Qualitative Perspectives of Primary Care Providers Who Treat Medicaid Managed Care Patients

Gordon SH, Gadbois EA, Shield RR, Vivier PM, Ndumele CD, Trivedi AN
Source: BMC Health Serv Res
Publication Year: 2018
Population Focus: Medicaid beneficiaries
Study Design: Other Study Design
Type of Literature: White
link: https://www.ncbi.nlm.nih.gov/pubmed/30241523
Abstract

BACKGROUND:
Declining job satisfaction and concurrent reductions in Medicaid participation among primary care providers have been documented, but there is limited qualitative work detailing their first-hand experiences treating Medicaid patients. The objective of this study is to describe the experiences of some primary care providers who treat Medicaid patients using in-depth qualitative analysis.

METHODS:
We conducted qualitative interviews with 15 primary care providers treating Medicaid patients in a Northeastern state. Participant recruitment efforts focused on including different types of primary care providers practicing in diverse settings. Qualitative interviews were conducted using a semi-structured interview protocol. We developed a coding scheme to analyze interview transcripts and identify themes.

RESULTS:
Providers expressed challenges effectively meeting their patients’ needs under current policy. They described low Medicaid reimbursement and underinvestment in care coordination programs to adequately address the social determinants of health. Providers shared other concerns including poor access to behavioral health services, discontinuous Medicaid coverage due to enrollment and renewal policies, and limited reimbursement for alternative pain treatment. Providers offered their own suggestions for the allocation of financial investments, Medicaid policy, and primary care practice.

CONCLUSIONS:
Underinvestment in primary care in Medicaid may detract from providers’ professional satisfaction and hinder care coordination for Medicaid patients with complex healthcare needs. Policy solutions that improve the experience of primary care providers serving Medicaid patients are urgently needed to ensure sustainability of the workforce and improve care delivery.

Insights Results

Overview of article

  • This article describes the experiences of some primary care providers who treat Medicaid patients

Methods of article

  • Semi-structured qualitative interviews were conducted with 15 physicians who provide primary care to Medicaid managed care beneficiaries in a Northeastern state. The interview protocol asked providers questions related to improving quality for beneficiaries with Medicaid managed care, but a large portion of physician responses focused on their own experiences
  • Participants included 11 pediatricians (of which 2 were residents), 1 pediatrician/internal medicine physician, 1 family physician, and 2 obstetricians. Practice settings included small private practices, community health centers, and large hospital-based clinics. 2 providers reported practicing in patient-centered medical home settings. The proportion of providers’ patient panels enrolled in Medicaid varied from 5% to 90%

Results

  • In general, providers described challenging experiences meeting the needs of their Medicaid patients and described a strained relationship with Medicaid managed care
  • Key themes from interviews include: 1) Addressing the social determinants of health and complex healthcare needs of Medicaid patients is challenging; 2) Low reimbursement rates and inadequate investment in quality management initiatives limit care coordination and the number of low-income patients providers treat; 3) Specific Medicaid policies (e.g., benefit design, Medicaid eligibility and enrollment policies that affect continuity of care, physician reimbursement) are perceived as detrimental to patient outcomes and quality of care by physicians and; 4) Providers offer suggestions (e.g., home-based risk assessments) for how to improve care delivery and reform Medicaid policy
  • These themes have been noted before in prior evaluations, suggesting minimal improvement in such areas

Key takeaways/implications

  • Overall, low reimbursement, inadequate financial resources, limited access to behavioral healthcare, and poorly designed Medicaid coverage policies reduced providers’ professional satisfaction and the quality of care
  • Providers identified policy recommendations that could address their aforementioned challenges. These recommendations include combining parent-child visits, extending the Medicaid eligibility period for pregnant women to include the standard postpartum care timeline, providing on-site mental health consultations to facilitate connection to behavioral health services, and in-home risk assessments of the social determinants of health administered by non-physician staff
  • Limitations to the study include small sample size, use of 1 state, and potential response bias
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