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


Many of the state officials interviewed emphasized that the development of relationships with participating physicians is critical to keeping physicians enrolled and active in the program. Generally, case-study states reported that physicians accept the PCCM system and often prefer it over an MCO network. One of the physicians interviewed said that he likes the simple logic of PCCM -- linking the patient directly with a PCP. The case management fee is an incentive for the PCP to establish that relationship with his or her patients. As Chart K demonstrates, the case-study states cultivate this willingness to participate by providing information, support, and opportunities for physician input.

State Program Services
Chart K:
Provider Services
Alabama Patient 1st Provider hotline, utilization performance feedback, outreach and education unit provide on-site education for providers who request, or who the state feels need it; will be doing provider profiling as of Spring 2001
Florida MediPass Provider focus groups/surveys (esp. in rural areas), utilization performance feedback, newsletter, outreach through disease management organizations
Iowa MediPASS Hotline, utilization performance feedback, newsletter, advisory committee includes physician from each of six regions
Maine Maine PrimeCare Newsletter, provider help line, utilization performance feedback (part of incentive payment system), physician advisory committee
MaineNET/ Partnership Case manager coordinates long-term care svcs.; pharmacy profiling report
North Carolina ACCESS I Quarterly utilization reports, (moving toward risk-adjusted utilization reports) targeted services reports, referral reports (all shown to doctors), regional consultants (state employees) serve as resources
ACCESS II rovider hotline, utilization performance feedback/provider profile, state staff follow up with members to keep appointments, members can sign up with a practice, providers contract with 24-hour-a-day nurse phone service (can make referrals or authorize services), website
Oklahoma SoonerCare Choice PCCM Model Toll-free phone line, provider relations staff, specialty care work group, provider trainings (CEUs), nurse advice line for 24-7 coverage, allow provider groups to contract as a whole, follow-up on high ER users, language line, provider updates (on standards), on-site training soon, Exceptional Needs Coordinators (ENCs)
Texas Texas Health Network Regional advisory committees and function-specific work groups include doctors, customize national standards to reflect unique needs of local populations, provider hotline, utilization performance feedback, network administrator staff follow up with members on missed appointments, network administrator's provider relations staff do outreach with PCCM offices and recruit new providers, annual provider survey, educational workshops/meetings/in-service trainings
Virginia MEDALLION Provider hotline, provider relations staff, fiscal agent has dedicated provider service staff, regional provider advisory committees, dedicated quality assurance review analysts

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