to reduce visits to hospital based physicians (ER) and health departments. While studies have examined PCCM and utilization/expenditures its effect on provider systems has not been reported. Objective: To use a natural experiment in two southern states to examine the effect of implementing PCCM on the distribution of childrens’ visits across office-based and safety net provider sites. Methods: We use Medicaid claims data to construct a longitudinal data file that records primary care visits for Medicaid enrollees, by provider type. We combined the claims data with demographic characteristics of the market (zip codes where 80 % of the patients using care in a community reside), and construct an index of Medicaid fees relative to private reimbursements. We estimated fixed-effects models of the share of Medicaid visits to four provider types: Office-based physicians, hospital-based physicians, health departments and clinics (both rural and Federally Qualified Health Clinics). PCCM penetration is measured by the percent children covered by PCCM in each market. Results: As expected, we implementing PCCM led to a decline in the share of visits to hospital based physicians in both states. In Alabama, the market share of hospitals declined by 2.4 percentage points and in Georgia, 2.8. The states differed, however, in terms of the market sectors that grew after PCCM. While the share of visits to office-based physicians increased 3.5 percentage points in Georgia, this share declined in Alabama by 2.0%. The clinic sector, on the other hand, grew by almost 4 percent in Alabama. In both states, the share of primary care visits at health departments did not change significantly after PCCM. Conclusions: The implementation of PCCM for Medicaid shifts the distribution of physician visits away from hospital-based physicians toward other care sites. This is consistent with the expectation that Medicaid enrollees will be less likely to seek care from the ER if they have a regular source of care, or if care in the hospital setting is not reimbursed without a PCP referral. The Alabama results, however, shows that PCCM did not “mainstream” Medicaid enrollees to office-based physicians but rather, toward other safety net providers.

Learning Objectives:

• Describe effects of implementing PCCM in two southern states on offce and safety net providers
• Articulate policy concerns about effects
• Consider reasons PCCm might not mainstream Medicaid recipients into office-based care

Keywords: Access to Care, Safety Net Providers

Presenting author's disclosure statement:
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.