Health Care Costs and Financing

One form of managed care was associated with declines in physician participation in Georgia and Alabama Medicaid programs

Primary Care Case Management (PCCM) has been implemented by many State Medicaid programs over the past few years. Its success depends in part on the expanded availability of primary care physician sites to substitute for hospital-based outpatient care and to provide a medical home for enrollees. PCCM requires participating physicians to accept assignment of a caseload of patients and to provide all of their primary care. In addition, in the States considered in this study, doctors were instructed to provide around-the clock office or telephone access, better coordinate primary care services, and refer enrollees for specialty care and hospital services when needed.

In the absence of increased physician reimbursement, PCCM was associated with reductions in the proportion of physicians participating in Medicaid, reductions in the number of very small Medicaid practices, and decreases in practice size, according to the study from the Child Health Insurance Research Initiative (CHIRI™), cosponsored by the Agency for Healthcare Research and Quality (HS10435), the David and Lucile Packard Foundation, and the Health Resources and Services Administration.

E. Kathleen Adams, Ph.D., of Emory University, and colleagues used Medicaid claims data to examine the effects of PCCM phase-in in Georgia (1994-1997) and Alabama (1996-1999) on several dimensions of Medicaid physician availability. In addition to the reductions in Medicaid participation by physicians, implementation of PCCM was associated with a drop in the number of primary care visits per Medicaid enrollee. However, preventive care services constituted a larger proportion of primary care visits in the post-PCCM period.

Details are in "The impact of Medicaid Primary Care Case Management (PCCM) on office-based physician supply in Alabama and Georgia," by Dr. Adams, Janet M. Bronstein, Ph.D., and Curtis S. Florence, Ph.D., in the Fall 2003 Inquiry 40(3), pp. 269-282.

Editor's Note: Another recent AHRQ study examined the effects of changes in Medicaid reimbursement on receipt of dental services. In that study, elimination of Medicaid reimbursement to dentists for adult dental problems also reduced visits to doctors for dental emergencies.

For details, see: Cohen, L.A., Manski, R.J., Magder, L.S., and Mullins, C.D. (2003, August). "A Medicaid population's use of physician offices for dental problems." (AHRQ grant HS10129). American Journal of Public Health 93(8), pp. 1297-1301.

Reprints (AHRQ Publication No. 04-R005) are available from AHRQ Publications Clearinghouse.

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