Emerging Practices in Medicaid Primary Care Case Management Programs. Provider Recruitment

06/01/2001

Provider participation is one of the cornerstones of a PCCM program. States with successful PCCM programs have worked hard to gain that participation. The case-study states report that they have learned that the time initially invested in educating physicians and practice office staff during the recruitment process pays off in physician participation later. State provider relations staff, or their contracted designees, visit individual practices, conduct regional orientation and training, and provide follow-up contact prior to finalizing a contract with the provider. Face-to-face contact seems to be extremely important in communicating state program expectations to physicians; according to state officials it cannot be done solely through memos and manuals. Case-study states that have implemented their PCCM programs gradually emphasize the benefits of this approach in attaining physician buy-in. Officials in states such as Iowa, Maine, and North Carolina note the importance of gaining sufficient participation of providers in a given area before activating beneficiary enrollment.

Increasingly, state Medicaid agencies are contracting with provider groups and hospital-owned practices instead of individual physicians. They are also focusing their recruitment activities on traditional Medicaid providers so that members can maintain continuity of care.

  • Three of the case-study states (North Carolina, Texas, and Florida) contract with provider service networks in certain areas of the state, in addition to individual PCPs and practices. In these instances, the networks are responsible for the recruitment of PCPs as well as other providers.
  • In the MaineNET/Partnership, the state has identified three primary care physician practices to serve as PCPs for MaineNET members. These practices were selected because of the large numbers of their patients who are enrolled in the Home and Community-based Services waiver program.

Case study state officials repeatedly noted the importance of clarifying the expectations of the PCP during the recruitment process. PCPs must understand the contract requirements and their responsibilities in order to avoid problems of misunderstandings or compliance. Some state agency staff acknowledge that initial recruitment was focused largely on getting sufficient provider participation to make the program operational. Now that they have adequate networks, state agency staff feel that they need to focus on improving the performance and caliber of the participating physicians. They want physicians to understand that being a PCP is more than business as usual in the Medicaid program.

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