UP - MCO PCP Availability (C4384)

Abstract Significance: Adequate access to primary care not only improves patient and population health but reduces unnecessary emergency department visits and the clinical consequences of delayed care for common ailments. Kentucky Medicaid has responded for years to beneficiary complaints about primary care access. One of the goals of MCO contracting was to expand provider availability to Medicaid beneficiaries by making the full network of MCO participant clinicians accessible to enrollees. However, concerns about PCP capacity persist. While DMS responds routinely to individual beneficiary access concerns by identifying alternative providers, its customer service function is not structured to identify systemic issues. The proposed investigation will yield evidence to support broader analysis and the development of strategies to address the chronic problem of PCP access. Background: Kentucky’s government-assisted health centers provide primary care to over half a million Kentuckians, or about 12% of the population, according to the Ky Primary Care Association. In contrast, one-third of the state’s population is covered by Medicaid as of November 2022. Over one-fifth of the state’s population and nearly two-thirds (about 62%) of Medicaid beneficiaries thus seek primary care from providers in private practice. Unlike their colleagues in subsidized clinical settings, these PCPs are not compelled to take all Medicaid patients and often limit the proportion of Medicaid beneficiaries because of the perception that their care makes more demands on the practice than commercially insured patients and is not reimbursed at commensurate level. Thus, the real PCP capacity of an MCO may be far lower than the apparent capacity based on provider directory listings. Aims and Deliverables: The proposed project has four aims, each of which will yield a deliverable to support DMS in improving primary care access. Aim 1: To identify the proportion of private practice PCPs listed in Kentucky MCO provider directories that are taking new Medicaid patients. We will conduct secret shopper surveys at two times when PCP access is of greatest importance to families and to beneficiaries in general: the back-to-school season in July and early August (for children), and the peak flu season in winter (for all ages). Using scenarios adapted from similar surveys in other states, trained research assistants will call practices in MCO primary care listings to request new patient appointments Aim 2: To provide the Kentucky Department for Medicaid Services (DMS) with a detailed description of PCP availability by MCO, region, and population served (adults, children, all ages). We will analyze the data generated by the secret shopper survey using descriptive statistics to respond to these and any other concerns identified by DMS. Aim 3: To prepare and present a summary of findings to stakeholders, including representatives from DMS, MCOs, and patient advocacy groups. We will convene a (likely virtual) forum of stakeholder groups, present our findings, and solicit their input Aim 4: To prepare a final analysis, including feedback from Aim 4, for the use of DMS in negotiating and monitoring future MCO contracts. We will prepare a one-page summary and other manuscripts and presentation materials developed in discussions with DMS and other Cabinet staff.