Advancing comprehensive primary care in Medicaid

Advancing comprehensive primary care in Medicaid

Collection:
Health Policy and Services Research
Contributor(s):
Bipartisan Policy Center, issuing body.
Publication:
Washington, DC : Bipartisan Policy Center, July 2020
Language(s):
English
Format:
Text
Subject(s):
Medicaid -- legislation & jurisprudence
Medicaid -- organization & administration
Medicaid -- standards
Primary Health Care
Healthcare Disparities
Insurance, Health
United States
Genre(s):
Technical Report
Abstract:
Access to primary care can help individuals live longer and help avoid or delay the onset of costly chronic conditions such as diabetes, heart disease, and cancer. Access to primary care can also help reduce more expensive care, including hospitalizations and emergency department visits. As health care policymakers seek to move away from volume-driven fee-for-service health care toward better integrated systems of care, they recognize the importance of primary care providers to improve health outcomes and lower overall healthcare costs. As evidence builds on best practices, primary care providers--who are among the lowest paid health professionals--are being asked to do more than just see patients and treat their illnesses. Effective primary care models incorporate physicians, nurses, pharmacists, social workers, and other professionals to address a broad range of patient needs. New payment and delivery models that have proven effective include patient-centered medical homes and Medicaid health homes. Historically, those payment models have included additional payments to coordinate care, enhanced payment rates, and payments or grant funding to help cover the up-front costs of building a comprehensive primary care practice. Some care models receive a share of savings generated through better coordination. The majority of Medicaid-enrolled individuals under age 65 receive care through Medicaid Managed Care Organizations. Despite the benefits of these new models, only about half of all states include language in their managed care quality assessment and improvement strategies to improve primary care through payment reform. While this report identifies barriers to the provision of primary care in Medicaid, all payers would benefit from a more comprehensive approach to improving primary care. Improving access to health insurance coverage is not the focus of this report, but lack of access to health insurance coverage is a significant barrier. Another barrier is a lack of nurses, physicians, and other providers who choose to go into primary care--in many cases because of lower payment rates across payers. The difference in payment between primary and specialty care is even more problematic for those who choose to serve low-income populations, given historically lower payments in Medicaid. BPC also identified as a barrier to primary care in Medicaid--and across our health care system--the need to address racial, ethnic, and economic barriers to care. Many of these recommendations will increase Medicaid spending in the short-term. However, failure to address the lack of good primary care will lead to even higher state and federal costs in Medicaid over time. Health Management Associates evaluated each of the proposed legislative options to determine the potential costs or savings to the federal government over the next 10 years. Current expectations in Medicaid, including the assumed impact of the COVID-19 economic downturn over the next several years were accounted for in these calculations. It was found that two of the proposed options, namely allowing non-expansion states an opportunity to expand their Medicaid programs with an enhanced Federal Medical Assistance Percentage as well as auto-enrolling individuals in Medicaid or Marketplace plans, could increase the federal budget by $100-200 billion over 10 years, while also reducing the number of uninsured by 2.5-6.0 million. Other proposed options, including allowing states to offer 12 months of continuous Medicaid eligibility for adults, increasing Federal Medical Assistance Percentage for primary care services in Medicaid if paid at the same level as Medicare, or reauthorizing funding for community health centers for 10 years, could each increase the federal budget by $25-40 billion over 10 years. Finally, some of the proposed options would likely have an uncertain impact on the federal budget, as evidence of costs or savings is not well established. BPC's efforts to develop policy recommendations to overcome these barriers began in August 2019. COVID-19 has amplified the barriers to primary care in Medicaid. Primary care providers are increasingly worried about their ability to continue to manage their practices. Two million Americans have filed unemployment claims, resulting in an increase in the number of individuals without employer-sponsored health insurance. The resulting increase in Medicaid eligibility and decrease in tax revenues will force states to make difficult choices in the coming year. BPC's recommendations seek to address both the short-term and long-term barriers to primary care in Medicaid.
Copyright:
The National Library of Medicine believes this item to be in the public domain. (More information)
Extent:
1 online resource (1 PDF file (54 pages))
NLM Unique ID:
101778499 (See catalog record)
Permanent Link:
http://resource.nlm.nih.gov/101778499