Emerging Practices in Medicaid Primary Care Case Management Programs. Providers


Case study state officials agreed that provider commitment is the key to their success. Their advice stressed identifying and implementing ways to obtain the buy-in of a wide variety of providers.

  • Meet with medical societies and other key players who can positively influence providers to participate in the program.
  • Face-to-face communication with providers (both PCPs and practice staff) is key to good state-provider relations.
  • Set expectations for providers from the beginning; make clear that this is not just another fee-for-service program.
  • Do your homework in communities before beginning to recruit providers: physically inspect offices and meet with all practice staff.
  • It is critical for state staff to support providers on an ongoing basis, to take their concerns seriously, and to develop new ways to better serve them.
  • Allow providers to police themselves; second-guessing their decisions does not work. The state's job is to provide the tools to facilitate that process (e.g., utilization review, provider profiling, information on best practices) and to work with outliers to get their practices in line with state expectations.
  • Work with providers to modify inappropriate patient behaviors (e.g., emergency room use).

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