title: The impact of Medicaid primary care case management on office-based physician supply in Alabama and Georgia.
abstract: 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 Georgia and Alabama. We find that the implementation of PCCM under these conditions often was associated with reductions in the proportion of physicians participating in Medicaid, reductions in the number of very small Medicaid practices, and declines in Medicaid visit volumes across all participating physicians. We also find 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.
authors.affiliation: Rollins School of Public Health, Emory University, USA.
authors.forename: E Kathleen
authors.initials: EK
authors.lastname: Adams
authors.forename: Janet M
authors.initials: JM
authors.lastname: Bronstein
authors.forename: Curtis S
authors.initials: CS
authors.lastname: Florence
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000706:statistics & numerical data; D000407:Alabama; D019090:Case Management; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data; D002675:Child, Preschool; D005251:Fees, Medical; D005845:Georgia; D006297:Health Services Accessibility / Q000706:statistics & numerical data / Q000639:trends; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008329:Managed Care Programs / Q000458:organization & administration; D008484:Medicaid / Q000458:organization & administration*; D010821:Physicians, Family / Q000191:economics / Q000600:supply & distribution*; D011320:Primary Health Care / Q000458:organization & administration; D011365:Professional Practice Location / Q000191:economics / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000191:economics; D013221:State Health Plans / Q000458:organization & administration; D014481:United States; D019037:Urban Health Services / Q000191:economics; D000078329:Workforce