Administrative burden, lack of technology, hamper PCP Medicaid participation: study

States can increase primary care access for residents with Medicaid, new study shows.

States can increase primary care access for residents with Medicaid by helping small, independent practices overcome administrative and technological obstacles to accepting the coverage, a new study suggests.

The authors used data from the National Survey of Healthcare Organizations to examine differences among primary care practices with no Medicaid revenue, those with Medicaid revenue of 10% or less, and those with Medicaid revenue greater than 10%. They also look at practice capabilities and characteristics such as care processes for complex patients, use of registries across clinical conditions, screening for social determinants of health, and health information exchange capabilities.

The researchers found that compared to practices with little or no Medicaid revenue, those with the highest proportion of Medicaid revenue are more likely to:

  • be owned by a hospital or health system,
  • be in a Medicaid expansion state,
  • be in or near a large city,
  • have fewer primary care providers,
  • care for more low-income patients, and
  • have Federally Qualified Health Center designation

In addition, the study finds that practices with no Medicaid revenue generally lack the technological and organizational capabilities, such as population health registries required to care for patients with complex needs.

The authors note that one implication of their findings is that Medicaid access may increase as primary care practices consolidate under the ownership of hospital systems, because large systems are better equipped to handle Medicaid’s administrative requirements than an individual practice.

Similarly, they say, consolidation can bring providers greater negotiating power, resulting in higher reimbursements and other types of income, such as care management payments, that make Medicaid participation more financially attractive.

The authors recommend that states and health plans improve Medicaid access by focusing on small practices, particularly by easing or removing their Medicaid-related administrative burden and helping them improve their population health capabilities.

The study, “Avoiding Medicaid: Characteristics of Primary Care Practices with no Medicaid Revenue” appears in the January 2021 issue of Health Affairs.