Emerging Practices in Medicaid Primary Care Case Management Programs. Intent


States began enrolling beneficiaries in their PCCM programs by the mid-1980s. In 1986, seven states had implemented PCCM programs, 4 and by 1990, 19 states had such programs. 5 Several factors motivated decisions to implement PCCM programs.

  • States wanted to increase access to care. First, by offering physicians a small payment, state officials hoped more providers would accept Medicaid beneficiaries. Then each beneficiary would choose or be assigned to a participating physician, rather than needing to locate a provider who would accept Medicaid on his/her own; this would serve as his/her "medical home."
  • States hoped to save money by reducing inappropriate emergency room (ER) and specialist use and other high-cost care. With continuity of care established, the member would presumably contact this medical home, rather than the emergency room, when health problems arose. Moreover, continuity of care would, in all likelihood, lead to better quality of care as well as more preventive care.
  • States felt PCCM would be more palatable to physicians than risk-based managed care.
  • States believed PCCM was better suited than MCOs in certain areas, such as rural regions where it would be difficult for MCOs to maintain an adequate population base for financial viability.

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