The Impact of Medicaid Primary Care Case Management (PCCM) on Office-Based Physician Supply in Alabama and Georgia
This paper was presented at the Academy for Health Services Research and Health Policy Meetings, June 2001, in Atlanta, GA, and will be published in the fall 2003 issue of the journal Inquiry.
By E. Kathleen Adams, Emory University, Janet Bronstein, University of Alabama, and Curtis S. Florence, Emory University.
The success of the primary care Case management (PCCM) form of managed care implemented in many state Medicaid programs over the past several years 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. However, the PCCM requirement for physicians to accept assignment of a caseload of patients and to provide all of their primary care likely conflicts with the approach of limited Medicaid participation favored by many Medicaid physician participants. This study examines the early impact of PCCM implementation, in the absence of physician reimbursement level increases, on the patterns of Medicaid participation by physicians in communities in Alabama and Georgia.
This study takes advantage of the phase-in of PCCM by county in Alabama (1996-99) and Georgia (1994-97) to examine its effect on several dimensions of Medicaid physician availability. Medicaid claims data for children between birth and age 18 were examined to identify the number of physician sites providing care to Medicaid-covered children and the number of visits they provided.
Implementation of PCCM under a phase-in process was often associated with reductions in the proportion of physicians participating in Medicaid, in the number of very small Medicaid practices and in declines in Medicaid visit volumes across all participating physicians. The study also finds evidence of an overall reduction in the number of primary care visits per Medicaid enrollee, but an increase in the proportion of these visits that were for preventive care services associated with initial PCCM implementation.