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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Janet M. Bronstein, PhD1, Francis X. Mulvihill, PhD1, E. Kathleen Adams, PhD2, and Curtis Florence, PhD3. (1) School of Public Health, University of Alabama at Birmingham, RPHB 330, 1665 University Blvd, Birmingham, AL 35294, 205-975-8962, jbronste@uab.edu, (2) Rollins School of Public Health, Emory University, 1518 Clifton Road, N.E., Atlanta, GA 30322, (3) Health Policy and Management, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322
Our previous studies of the implementation of primary care case management (pccm) in the Georgia and Alabama Medicaid programs showed a reduction in practice size for Medicaid participating physicians, a shift of care away from hospital-based providers and more use of community health clinics. This study examines the impact of pccm on children’s use of care. We report on Medicaid claims data analysis for children ages 0 to 18 in the two states for the four years of program implementation (1994-1997 in Georgia and 1996-1999 in Alabama) and on 12 focus groups conducted with Medicaid enrollees in the two states in the spring of 2001. Analysis of Georgia Medicaid claims showed a decline in overall use, from 89% to 81%, a decline in primary care (defined as evaluation and management services) use, from 70% to 65%, a decline in well visit use, from 48% to 44%, a decline in specialty (medical diagnostic and surgical) care from 50% to 39%, and a decline in emergency department use, from 35% to 21% of children. Alabama Medicaid claims showed similar, though not quite as dramatic declines in utilization with the implementation of pccm. Overall use declined from 71% to 68%, primary care use remained stable at 45% of children, well visit use declined from 49% to 41%, specialty care use declined from 41% to 38% and emergency department use declined from 36% to 21% of children. Medicaid enrollees in both states in 2001 reported confusion over their gate keeping physician assignments, a sense that these were assigned and not selected physicians and difficulty in changing assignments of physicians. Families acknowledged the value of using a physician familiar with their children, but did not consider it a high priority. They viewed physician assignment as more of a cost saving measure for Medicaid. Many still attempted to use hospital emergency departments if an illness seemed urgent or if care was not available immediately on a walk-in basis at a doctor’s office. These findings suggest that, at least in the initial phase of implementation of primary care case management in Medicaid, assignment to a primary care physician did not improve children’s access to care or increase the use of primary or preventive care services. Program changes impeded the use of hospital emergency departments as sites of routine care but did not alter enrollees’ preferences for this type of care.
Learning Objectives:
Keywords: Access and Services, Medicaid Managed Care
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.