Emerging Practices in Medicaid Primary Care Case Management Programs. Input from PCPs


Many states establish both formal and informal mechanisms by which providers have input into the program. They conduct provider satisfaction surveys, hold focus groups, and organize work groups to address specific program issues. Several states have provider advisory committees for their managed care programs as well as other forums for provider input so that they can maintain ongoing communication with the provider community.

  • Alabama has formed the Patient 1st Advisory Council, composed of ten physicians who serve as policy advisors to the Agency. One of their first recommendations was to tighten the contract language to encourage compliance with PCP requirements, particularly in the area of 24-7 coverage.
  • Iowa has a Managed Health Care Advisory Committee, composed of six physicians from the state's service regions who provide input to the state on both the MCO and PCCM programs.
  • Maine formed a Physician Advisory Committee in June 2000 so that physicians can have ongoing input into the Maine PrimeCare program. The committee is co-chaired by the state Medicaid agency's medical director and the Maine PrimeCare director.
  • Oklahoma schedules periodic regional meetings for physicians so that they can give their feedback to the Medicaid agency about various managed care program issues.
  • North Carolina has asked physicians to define best practices for the purpose of developing quality improvement measures for the ACCESS II and III programs. The physicians have chosen their own performance measures and, according to state officials, have probably set higher standards for themselves than the state program would have.

Physician satisfaction surveys and anecdotal reports indicate that physicians are generally happy with their participation in PCCM programs. After some initial skepticism, they are satisfied with the case management fee and find that it adds a significant monthly payment to their practice for prevention and patient education activities. They are also glad to be in charge of their patients and not be required to go through an intermediate authorization process. From state officials' comments, physicians seem to want to work with their states to improve the quality of their respective PCCM programs.

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