Just a small portion of the providers theoretically available to serve individuals enrolled in Medicaid managed care plans are actually caring for such patients, a new study has found.
According to a report in Health Affairs, 25 percent of the primary care physicians serving patients in selected managed care plans are providing 86 percent of the primary care to those plans’ members while 16 percent of those plans’ listed primary care providers have gone more than a year without filing a single claim.
Similarly, 25 percent of the medical specialists participating in the plans provided 75 percent of the plans’ specialty services while one-third of the plans’ primary care physicians and specialists saw fewer than 10 Medicaid patients in a given year.
As the Health Affairs study concluded, “Our findings suggest that current network adequacy standards might not reflect actual access; new methods are needed that account for beneficiaries’ preferences and physicians’ willingness to serve Medicaid patients.” Healthcare Dive reviewed the same numbers and took its conclusion a step further, suggesting “… that private insurers may be ‘padding’ the Medicaid managed care networks with physicians, some of whom may be unwilling to treat program beneficiaries.”
Learn more about the question of the adequacy of Medicaid managed care provider networks in the Healthcare Dive story “Insurers may be padding Medicaid physician networks, study finds” and the Health Affairs report “In Medicaid Managed Care Networks, Care Is Highly Concentrated Among A Small Percentage Of Physicians.”